Entering the Room

 The 3 I’s of entering a patients room.

 The Feynman Technique

Step 1: What do you want to learn about?

• Identify a topic and start with a blank document. (A blank sheet, either paper or electronic). Write out everything you know about the subject as if you were teaching it to a child.
• As you learn more about the topic, add it to your sheet. 
• Use your organization tools of choice (colors, bullet points, outlines) so you can see your knowledge develop.

Step 2: Explain it to a 12-year-old

• Now that you think you understand a topic, explain it to a 12-year-old.
• Use your document as a reference to remove unnecessary jargon and complexity. Only use words a 12 year old would understand.

• Anyone can make a subject complicated but only someone who understands it can make it simple.

Step 3: Reflect, Refine, and Simplify

• Review your notes to make sure you didn’t mistakenly gloss over anything or insert unnecessary jargon.
• Read it out loud. If the explanation isn’t simple enough or sounds confusing, reflect and refine.
• Go back to the source material, reviewing the parts you don’t understand. Repeat until you have a simple explanation.

Step 4: Organize and Review

• Test your understanding in the real world, by teaching it to someone. 
• How effective was your explanation? What questions were asked? What parts caused confusion?
• Reflect, Refine, and Simply

Optimizing Therapeutic Cough

Shaping the Patient’s Therapeutic Cough

Shaping a patient’s therapeutic cough plays an integral part in every patent encounter.  Whether the primary therapy visit is for bronchial hygiene, hyperinflation, inhaled medication, peri-operative care or patient education, cough evaluation and instruction is a vital component of every visit. 

 
The scope of this discussion does not include or address the diagnosis or treatment of “chronic cough” although some of the techniques addressed can be helpful in addressing that specific clinical challenge. 

By optimizing the therapeutic cough you can assist the patient in the following:
1) Decreasing the tendency toward uncontrolled, spasmodic ineffective couch. 
2) Assist in opening collapsed lung and mobilizing secretions. 
3) Decrease the shortness of breath associated with uncontrolled cough.

The framework of primary cough instruction outlined below is divided into, 3 sustained deep breaths with a 3 count breath-holds followed by a set of 3 controlled coughs.

Optimizing those 3 steps will be explored in a later post.

Breaking down clinical instruction into sets of 3, increases the likelihood that our already overwhelmed patients can remember and use techniques effectively. The pattern of, 3 breaths with breath-holds followed by the 3 controlled coughs after the 3rd breath-hold will be utilized as our primary framework of instruction.

Prior to all directed cough maneuvers the patient is instructed in slow deep breathing and breath hold. These slow deep breaths with sustained inspiration are used both in preparation for the maneuvers and between sets of cough instruction. These controlled breaths are directed at re-expanding lung, introducing air behind retained secretions, and helping the patient reduce dyspnea and the tendency toward convulsive cough. All 3 of these effects are more likely accomplished if the deep breaths are accompanied by a breath hold.

Step One – Coach the patient to take their first slow moderately deep breath.

Step Two - Say slowly and out loud for the patient, “hold it, hold it, hold it” in a fashion that results in at least at three second breath hold. (Another set of 3) 

Step Three - Encourage the patient to exhale slowly to resting exhalation . 

Step One Repeat - The patient is instructed to take second somewhat deeper breath. 

Step Two Repeat – And, again coached to, “hold it, hold it, hold it”, encouraging a slightly longer breath hold.  

Step Three Repeat - Encourage the patient to exhale slowly to resting exhalation . 

Step Three Concluding - For the 3rd and concluding breath the patient is encouraged to inhale to near maximum. 

Step Two Concluding- and couched again to, “hold it, hold it, hold it”, while preparing the patient to perform a controlled cough from the near maximal .

Step Three Concluding - 

* Instruct the patient produce 3 moderate controlled coughs from the same deep held inspiration. 

* Immediately have the patient inhale again to near maximal inspiration and coach them one again to, “hold it, hold it, hold it”, and then encourage 3 slightly more vigorous coughs from the held breath. 

* And finally, encourage the patient one final time to inhale maximally and to, “hold it, hold it, hold it”, and then encourage 3 slightly more vigorous coughs from the held breath. 

* Return the patient to normal breathing and reassess. 

C.O.P.D. Includes What Diseases?

 Chronic Obstructive Pulmonary Disease (COPD):

Includes the the following under its clinical umbrella or has significant clinical overlap.  

The acronym - B.A.B.E.

* Bronchitis, Chronic

* Asthma COPD Overlap

* Bronchiectasis,  Bronchiectasis Nontuberculous Mycobacterial 

* Emphysema

Medical Calculators

Respiratory Calculators

Medscape and Epocrates give you access to an astounding array of integrated medical formulas. They include detailed links and bibliographic references for each formula. The categories let you filter down to more specific respiratory calculations or to the topics that you are searching.  This is a free resource with the basic services.

https://www.epocrates.com/

https://www.medscape.com/public/medscapeapp

Shop and Give Back to the COPD Foundation

Every penny counts! 

Your online purchases through Amazon can go the extra mile and help support the nonprofit COPD Foundation. 

When you designate the Foundation as your charity of choice, Amazon contributes to the Foundation following your purchase(s). 

https://smile.amazon.com/?ref_=smi_ge_rl_rd_gw

COPD Teaching and Reference

The COPD 101 Library 

The COPD Foundation has created the COPD 101 Library which is an excellent overview of key clinical concepts for COPD & Genetic COPD, including risk factors, epidemiology, screening and diagnostics, and treatment strategies. This presentation can be a starting point for anyone new to COPD or seeking to improve overall care. Patient education materials, created specifically to assist clear communication of disease management concepts, are also included to help optimize therapy plans.

COPD 101 is available on the site below and is in Basic PDF, Enhanced PDF (including speaker notes), and Full PowerPoint (presentation-ready) formats.  Presentations on inhaled medication delivery have also come online mid-2022.

https://www.copdfoundation.org/Learn-More/I-am-a-Healthcare-Provider/The-101-Library.aspx