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When To Check The RT Notes

Category: Legal Nurse     Author: Georgina Bell     Posted: Friday - July 8, 2022

Respiratory therapists (RTs) are healthcare workers who specialize in respiratory system dysfunction. Because part of their job is managing ventilators, RTs typically work in step-down or critical care units. There are many health conditions which, if seen in medical records, should prompt the attorney or legal nurse to pay special attention to RT documentation in addition to the standard nursing flowsheets and provider notes.

SEVERE COVID-19 INFECTION. A common sequela in critically ill COVID patients is pulmonary fibrosis, or a stiffening of the lung tissue. This makes ventilation, the act of breathing in and out, quite problematic as the lung tissue resists movement. Peak inspiratory pressure (PIP) is a ventilator reading documented by RTs that is associated with lung tissue noncompliance. A normal PIP is typically less than 20cmH2O. PIPs of around 30-40cmH2O signal respiratory failure, and a PIP of 50cmH2O and above is a severely critical finding associated with poor outcomes.

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS). ARDS occurs when fluid fills the small air sacs called alveoli within the lungs. Chest x-ray reports often describe it as a “white-out” of one or both lungs. Patients with ARDS usually require increased fraction of inspired oxygen (FiO2) delivery through the ventilator. ARDS is defined as a ratio of the partial pressure of arterial blood oxygen (PaO2) to FiO2 of less than 300. RTs often draw the arterial blood gas, so this PaO2/FiO2 ratio calculation will typically be found in their flowsheets or notes.

TRAUMATIC BRAIN INJURIES. The RT’s role in caring for TBI patients is grossly underrated. Intracranial pressure (ICP) has a direct correlation with the body’s carbon dioxide levels, increasing when carbon dioxide levels increase. The ICP of ventilated TBI patients can sometimes be simply managed with a few ventilator adjustments, including increasing the set respiratory rate in order to remove excess carbon dioxide by hyperventilating the patient.

Other conditions in which RT documentation is important include asthma exacerbations, smoke inhalation, COPD, cystic fibrosis, and spinal cord injuries. If the client was intubated in a critical care unit or emergency department, ensure that the respiratory therapy records are present. Many hospitals do not allow providers or nurses to adjust ventilator settings, so if the ventilator management is questioned in a case, consider obtaining the opinion of an expert respiratory therapist.


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