Formative CPAP

CPAP
MonthDayYearHourMinutes
What class is the student in?*

ABCEvening
A Shift*
B Shift*
C Shift*
Evening Class*
Who is the Evaluator?*

InstructorA Shift Student EvaluatorB Shift Student EvaluatorC Shift Student EvaluatorEvening Class Student Evaluator
Instructor*
A Shift Student Evaluator*
B Shift Student Evaluator*
C Shift Student Evaluator*
Evening Class Student Evaluator*
Prepares patient

Takes or verbalizes appropriate PPE precautionsAssures adequate blood pressurePositions patient in a position that will optimize ease of ventilation (high Fowler’s)Assesses patient to identify indications for CPAPAssesses patient to identify contraindications for CPAP
Selects, checks, assembles equipment

Assembles mask and tubing according to manufacturer instructionsCoaches patient how to breathe through maskConnects CPAP unit to suitable O2 supply and attaches breathing circuit to device (not using oxygen regulator or flow meter)Turns on power/oxygenConnect inline nebulizer
Performs procedure

Places mask over mouth and nose (leaves EtCO2 nasal cannula in place)Adjust CPAP pressure based on local protocols (Max 5-10 cm H2O)Coaches patient to breathe normally and adjust to air pressureFrequently reassesses patient for: Decreased ventilatory distress,SpO2 > 92%,Decreased adventitious lungs sounds,Absence of complications (barotrauma and pneumothorax)Records settings/readings and documents appropriately
Affective

Accepts evaluation and criticism professionallyShows willingness to learnInteracts with simulated patient and other personnel in professional manner
Critical Criteria

Failure to take or verbalize appropriate PPE precautionsFailure to identify 2 indicationsFailure to identify 2 potential complicationsFailure to frequently reassess the patient after application of the CPAP deviceFailure to ensure that the patient understands the procedureFailure to set the proper parameters for the device (pressure relief, tidal volume, oxygen concentration, rate, etc.)Failure to test the pressure relief valve prior to applicationExhibits unacceptable affect with patient or other personnel
Evaluator Comments
Was the student successful or unsuccessful in this skill?*

SuccessfulUnsuccessful
Signature*
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