GOALS AND INSTRUCTIONAL OBJECTIVES

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1 October 4-7, 2004 Respiratory GOALS: GOALS AND INSTRUCTIONAL OBJECTIVES By the end of the week, the first quarter student will have an in-depth understanding of the diagnoses listed under Primary Diagnoses and Secondary Common Diagnoses. The first quarter student will accurately perform an appropriate history and physical exam on a patient or patient model presenting with one of the respiratory diagnoses listed under Primary Diagnoses, Secondary Diagnoses, and Tertiary Diagnoses when seen at the student s clinical site or during a practicum exam. OBJECTIVES The first quarter student will complete the following:! Accurately explain the epidemiology of primary and secondary common diagnoses.! Name the (S) chief or common presenting complaint and relevant descriptors of the primary, secondary common and uncommon and tertiary diagnoses.! Accurately distinguish between (O) Objective negative and positive findings while performing a routine or specialty physical exam technique when evaluating for, or in the presence of, the conditions listed for each primary, secondary common and uncommon, and tiertiary diagnosis, with special focus on the following conditions. Acute bronchitis Laryngotracheobronchitis Airway foreign body Pneumonia Pneumothorax Bronchiolitis Asthma COPD Tuberculosis! Formulate a (A) Diagnosis and list relevant differential diagnoses from information gathered through history taking, physical exam, and diagnostic test results provided via case studies or reports or collected in the clinical setting. Identify risks associated with specific missed diagnosis 1

2 ! Identify on written exam or in case presentation of a patient model or clinic patient, a (P) Plan outlining the appropriate medication, non-medicinal treatment, patient education and follow-up evaluation for primary and secondary common diagnoses.! List and explain the significance of the test results of the relevant diagnostic tests used to diagnose and evaluate: Tuberculosis Asthma COPD! List six indications to order a chest x-ray! Describe the general approach to reading a chest x-ray.! Describe and recognize the following: a normal chest x-ray. abnormal collections of fluid seen on the chest x-ray. Identify common chest x-ray features of the following conditions: Pneumonia Asthma COPD Tuberculosis Airway foreign body Pneumothorax (D) = definition only RESPIRATORY: ANATOMY AND PHYSIOLOGY The first quarter student will recognize and explain the anatomy, physiology, and common pathophysiology in sufficient depth for clinical application related to the following Respiratory components. To meet this objective the student will utilize textbooks, models, electronic, computer or web-based programs, radiographic resources, and lectures according to the standards identified in the Primary Care Associate Program required texts (see booklist in Student Manual). The first quarter student will be responsible for basic anatomic knowledge of the respiratory system with emphasis on clinically relevant areas. The first quarter student will utilize required texts and lecture material to develop an understanding of the clinically important concepts of the following:! Chest and lungs: Trachea Carina Main stem bronchi 2

3 Bronchioli Alveoli 5 major lobes Lingula Intercostal and accessory strap muscles of respiration Diaphragm! Pulmonary circulation: Right ventricle Pulmonary artery Capillary bed Pulmonary veins (into left atrium)! Breathing patterns in developing children: Obligatory nasal breathing Periodic breathing Apnea Tachypnea.! Describe the physiology of respiration and the physiologic impact of hyperventilation, hypoventilation, and obstructive lung disease on PO2, PCO2, and acid / base balance. DISEASE Primary Diagnoses: The first quarter student will state the epidemiology, basic pathophysiology, etiological agents, and/or risk factors, preventive measures, signs and symptoms, differential diagnoses, investigative measures, management and patient education for the following diagnoses:! Infectious disorders Acute bronchitis Acute bronchiolitis Pneumonia Bacterial Viral Fungal HIV-related! Obstructive Pulmonary Disease Chronic bronchitis (also referred to as Chronic Obstructive Pulmonary Disease or COPD) Emphysema (also referred to as Chronic Obstructive Pulmonary Disease or COPD) Asthma - stable Asthma - acute exacerbation necessitating steroid taper 3

4 ! Other Associated Disease Atopic dermatitis Eczema Urticaria Secondary Diagnoses (Common): The first quarter student will state the epidemiology, basic pathophysiology, etiological agents, and/or risk factors, preventive measures, signs and symptoms, differential diagnoses, investigative measures, general principles of management and patient education for the following diagnoses. Physician consultation is expected.! Infectious disorders Croup Influenza Pertussis Respiratory syncytial virus infection Tuberculosis Secondary Diagnoses (Uncommon): The first quarter student will state the epidemiology, basic pathophysiology, signs and symptoms of the following diseases.! Infectious disorders Lung Abscess Coccidiomycosis (may be secondary diagnosis common depending on student's geographic location) Histoplasmosis! Obstructive Pulmonary Disease Cystic Fibrosis Atelectasis Bronchiectasis! Restrictive pulmonary Disease Idiopathic pulmonary fribrosis Sarcoidosis! Pulmonary Circulation Pulmonary hypertension Cor pulmonale! Pleural Diseases 4

5 Pleural effusion Tertiary Problems: Problems Requiring Emergency Management or Hospitalization: The first quarter student will be able to recognize these disorders and initiate treatment. As well, they should be able to describe and identify the basic pathophysiology, risk factors, preventive measures, patient education and referral sources as appropriate:! Infectious disorders Acute epiglottitis! Obstructive Pulmonary Disease Status asthmaticus Cor pulmonale! Pneumothorax Primary Secondary Traumatic Tension! Other respiratory emergencies Acute respiratory distress syndrome Anaphylaxis Carbon monoxide (CO) poisoning Chemical inhalation injury Airway foreign bodies Pulmonary embolism CLINICAL PROBLEMS For each problem the first quarter student will be able to perform a focused history and physical, generate a differential diagnosis, and order appropriate diagnostic tests. They will be able to present the problem orally, do a write-up in SOAP format, and manage the diagnoses in Primary and Secondary Common Diagnoses. Cough due to lower respiratory etiology Chest pain Cyanosis Hemoptysis Hyperventilation Hypoventilation Shortness of breath/dyspnea Stridor Tachypnea Wheezing 5

6 OBJECTIVE In addition to the basic exam, the first quarter student will be able to perform the following physical exam maneuvers:! Special PE techniques Egophony Bronchophony Whispered pectoriloquy Recognize the listed abnormalities:! Bronchospasm! Barrel chest! Cyanosis! Grunting! Lung dullness, hyperresonance, fremitus, egophony! Nasal flaring! Periodic breathing! Rales / Crackles! Retraction! Rhonchi / Wheezes! Stridor! Tachypnea PLAN Evaluation studies: State the indications for the following tests. Explain the significance of a normal vs abnormal result in relation to the diagnoses listed under Primary, Secondary Common and Uncommon, and Tertiary Diagnoses, and describe the general cost effectiveness of the following tests:! Lab ABG s (Arterial Blood Gases) Cultures - bacterial, fungal Cultures/acid-fast stains for AFB (Acid-fast Bacilli) Gram stain Induced sputum Sweat chloride! Radiology Chest X-ray - including: When to order a chest x-ray How to read a chest x-ray Inspiratory 6

7 Expiratory PA / lateral / and lordotic views! Other studies Office spirometry Pulmonary function test Bronchoscopy! Treatment The first quarter student will identify the indications, contraindications, adverse effects and describe the general cost effectiveness of the following treatment approaches: Medications (Also see Pharmacology syllabus.) Antimicrobial Antibiotics Antituberculin drugs Expectorants Antitussives Bronchodilators long acting short acting Inhaled steroids Immunizations Influenza vaccine Pneumococcal vaccine Surgical / invasive procedural interventions: State indications for: Bronchoscopy Lobectomy Non-invasive / non-drug Treatments: State indications for: Percussion Postural drainage Hydration Humidifier Patient Education: The first quarter student will be able to identify and then explain to patients 7

8 the following topics:! Smoking - effects on the respiratory system! Allergy inhaled irritants desensitization! Respiratory drug side effects! Environmental factors smog pets plants foods! Value in general to this system of increasing oral fluids! Exercise! Use of the following: hand held nebulizer inhalers spacers peak flow meters pulse oximeter 8

9 October 4-7, 2004 Respiratory Reading Assignment: th BA 8 ed th To 10 ed Current Emergency th BBZ 6 ed Feldman Tierney th th Wasson 5 ed Sa 2004 ed Bu 2000 Fischbach Ro Mettler nd Pfenninger 2 ed PHARMACOLOGY: note: bring to class Pharm Syllabus pages related to respiratory disease. Pharmacotherapeutics for Advanced Practice 9

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