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1 Respiratory System Case Study MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6 Tim’s Case: Ominous Signs? OVERVIEW: Four-year-old Tim has developed some strange new physical health symptoms. Alone, none seem too concerning, but together they must be taken seriously. Can you determine whether Tim is facing a benign or serious illness? Can you help develop a treatment plan to help him? GOALS: 1. Identify objective data to gather in order to make a diagnosis. 2. Create an aligned, thoughtful, and evidence-based plan. ROLE: You are a team working at a comprehensive pediatrics primary care clinic. Some of the roles on your team include: a Pathologist, Geneticist, General Pediatrician, Physician Assistant (PA), Nurse, a Respiratory Therapist, and Child Psychiatrist. OBJECTIVE: Obj. 14.6: Identify the structures, functions, and pathophysiology of the respiratory system. DELIVERABLE: 1) SOAP Note 2) Post-Assessment Questions ASSESSMENT CRITERIA: Objective & Assessment Sections: 1) one or more tests or labs is run in order to provide evidence for/against a diagnosis; 2) test or lab to collect objective data is explained clearly and results are interpreted logically Plan Sections: 1) comprehensive (includes physical, social & mental health); 2) aligned to facts of the case; 3) evidence-based; 4) addresses short- & long-term INSTRUCTOR’S GUIDE PLANNING NOTES: (1) Teams: 4 students; (2) Length: Approx. 3 classes (Day 1: Subjec>ve & Objec>ve: Day 2: Research & Assessment; Day 3: Plan & PostAssessment Ques>ons (3) Resources Needed: Computers; Copies of student workbook DIAGNOSIS: Cys$c Fibrosis (CF) SOAP Note: If students have NOT done modules/case studies using the SOAP method, some prep is required (sugges>on: 23 class periods. See SOAP resource lessons). Health Professions: Students should choose their role from among these or others they know; they should then analyze the pa>ents’ situa>on to iden>fy issues their profession may be concerned with Note on use of case studies: These case studies are designed to be used as an introduc>on to a body system in an A&P course OR as a supplement &/or authen>c assessment tool to the middle or end of unit. The case studies are compa>ble with any other A&P curricula & reference online resources so that no formal text or other curricular source is required. They can also be used in a shorter “survey”/casebased course of A&P to give students a preview of applica>ons for A&P, while engaging & ”hooking” them on A&P! :)

14.6 - Instructor Guide (Respiratory) · Case Study MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6 Tim’s Case: Ominous Signs? OVERVIEW: ... 14.6 - Instructor Guide (Respiratory)

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Respiratory System Case Study

MODULE 14:

ANATOMY & PHYSIOLOGY

CASE STUDY #6

Tim’s Case: Ominous Signs?

OVERVIEW:Four-year-old Tim has developed some strange new physical health symptoms.

Alone, none seem too concerning, but together they must be taken seriously.

Can you determine whether Tim is facing a benign or serious illness? Can you help

develop a treatment plan to help him?

GOALS:1. Identify objective data to gather in order to make a diagnosis.

2. Create an aligned, thoughtful, and evidence-based plan.

ROLE:You are a team working at a comprehensive pediatrics primary care clinic. Some

of the roles on your team include: a Pathologist, Geneticist, General Pediatrician,

Physician Assistant (PA), Nurse, a Respiratory

Therapist, and Child Psychiatrist.

OBJECTIVE: Obj. 14.6: Identify the structures, functions, and

pathophysiology of the respiratory system.

DELIVERABLE: 1) SOAP Note

2) Post-Assessment Questions

ASSESSMENT CRITERIA: Objective & Assessment Sections: 1) one or more

tests or labs is run in order to provide evidence

for/against a diagnosis; 2) test or lab to collect

objective data is explained clearly and results are

interpreted logically

Plan Sections: 1) comprehensive (includes physical, social & mental health); 2)

aligned to facts of the case; 3) evidence-based; 4) addresses short- & long-term

INSTRUCTOR’S  GUIDE  

PLANNING  NOTES:      (1)  Teams:  4  students;      (2)  Length:  Approx.  3  classes  (Day  1:  Subjec>ve  &  Objec>ve:    Day  2:  Research  &  Assessment;  Day  3:  Plan  &  Post-­‐Assessment  Ques>ons      (3)    Resources  Needed:  Computers;    Copies  of  student  workbook

DIAGNOSIS:  Cys$c  Fibrosis  (CF)

SOAP  Note:      If  students  have  NOT  done  modules/case  studies  using  the  SOAP  method,  some  prep  is  required  (sugges>on:  2-­‐3  class  periods.  See  SOAP  resource  lessons).

Health  Professions:  Students  should  choose  their  role  from  among  these  or  others  they  know;  they  should  then  analyze  the  pa>ents’  situa>on  to  iden>fy  issues  their  profession  may  be  concerned  with    

Note  on  use  of  case  studies:      These  case  studies  are  designed  to  be  used  as  an  introduc>on  to  a  body  system  in  an  A&P  course  OR  as  a  supplement  &/or  authen>c  assessment  tool  to  the  middle  or  end  of  unit.  The  case  studies  are  compa>ble  with  any  other  A&P  curricula  &  reference  online  resources  so  that  no  formal  text  or  other  curricular  source  is  required.  They  can  also  be  used  in  a  shorter  “survey”/case-­‐based  course  of  A&P  to  give  students  a  preview  of  applica>ons  for  A&P,  while  engaging  &  ”hooking”  them  on  A&P!  :)

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UNIT 1: MENTAL HEALTH LESSON 1.1

Case Study Steps:

_____ 1. Review the coversheet information. Assign team roles.

_____ 2.. Read the case information and fill out the SOAP note.

_____ 3. Research possible conditions or diseases.

_____ 4. Determine one or more lab/tests to gather objective data.

_____ 5. Complete the Assessment and Plan for the patient.

_____ 6. Complete the Post-Assessment Questions.

MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

Steps:      This  checklist  will  help  orient  students,  encourage  them  to  manage  their  >me  and  tasks,  and  help  them  process  the  flow  of  the  case.

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UNIT 1: MENTAL HEALTH LESSON 1.1

Health Care Provider Roles:

Determine the role of each team member. Then work together to determine what

focus area you will be in charge of in Tim’s case.

Team Member Role Specific Focus Areas

MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

Roles:      Remind  students  to  return  to  the  cover  sheet  “roles”  sec>on  to  iden>fy  possible  roles.  For  “specific  focus  areas”,  provide  a  few  examples.

e.g.,  #1:    child  psychiatrist  may  be  concerned  with  pa>ent’s  (and  parents)  mental  health  a\er  receiving  diagnosis

e.g.,  #2:  respiratory  therapist  might  be  concerned  with  the  specific  breathing/airway  issues  and  that  por>on  of  the  treatment  plan

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Case Information:

Jane brings in her four-year-old named Tim to a comprehensive pediatrics

clinic in order to assess his health status. Jane reports that Tim is very curious and

smart and gets along socially with other children. Jane says that Tim’s preschool

teacher suggested she take him into the doctor for a health screening, because

she has noticed his stools looking oily when he uses the bathroom.

Patient History:

Tim’s mother Jane is a former drug user and has no family in the area. For these

reasons, along with the socioeconomic status of his household (below the poverty

line), Tim had a difficult first few years of life. However, recently his mom got help

from social services and has been drug-free for six months. They are living in a new

rental home and Tim is adjusting well to his new living situation, but is still struggling

at school. He recently had several accidents and so they temporarily put him in

pull-up diapers. He has also shown to be hesitant in engaging in physical activity

and seems more tired and exhausted than a typical four-year-old should be.

Measurements & Vital SignsAge: 4.5 yrsHeight: 3 ft. 7 inchWeight: 32 lbs. Pulse: 108 bpmRespiratory Rate: 30 breaths/minTemperature: 99.1 degrees FBlood pressure: 100/55 mmHg

Physical Exam:General appearance: Good-natured, active, secureEar, Nose & Throat: Runny nose. Ears do not show sign of infectionAbdominal: Normal; no pain reported upon touchingNeuro: NormalRespiratory: Cracking/wheezing sounds; slight coughCardio: NormalNails: Nails normal in color but nail beds are slightly curved

MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

THOROUGHNESS:    Remind  students  to  be  thorough  when  documen>ng  the  details  in  the  SOAP  note.  Even  if  a  detail  seems  irrelevant,  it  may  be  important  later.  Simultaneously,  encourage  them  to  be  succinct  &  concise  in  their  notes.

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

All  details  from  previous  page  should  be  documented!

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Research:

Team MemberPossible

DiseasesNotes

UNIT 1: MENTAL HEALTH CASE STUDY #1: TOBY’S TROUBLESMODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

RESEARCH:      Have  students  complete  this  before  wri>ng  the  assessment  &  final  plan.    Before  students  decide  what  they  will  focus  on  for  research,  remind  them  to  think  about  their  interest/areas  of  exper>se  as  well  as  the  key  issues  in  Tim’s  case.  Once  research  is  complete  have  them  return  to  teams  and  share  informa>on,  no>ng  the  key  points  from  one  another’s  reports.  Remind  them  to  ask  ques>ons  and  write  any  follow-­‐up  ques>ons  or  points  of  confusion  or  clarifica>on  they  need  to  look  up  prior  to  deciding  on  the  diagnosis  &  plan.

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MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

CysMc  Fibrosis-­‐-­‐Sweat  chloride  test,  spirometry  test,  chest  x-­‐ray,  arterial  blood  gas  check,  &  secre>n  s>mulator  test-­‐-­‐consistency  of  stools  (oily,  greasy)-­‐-­‐Runny  nose,  cracking/wheezy  breathing  sounds,  cough-­‐-­‐Curved  nail  beds

CysMc  Fibrosis  Treatment  OpMons:-­‐-­‐Changes  to  diet  (increasing  calories)-­‐-­‐An>-­‐inflammatory-­‐-­‐Medica>ons:  bronchodilators,  mucoly>c  agents,  an>bio>cs,  pancrea>c  enzyme  replacement-­‐-­‐Airway  clearance  therapy-­‐-­‐Eventually,  the  possibility  of  lung  transplanta>on  

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Post-Assessment Questions:

1. What does a spirometer measure? How does it work? Who would it be used on?

2. Explain the diagram on the right. What does each component represent?

3. What are the main functions of the respiratory system? Which are currently or may be in the future compromised in Tim?

4. Describe normal developmental changes in the respiratory system?

5. Name & describe a few of the most common respiratory illnesses to affected children and teenagers.

MODULE 14: ANATOMY & PHYSIOLOGY CASE STUDY #6: RESPIRATORY SYSTEM

PURPOSE:    These  ques>ons  will  help  learners  connect  the  case  study  pa>ent  scenario  with  the  structure,  func>on  &  pathophysiology  of  the  skin  system.  

USE  OF  THESE  QUESTIONS:    The  amount  of  >me  students  need  to  research  answers  to  these  ques>ons  will  depend  on  the  concurrent  or  previous  level  of  instruc>on/pre-­‐reading  about  the  skin  system.

A  spirometer  is  an  instrument  for  measuring  the  air  capacity  of  the  lungs.Source  for  more  info:Mayo  Clinic:  hap://www.mayoclinic.org/tests-­‐procedures/spirometry/basics/defini>on/prc-­‐20012673Cleveland  Clinic:  hap://my.clevelandclinic.org/services/surgery/hic_how_to_use_an_incen>ve_spirometer.aspx

Source  sugges>on:hap://en.wikipedia.org/wiki/Lung_volumes

A)  Supplies  body  with  O2  and  disposes  of  CO2  (i.e.,  respira>on  and  ven>la>on).B)  Houses  olfactory  (smell)  receptors.C)  Provides  sound  and  speech  making  organs  and  >ssues.

Source  Images  for  >meline  of  childhood  lung/respiratory  development:  hap://www.environment.ucla.edu/reportcard/ar>cle1700.htmlChanges  in  aging:    hap://www.nlm.nih.gov/medlineplus/ency/ar>cle/004011.htm

Source  sugges>ons:AANMA:  hap://www.aanma.org/faqs/welcome-­‐to-­‐precious-­‐breathers/respiratory-­‐

diseases/Cleveland  Clinic:  hap://my.clevelandclinic.org/healthy_living/childrens_health/

hic_childhood_respiratory_infec>ons_and_other_illnesses.aspx

When  you  look  at  this  diagram  think,  as  the  line  goes  up  (and  >me  goes  on,  across  the  x-­‐axis)  a  person  is  breathing  IN,  and  when  the  line  is  going  down  they  are  breathing  OUT.    Try  it.  Breath  in,  line  up.  Breath  out,  line  down.    Think  of  IRV  as  a  “BIG  breath  IN”  (the  most  you  could  possibly  breath  in)  and  ERV  as  a  big  breath  out  (the  most  you  could  exhale).  Try  it  again…  Look  up  what  the  abbrevia>ons  mean  on  p.  448  and  it  should  be  easy  to  remember  which  is  which  when  you  see  them  E=Expira>on;  I=Inspira>on.    When  you  see  the  TV,  think  of  a  Tide  in  the  Ocean…it  goes  in  and  out  back  and  forth,  this  is  normal  breathing  (Tidal  Volume).    Think  of  Vital  Capacity  as  the  total  amount  of  air  that  can  be  exchanged.    DEAD  space  is  unusable  air,  (in  the  trachea,  bronchi,  etc.)  that  never  touches  the  alveoli!    Residual  volume  (RV)  is  the  amount  of  space  le\  in  the  lungs  that  can  never  be  forced  out  (or  your  lungs  would  collapse!).  There  is  always  a  >ny  bit  of  air  in  them.