What comprehensive questions should a sole respiratory therapist on a pediatric medical floor ask to assess the patient, operate equipment, communicate effectively, and fulfill professional responsibilities when working independently?

Essential Questions for Independent Respiratory Therapy Practice on a Pediatric Medical Floor

As a sole respiratory therapist working independently on a pediatric medical floor, you must systematically assess patient status, equipment function, emergency preparedness, and communication protocols to ensure safe, effective care that prevents morbidity and mortality.

The American Thoracic Society guidelines for pediatric respiratory care 1 provide a comprehensive framework that, while designed for home ventilation caregivers, translates directly to the competencies required for independent hospital practice. These represent the gold standard for what you need to know when working alone.

Patient Assessment Questions

Respiratory Status Evaluation

Ask yourself these specific questions for each patient encounter:

• What are the current vital signs? Specifically: respiratory rate, heart rate, oxygen saturation, work of breathing 1
• What signs of respiratory distress am I observing? Look for: increased or changed color of tracheal secretions, retractions, increased work of breathing, cough, color changes (cyanosis, pallor), nasal flaring, tachycardia or bradycardia, tachypnea or bradypnea, desaturation, anxiety, abnormal breath sounds 1
• What do the lung sounds reveal? Assess all lung fields bilaterally - this is rated as the highest priority assessment skill by physicians (mean score 4.8/5.0) 2
• What are the current arterial blood gas values and what do they mean? Physicians expect high-level interpretation skills here (4.5/5.0 rating) 2
• Is the patient's oxygen saturation reading accurate or artifact? You must differentiate true from false oximeter readings 1

Airway Management Assessment

For patients with artificial airways:

• What type and size tracheostomy tube does this patient have? Know if it's cuffed or uncuffed, cuff inflation parameters if applicable 1
• Where is the backup tracheostomy tube and emergency supplies? The "Go Bag" must be immediately accessible 1
• What are the signs of tracheostomy obstruction in this patient? Be prepared to list and recognize them immediately 1
• What is the correct suction catheter size, pressure, and depth for this patient? These must be patient-specific 1

Equipment Operation Questions

Ventilator Management

When managing mechanically ventilated patients, ask:

• What are the current ventilator settings and are they appropriate? Know how to verify and adjust settings 1
• Do I understand every alarm on this ventilator and how to troubleshoot each one? This is non-negotiable for independent practice 1
• What is the battery life of this equipment and is backup power ready? Know approximate battery duration for each device 1
• Is the ventilator circuit properly assembled with appropriate humidification? 1
• How do I drain condensation from the circuit safely? (Down and away from the child) 1
• Where are the electrical power sources and what's the backup plan? 1

For pediatric mechanical ventilation monitoring, you need at least four parameters: alveolar PCO2, arterial oxygen saturation, the mechanical RC time constant, and functional residual capacity 3. Understanding the relationship between ventilator mechanics and patient respiratory system properties is essential.

Oxygen Delivery Systems

• What oxygen delivery equipment is being used and is it functioning properly? (Cylinders, concentrators, blenders) 1
• What are the oxygen safety hazards in this environment? Consider fire risks, flammable products, heat sources 1
• When and how should oxygen be adjusted for this patient? 1

Monitoring Equipment

• Is the pulse oximeter probe properly and securely placed? 1
• What is the normal oxygen saturation range for this patient and what's my response plan if it falls below? 1
• Are ventilator alarms audible from where staff are located? 1

Emergency Preparedness Questions

Immediate Emergency Response

These questions address life-threatening situations:

• Can I perform an emergency tracheostomy tube change alone without assistance? You must be able to demonstrate this 1
• Do I know the criteria for calling a code or emergency services? 1
• Can I demonstrate proper bag-mask ventilation technique right now? Both routine and emergency procedures 1
• What are the emergency contact numbers? Physicians, respiratory supervisor, equipment suppliers, rapid response team 1
• Where is the self-inflating bag and mask for this patient? 1
• What emergency medications might this patient need and do I know their indications? 1

Disaster Planning

• What is the plan for power failure on this unit? 1
• What is the evacuation plan for ventilator-dependent patients? 1

Medication Administration Questions

For respiratory medications:

• What is the dose, frequency, indication, and side effects of each respiratory medication this patient receives? 1
• When are inhaled medications required for this patient? 1
• How do I deliver nebulized medications through the ventilator circuit if applicable? 1
• Can I properly prepare and administer these medications? 1

Infection Control Questions

Critical for preventing hospital-acquired infections:

• Am I following proper hand hygiene before and after each patient contact? 1
• How do I properly clean and disinfect reusable equipment for this patient? 1
• How do I dispose of contaminated materials correctly? 1
• What infection control precautions are specific to this patient? 1

Communication and Documentation Questions

Team Communication

Effective communication significantly impacts patient outcomes 4:

• Who is the attending physician and how do I contact them? 1
• What information must I communicate immediately versus what can wait?
• How do I document my assessments and interventions?
• When should I request a consultation or additional help?

Research shows respiratory therapists need proficiency in introducing themselves to patients, using open-ended questions, and allowing adequate time for patient concerns 4. Female practitioners show particular strength in concluding patient interviews, while males excel in communicating with unconscious patients 4.

Patient and Family Communication

• How do I explain procedures to pediatric patients at their developmental level?
• What do parents need to know about their child's respiratory status?
• How do I communicate with unconscious or sedated patients? This requires specific techniques 4

Structural and Workflow Questions

Unit-Specific Information

• Where is all respiratory equipment stored on this unit?
• What is the process for obtaining additional supplies after hours?
• Who covers respiratory therapy when I'm on break?
• What is the chain of command for clinical concerns?
• Where are the unit-specific protocols and policies?

Scope of Practice

• What procedures am I authorized to perform independently versus requiring physician orders?
• What are the hospital's respiratory therapy protocols and standing orders?
• When must I obtain additional authorization or supervision?

Quality Control Questions

Equipment Maintenance

• When was this equipment last calibrated? 5
• Is there a maintenance log and is it current? 5
• How do I test suction pressure? 1
• How do I test the ventilator before patient use? 1

Clinical Competency

• Am I current on CPR certification? This is mandatory 1
• Have I completed required competencies for all equipment I'm using?
• Do I know how to access current clinical guidelines and protocols?

Common Pitfalls to Avoid

Critical safety considerations when working independently:

1. Never assume equipment is functioning properly - Always test ventilators and verify settings before use 1

2. Don't rely solely on alarms - Pulse oximetry is preferred over standard cardiorespiratory monitors because hypoxemia is an earlier indicator of problems than bradycardia or apnea in children 1

3. Avoid alarm fatigue - Ensure you can differentiate true alarms from false alarms, particularly with pulse oximetry 1

4. Don't delay emergency response - Know your criteria for calling for help immediately versus attempting independent intervention 1

5. Never work beyond your competency level - Recognize when you need consultation or assistance, particularly with difficult pediatric airways 6

6. Don't forget the backup equipment - Always know where emergency supplies are located before you need them 1

This systematic approach ensures you can function safely and effectively as an independent respiratory therapist on a pediatric medical floor, prioritizing patient safety and optimal outcomes.