Royal London Hospital — Paediatric Respiratory Physiotherapy

This workbook is designed for new starters joining the paediatric respiratory physiotherapy team. It covers common respiratory conditions, assessment, treatment modalities, equipment, medications, pathogens, and antibiotics. Sections marked with prompts are fill-in exercises for learners to complete as part of their onboarding.

Learning Level: Foundation (Band 5 / new starters) unless otherwise noted.

Orientation Record

Contents

Part 1: Common Respiratory Conditions

1.1 Cystic Fibrosis

Learning Level: Foundation

Exercise: For each prompt below, research and write your answers. Discuss with your senior physiotherapist or clinical educator.

What is CF?

(Fill in your answer here)

CF Epidemiology:

(Fill in your answer here)

CF Genetics and diagnosis:

(Fill in your answer here)

How does CF affect the Respiratory System?

(Fill in your answer here)

What other systems are affected by CF?

(Fill in your answer here)

What are common physiotherapy interventions?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.2 Bronchiectasis

Learning Level: Foundation

What is Bronchiectasis?

(Fill in your answer here)

Bronchiectasis Epidemiology:

(Fill in your answer here)

Why does a child develop bronchiectasis and how is it diagnosed?

(Fill in your answer here)

How does Bronchiectasis affect the Respiratory System?

(Fill in your answer here)

What other systems are commonly affected in children with bronchiectasis?

(Fill in your answer here)

What are common physiotherapy interventions?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.3 PCD (Primary Ciliary Dyskinesia)

Learning Level: Foundation

What is PCD?

(Fill in your answer here)

PCD Epidemiology:

(Fill in your answer here)

PCD Genetics and diagnosis:

(Fill in your answer here)

How does PCD affect the Respiratory System?

(Fill in your answer here)

Are any other systems affected by PCD?

(Fill in your answer here)

What are common physiotherapy interventions?

(Fill in your answer here)

Where are the PCD centres in England?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.4 Complex Needs

Learning Level: Foundation

Briefly describe what is meant by ‘complex needs’:

(Fill in your answer here)

Why are children with complex needs more vulnerable to RTIs?

(Fill in your answer here)

What services are available to those with complex needs and respiratory issues in Tower Hamlets?

(Fill in your answer here)

How do these services differ for children not living in Tower Hamlets?

(Fill in your answer here)

What are common physiotherapy interventions?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.5 HbSS (Sickle Cell Disease)

Learning Level: Foundation

What is HbSS?

(Fill in your answer here)

HbSS Epidemiology:

(Fill in your answer here)

HbSS Genetics and diagnosis:

(Fill in your answer here)

What are the different types of HbSS Crises?

(Fill in your answer here)

What causes a crisis?

(Fill in your answer here)

What are the signs and symptoms of a crisis?

(Fill in your answer here)

What is acute chest syndrome?

(Fill in your answer here)

What is our physiotherapy intervention:

On wards:

(Fill in your answer here)

On PCCU:

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.6 Neonates

Learning Level: Foundation

When is ‘term’?

(Fill in your answer here)

When is considered:

• Extreme prematurity? (Fill in your answer here)
• Very premature? (Fill in your answer here)
• Moderate to late prematurity? (Fill in your answer here)

Fetal Lung Development

Exercise: Please fill in the below table:

What are some neurological risks of prematurity?

(Fill in your answer here)

Physio safety considerations / recommendations for practice (Cull 1999):

(Fill in your answer here)

When to treat:

(Fill in your answer here)

When not to treat:

(Fill in your answer here)

What not to do:

(Fill in your answer here)

How can you minimise the risk to the premature brain during chest physio?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.7 Bronchiolitis

Learning Level: Foundation

What is bronchiolitis?

(Fill in your answer here)

How often does bronchiolitis occur?

(Fill in your answer here)

What physio intervention is ‘normal’ for patients with bronchiolitis & what is the evidence?

(Fill in your answer here)

What might be the exceptions to this?

(Fill in your answer here)

Other:

(Any additional notes or observations)

1.8 Asthma

Learning Level: Foundation

What is Asthma?

(Fill in your answer here)

What is the epidemiology of asthma?

(Fill in your answer here)

What physio intervention is ‘normal’ for patients with asthma?

(Fill in your answer here)

What / when might be the exceptions to this?

(Fill in your answer here)

Other:

(Any additional notes or observations)

Part 2: Respiratory Physiotherapy Assessment

Learning Level: Foundation

2.1 Lung Anatomy

Describe basic lung anatomy / draw a diagram (including location of lobes)

Exercise: Draw and label a diagram of the lungs including the location of all lobes.

(Draw / fill in your answer here)

2.2 Auscultation

Where and how do you auscultate?

(Fill in your answer here)

What should you hear in ‘normal lungs’ during auscultation?

(Fill in your answer here)

What additional sounds may you hear in auscultation and what do they mean?

(Fill in your answer here)

2.3 Chest X-Ray Interpretation

What approach do you use to reading chest X-rays?

(Fill in your answer here)

Case Study

Exercise:

• Pick a patient and review some of their CXRs.
• What can you identify on their CXRs, is what you identified the same as the report?
• Peer learning — discuss CXR with a peer

(Fill in your answer here)

2.4 HRCT (High Resolution CT)

HRCT

• What does a ‘normal’ CT look like?
• What additional things are you looking out for?

(Fill in your answer here)

Case Study

Exercise:

• Pick a patient and review their CT
• What can you identify on their CT, is what you identified the same as the report?
• Compare their CT to their CXR — is what you can see on CT what you expected from their CXR?
• Peer learning — discuss CXR with a peer

(Fill in your answer here)

2.5 Spirometry

What is spirometry?

(Fill in your answer here)

Label the below diagram

Exercise: The original workbook provides a blank space here for labelling a spirometry diagram (lung volumes and capacities).

(Draw / label the diagram here)

2.6 Paediatric Normal Values

Exercise: Fill in the below table with normal paediatric vital sign ranges:

What obs charts do we use on the wards? Familiarise yourself with them

(Fill in your answer here)

2.7 Blood Gas Interpretation

Exercise: Fill in the below table with normal blood gas values:

Part 3: CF / Chronic Respiratory Related

Learning Level: Foundation / Intermediate

3.1 Exercise Outcome Measures

What exercise outcome measures do we use?

(Fill in your answer here)

How often do we use exercise outcome measures?

(Fill in your answer here)

How and who completes formal exercise testing if needed?

(Fill in your answer here)

How can you ensure your exercise sessions are age appropriate?

(Fill in your answer here)

How do you monitor a child whilst exercising and how do you know if they are working at an appropriate level?

(Fill in your answer here)

3.2 Hydration and Exercise

How do you know a patient’s target fluid intake?

(Fill in your answer here)

Why is hydration / fluid intake important whilst you are exercising a patient?

(Fill in your answer here)

How much fluid is lost per 1 hour of exercise?

(Fill in your answer here)

3.3 CF-Related Diabetes (CFRD)

What is CFRD?

(Fill in your answer here)

What implications does CFRD have on exercise?

(Fill in your answer here)

How do you monitor a child with CFRD?

(Fill in your answer here)

When should you take precautions with a child with CFRD (in relation to an exercise session) and what steps can you take to ensure the child’s BMs are stable during a session?

(Fill in your answer here)

Part 4: Acute Respiratory Related — Treatment Modalities

Learning Level: Foundation

Exercise: For the below treatment modalities please look into:

• Indications
• Contraindications / precautions
• How to complete
• Evidence

4.1 Suctioning

4.2 Manual Assisted Cough

4.3 Vibrations (Vibs)

4.4 Percussion

4.5 Autogenic Drainage (AD) — Passive & Active

4.6 Other:

(Any additional treatment modalities observed)

Part 5: PCCU Related

Learning Level: Intermediate / Advanced

5.1 Ventilators

What makes and models of ventilator do we have on PCCU?

(Fill in your answer here)

5.2 Non-Invasive Ventilation (NIV)

Exercise: For NIV, address each of the following:

• What modes are there?
• What does each mode do?
• What is set on each mode?
• What is recorded on each mode?
• When is each mode indicated?
• What considerations may you need in terms of a patient’s diagnosis and what mode is chosen?
• What interfaces can be used?

(Fill in your answer here)

5.3 Invasive Ventilation (I&V)

Exercise: For I&V, address each of the following:

• What types of tube may be used?
• What modes are there?
• What does each mode do?
• What is set on each mode?
• What is recorded on each mode?

(Fill in your answer here)

5.4 Neuroprotection

Learning Level: Advanced

Exercise: For neuroprotection, address each of the following:

• What types of patient / conditions do you need to consider?
• What is ICP?
• What is MAP?
• What is CPP?
• Where can you find the Barts Health Policy?
• What management is within our policy that you need to consider?
• What may happen when you Ax / Rx a patient?
• What medication may be needed during your treatment and why?

(Fill in your answer here)

5.5 Spinal Protection

Learning Level: Advanced

Exercise: For spinal protection, address each of the following:

• What types of patient / conditions do you need to consider?
• Where can you find the Barts Health Policy?
• What management is within our policy that you need to consider?
• What additional things do you need to do when treating these patients?

(Fill in your answer here)

Part 6: Equipment

Learning Level: Foundation / Intermediate

6.1 PEP (Positive Expiratory Pressure)

What does PEP mean?

(Fill in your answer here)

How does PEP assist with airway clearance?

(Fill in your answer here)

What are the indications for the use of PEP?

(Fill in your answer here)

What are the contraindications for the use of PEP?

(Fill in your answer here)

PEP Devices

Exercise: Please list the different PEP devices we use and fill in the table:

Other:

(Any additional notes or observations)

6.2 MI:E (Mechanical Insufflation-Exsufflation)

What is MI:E?

(Fill in your answer here)

How does MI:E work?

(Fill in your answer here)

What are the indications for the use of MI:E?

(Fill in your answer here)

What are the contraindications for the use of MI:E?

(Fill in your answer here)

MI:E Devices

Exercise: Please list the different MI:E devices we use and fill in the table:

Other:

(Any additional notes or observations)

6.3 HFCWO (High Frequency Chest Wall Oscillation)

What is HFCWO?

(Fill in your answer here)

How does HFCWO work?

(Fill in your answer here)

What are the indications for the use of HFCWO?

(Fill in your answer here)

What are the contraindications for the use of HFCWO?

(Fill in your answer here)

Other:

(Any additional notes or observations)

6.4 Ultrasonic Nebuliser

How does the ultrasonic neb work?

(Fill in your answer here)

What are the indications for the use of an ultrasonic neb?

(Fill in your answer here)

What are the contraindications for the use of an ultrasonic neb?

(Fill in your answer here)

Other:

(Any additional notes or observations)

6.5 Aeroneb

How does the aeroneb work?

(Fill in your answer here)

What are the indications for the use of an aeroneb?

(Fill in your answer here)

What are the contraindications for the use of an aeroneb?

(Fill in your answer here)

Other:

(Any additional notes or observations)

Part 7: Medications — Bronchodilators

Learning Level: Foundation

7.1 Salbutamol

How does salbutamol work?

(Fill in your answer here)

What ways can salbutamol be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for salbutamol?

(Fill in your answer here)

What are the contraindications for salbutamol?

(Fill in your answer here)

Other:

(Any additional notes or observations)

7.2 Atrovent (Ipratropium Bromide)

How does atrovent work?

(Fill in your answer here)

What ways can atrovent be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for atrovent?

(Fill in your answer here)

What are the contraindications for atrovent?

(Fill in your answer here)

Other:

(Any additional notes or observations)

7.3 Adrenaline

How does adrenaline work?

(Fill in your answer here)

What ways can adrenaline be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for adrenaline?

(Fill in your answer here)

What are the contraindications for adrenaline?

(Fill in your answer here)

Other:

(Any additional notes or observations)

Part 8: Medications — Mucolytics

Learning Level: Foundation

8.1 0.9% Saline (Normal Saline)

How does 0.9% saline work?

(Fill in your answer here)

What ways can 0.9% saline be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for 0.9% saline?

(Fill in your answer here)

What are the contraindications for 0.9% saline?

(Fill in your answer here)

Other:

(Any additional notes or observations)

8.2 Hypertonic Saline

How does hypertonic saline work?

(Fill in your answer here)

What doses of hypertonic saline are most commonly used?

(Fill in your answer here)

What ways can hypertonic saline be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for hypertonic saline?

(Fill in your answer here)

What are the contraindications for hypertonic saline?

(Fill in your answer here)

How do you complete a test dose of hypertonic saline?

(Fill in your answer here)

Other:

(Any additional notes or observations)

8.3 NAC (N-Acetylcysteine)

How does NAC work?

(Fill in your answer here)

When is NAC most commonly used?

(Fill in your answer here)

What ways can NAC be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for NAC?

(Fill in your answer here)

What are the contraindications for NAC?

(Fill in your answer here)

How do you complete a test dose of NAC?

(Fill in your answer here)

Other:

(Any additional notes or observations)

8.4 DNase (Dornase Alfa / Pulmozyme)

How does DNase work?

(Fill in your answer here)

When is DNase most commonly used?

(Fill in your answer here)

What ways can DNase be administered, and in what settings / interfaces?

(Fill in your answer here)

What are the indications for DNase?

(Fill in your answer here)

What are the contraindications for DNase?

(Fill in your answer here)

How do you complete a test dose of DNase?

(Fill in your answer here)

Other:

(Any additional notes or observations)

Part 9: Medications — Secretion Management

Learning Level: Foundation

9.1 Glycopyrrolate

How does glycopyrrolate work?

(Fill in your answer here)

When is glycopyrrolate most commonly used?

(Fill in your answer here)

How is glycopyrrolate administered?

(Fill in your answer here)

What are the indications for glycopyrrolate?

(Fill in your answer here)

What are the contraindications for glycopyrrolate?

(Fill in your answer here)

Other:

(Any additional notes or observations)

9.2 Hyoscine

How does hyoscine work?

(Fill in your answer here)

When is hyoscine most commonly used?

(Fill in your answer here)

How is hyoscine administered?

(Fill in your answer here)

What are the indications for hyoscine?

(Fill in your answer here)

What are the contraindications for hyoscine?

(Fill in your answer here)

Other:

(Any additional notes or observations)

Part 10: Common Respiratory Pathogens

Learning Level: Foundation

Exercise: For each pathogen complete:

• Are they gram negative or gram positive?
• What are our infection control policies?
• What antibiotics are most commonly used?

10.1 Staphylococcus aureus

(Fill in your answer here)

10.2 MRSA

(Fill in your answer here)

10.3 Pseudomonas aeruginosa

(Fill in your answer here)

10.4 Pan resistant Pseudomonas (Liverpool and Manchester strain)

(Fill in your answer here)

10.5 Stenotrophomonas maltophilia

(Fill in your answer here)

10.6 Streptococcus pneumoniae

(Fill in your answer here)

10.7 Serratia marcescens

(Fill in your answer here)

10.8 Klebsiella pneumoniae

(Fill in your answer here)

10.9 Burkholderia cepacia

(Fill in your answer here)

10.10 NTM (Non-Tuberculous Mycobacteria)

(Fill in your answer here)

10.11 Pandoraea

(Fill in your answer here)

10.12 Fungi — Aspergillus

(Fill in your answer here)

Part 11: Common Respiratory Antibiotics

Learning Level: Foundation

Exercise: Insert antibiotics that you have seen used with your respiratory patients and add in:

• Whether they are broad spectrum or target a particular pathogen / group of pathogens
• What subclass the antibiotic lies in and therefore how it works to kill / inhibit the pathogen

Embedded Images in Original Document

The original Word document contains 3 embedded images (extracted to images/new-starter-pack/):

1. img-001.png — Respiratory waveform icon/graphic (decorative, used as a design element on the cover/title page)
2. img-002.jpeg — Barts Health NHS Trust logo
3. img-003.jpeg — Illustrated London skyline (decorative branding graphic for the cover page)

Note: The spirometry labelling exercise and lung anatomy diagram exercise in the Assessment section are blank spaces for the learner to draw/label rather than pre-existing diagrams.

Document Footer

Page numbering footer present in original document (footer1.xml: “4”)

Source: New Starter Respiratory Pack.docx — Royal London Hospital Paediatric Respiratory Physiotherapy Team