SIMULATION LAB CASES
Role play simulation
Activity instructions
PART 2: Peer Feedback instructions
Performance:
Comfort: checks in with patient regarding positioning, comfort level during technique, pain or discomfort
Communication: empathetic nonverbal communication, adequately loud and clear voice, clear explanation, use of jargon kept to a minimum, demonstration used to backup verbal explanations.
Effective technique, positioning, and dosage: technique demonstrated as per Lab manual instructions
Gives appropriate feedback: adequately explains findings to patient, and/or corrects patient performance of technique or exercise
Case study #1 : Maxim
Students:
Max is a 17 year-old you are seeing in home care through the respiratory outpatient clinic at the rehab hospital where you work. He was dx @ age 4 with cystic fibrosis.
Needs a “check in” to update program to foster more independence, as compliance is becoming an issue, and caregiver fatigue.
The global goal of the current episode of treatment in the outpatient program is to increase independence and involvement of the child in self-managing his condition.
PMHx: cystic fibrosis, GERD & frequent abdominal upset, headaches.
MAX
S: Pt c/o productive cough (1-2 tbsp thick white-yellow sputum daily), dyspnea on exertion, unable to participate in sports activity, SOB ++ after climbing 2 flights of stairs; c/o chest pain up to 4/10 with vigourous coughing, and severe generalized fatigue. Has used postural drainage and percussions (by his mother) in the past to clear secretions. Now they have purchased an OPEP device (vibrapep) on advice of the pneumologist, but they are not sure how to use it. Mother also found a resource on “bubble PEP” and is wondering if this could be appropriate.
O: Pt motivated and collaborative. 7 year old child, small/thin for his age, mild barrel chest. Spontaneous strong wet cough, poorly controlled, productive of thick yellow sputum. Mildly dyspneic upon arrival (walked 500m from vehicle), RR 15 bpm, upper chest breathing with increased use of accessory muscles. Auscultation: diffuse wheezing and coarse inspiratory and expiratory crackles over entire lung. Endurance:
A: 7 y.o. with cystic fibrosis who will benefit from education to improve the following problems:
P1: Inadequate airway clearance management.
P2: Uncontrolled, painful cough.
P3: Dyspnea on effort limiting sports participation.
P4: Inadequate self monitoring of oxygenation, dyspnea and effort during exercise.
Objectives:
1. Teach patient independent airway clearance management.
2. Teach effective cough and/or cough alternative.
3. Teach dyspnea management strategies.
4. Teach patient and parent to use saturometer to monitor O2 sat and HR.
Case #1:MAX treatment planning notes
Treatment choice | Problems addressed/Rationale | Specs/notes (dosage etc) | Student assigned | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Debriefing & peer feedback notes MAX
Case study #2: RONAN
Students:
10 year old pt with asthma
HPI: Decreasing cardioresp fitness d/t covid isolation, now increasing inability to participate in sports activities (used to participate in judo and boxing) due to SOB and becomes SOB while walking quickly to school (often running late according to mother) in a.m. Serious attacks for which pt went to ER increased in frequency this year (2x this fall), rescue meds given. Would like to learn management strategies and overall improvement of resp function through exercise.
PMHx: allergies (pollen, dust), anxiety, severe headaches
RONAN
S: c/o general fatigue. c/o SOB on exertion (walking fast/running). Wheezing especially in first 5 minutes of physical activity, worse in cold weather. Frequent dry cough. Frequent upper respiratory tract infections (URTI)/bronchitis. See HPI.
O: SOB only during effort; 12 min run test: 980m (score for age = “poor”). Abdominal weakness (gr 3+) T.A. contraction poor, diaphragm weak. Patient has in his possession a device his mother read about on the internet and bought on amazon but has not yet had instruction on how to use. You recognize the device as an inspiratory muscle trainer (IMT). Poor posture can be corrected on demand, but also demonstrates mild upper thoracic stiffness (dec extension). Flowmeter WNL for age/size. VS WNL.
A: Problem list (form filled out by pneumologist)
P1: Weak respiratory musculature.
P2: Severe dyspneic episodes limiting recreational activity
P3: Poor posture (developing stiffness upper T-sp)
P4: Decreased endurance/CR fitness.
Objectives:
Case #2:ROWAN treatment planning notes
Treatment choice | Problems addressed/Rationale | Specs (dosage etc) | Student assigned | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Debriefing & peer feedback notes ROWAN
Case study #3: Felix
Students:
HPI: Felix is a 32 year-old who has just been discharged home from acute care admitted following “viral lobar pneumonia bilateral lower lobes”.
Pt is being treated with antibiotics and the physician has written an rx for “exercises to help mobilise secretions and improve lung ventilation”.
PMHx: smoking history includes daily use of marijuana only (medical management of pain and anxiety), type 1 diabetes, endocrine disorder. Meds: inhaled bronchodilators and steroid pump (new following this dx/hospit), cortef (5 more days), insulin, and immune suppressant for endocrine disorder).
SoHx: pt lives alone, second story duplex (14 stairs inside, 6 steps outside), two cats, works full time in tech (artificial intelligence). Hobbies: house reno ; )
FELIX
You have completed the subjective portion of your data collection. It looks like this:
S: Pt c/o productive cough, usually @ night or first thing in the morning, dyspnea ++ on minimal exertion (stairs and walking more than 1 block); c/o chest pain 3/10 with vigourous coughing, and severe generalized fatigue. Dizziness w/ position changes.
The following objective DC was obtained from the PT assessment at the hospital:
O: Appears frail, emaciated/pale. Spontaneous weak wet-sounding cough, non-productive. Dyspneic during subjective exam, RR 20bpm, upper chest breathing with increased use of accessory muscles. Poor thoracic spine mobility with slumped posture, kyphosis that corrects 80% partially on demand.
A: 32 y.o. hospitalized due to pneumonia-related respiratory distress, with multiple underlying health conditions, presents with the following problems:
1. Inability to clear secretions bilat lower lobe.
2. Ineffective cough.
3. Risk of atelectasis due to decreased ventilation/lung volume.
4. Severe dyspnea related to condition.
Objectives:
1. Teach exercise-based airway clearance (he does not own a PEP device and lives alone).
2. Teach patient effective coughing and/or huffing.
3. Improve ventilation/ lung volumes (pt was given incentive spirometer @ hosp, but not taught how to use it).
4. Teach patient dyspnea management techniques.
5. Teach one thoracic mobility exercise to further assist with lung volumes/ventilation.
Case #2:Felix treatment planning notes
Treatment choice | Problems addressed/Rationale | Specs (dosage etc) | Student assigned | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Debriefing & peer feedback notes FELIX
Sources:
https://bmjopen.bmj.com/content/6/1/e009721
Westergren T, Fegran L, Nilsen T, et al
Active play exercise intervention in children with asthma: a PILOT STUDY
BMJ Open 2016;6:e009721. doi: 10.1136/bmjopen-2015-009721