Therapist-Driven Protocols, Monitoring, and Quality
Core concepts
Questions here test whether you can apply protocols, interpret monitoring data, and act within scope. Understand how therapist-driven protocols work: assess, apply criteria, act, reassess, and document. Know the purpose of monitoring tools such as pulse oximetry (trend, not a substitute for ABG), capnography (ventilation and tube confirmation), and ventilator graphics. Recognize when a protocol allows you to adjust therapy (for example, weaning oxygen to a target SpO2) versus when you must notify the physician. Quality concepts include infection control, equipment cleaning, and recognizing when a value is artifactual.
Traps
A frequent trap is acting outside protocol limits or failing to reassess after a change. Another is treating a monitor number instead of the patient: a low SpO2 reading with poor waveform quality may be artifact, not hypoxemia. Questions also test the difference between initiating a protocol and modifying therapy under an existing order. Watch for items that ask what to do next after an intervention, where reassessment is the answer.
Rule of thumb
Follow the assess-act-reassess loop every time. If a protocol sets a target (for example, SpO2 88-92% for a COPD patient), titrate to that target and document; do not chase 100%. Worked example: a COPD patient on 4 L/min has SpO2 96% and is drowsy. The protocol target is 88-92%, so you titrate oxygen down toward the target and reassess, rather than leaving the high flow in place.