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Unit 3: Teacher NotesLesson 3.1: Introduction to Energy (Optional) Activity 3.1.1 Resources for LifeActivity 3.1.2 The Rule of ThreesLesson 3.2: FoodActivity 3.2.1 Action Molecules Project 3.2.2 Digestive System DesignProject 3.2.3 Living in a Material World (Optional)Project 3.2.4 Investigating Enzyme Action Activity 3.2.5 Metabolism – A Balancing ActActivity 3.2.6 In Search of EnergyLesson 3.3: OxygenActivity 3.3.1 Gasping for AirActivity 3.3.2 Measuring Lung CapacityActivity 3.3.3 Rx – Understanding PrescriptionsActivity 3.3.4 Respiratory Therapy Lesson 3.4: WaterActivity 3.4.1 Hook Up the PlumbingActivity 3.4.2 Spotlight on the KidneyProject 3.4.3 The Blood/Urine ConnectionActivity 3.4.4 Water BalanceActivity 3.4.5 UrinalysisLesson 1This lesson is meant to engage students in a discussion about power in the human body. The two activities in this lesson can be completed as described or the teacher can use elements of the activities as a quick classroom engagement discussion. The teacher may want to engage the class with photos, video clips, or stories that showcase people pushing their bodies to the limit. The story of Mauro Prosperi has been included in the Purpose of Activity 3.1.1 as an example. Additional information on Mauro Prosperi can be found in the book Surviving the Extremes: What Happens to the Body and Mind at the Limits of Human Endurance by Kenneth Kamler, MD. The National Geographic Channel’s series Expeditions to the Edge featured Mauro’s story in the episode Sahara Nightmare. Please see the National Geographic site at for additional information about the availability of the episode. The students will delve deeper into the book Surviving the Extremes: What Happens to the Body and Mind at the Limits of Human Endurance by Kenneth Kamler, MD in Unit 6, but you may want to consider assigning chapters to the class as they work through the activities in the next few units. The readings provide great discussion topics for issues of power and movement in the body. “Surviving the Extremes - Discussion Questions” can be used to review content, ignite discussion, and further illustrate the interactions of the human body systems. If using this lesson as engagement, consider introducing the case of Mauro Prosperi and completing the chart described in Activity 3.1.1 as a class brainstorm on the board. Have the class list the main resources for life (food, water, and oxygen) and brainstorm functions of these fuels, the body systems that may be involved with processing or delivering these fuels, as well as environmental and personal factors that could impact availability and utilization of each. As a class, rank the resources discussed in order of importance for the body, thinking about which would run out first. Use the Conclusion questions for Activity 3.1.1 to help lead the discussion. If desired, ask students to estimate how long a person could last without each key resource (as outlined in Activity 3.1.2). Compare classroom estimates with the “Rule of Threes” and discuss factors that might impact this rule. Remind students that in this unit, they will discuss each of the resources that power the human body as well as investigate the systems of the body that work to process and deliver these key fuels.Activity 3.1.1(Optional) – see general Lesson 1 note about using this activity as engagementIn this activity, students will begin to brainstorm the resources humans need to live, as well as the function food, water, and oxygen play in keeping a person healthy. Food serves as a source of energy for the body as well as a source of fat and insulation. This fat cushions organs and protects the human body. Water helps regulate body temperature, moistens tissues in the eyes, mouth and nose, lubricates joints, dissolves minerals and nutrients to make them accessible to the body, flushes out waste products and helps deliver nutrients and oxygen to cells. Oxygen is required to feed the body’s tissues and produce ATP in aerobic cellular respiration. The physical act of breathing assists with gas exchange and the removal of harmful gases from the body. Students will further investigate the way in which the body distributes, processes and utilizes food, oxygen and water in the next three lessons and will revisit the idea of energy as it relates to sports and movement in Unit 4. Students will also return to explore how all body systems are affected by extreme environments in the final unit. Activity 3.1.2 (Optional) - see general Lesson 1 note about using this activity as engagementThis activity is simply an extension of Activity 3.1.1. Students will compare their estimates to a general “rule” for how long a person can survive without vital resources. The Rule of Threes is referenced in survival handbooks and various adventure sports and military websites. This “rule” is one estimate on the power of the body’s resources and is used merely as an engagement point. Students will quickly see that this estimate is not an absolute. Students have probably already come to the conclusion that factors in the environment and factors unique to the person (overall health, age, weight, will and determination, etc.) directly relate to how long a particular fuel will last. They will list these factors and use this knowledge to write a disclaimer to go under the rule. Students will further explore how the body deals with food, oxygen, and water in the upcoming lessons. The Discovery Channel video clip can be viewed on the Internet or on the “Strength” DVD. The clip shows how an elite athlete’s body manages a fuel crisis and sets the stage for a discussion on macromolecules in food as a source of energy. Lesson 2Activity 3.2.1Students will be using a variety of materials to create a model of the lock and key and induced fit model of enzyme function. The list of materials provided can be changed or expanded as there are many ways to make the models. In Part A you may want to review with the students the use of the Inspiration software and the outlining techniques used to create the concept maps by developing a short review lesson.There is a sample outline and concept map provided. These designs are meant to be samples as there are many ways to create both the outline and the map.Materials for 3-D Modeling Kits:1 Styrofoam ball1 Styrofoam square1 12 cm piece of wire1 8 cm2 piece of modeling clay1 colored marker1 20 cm2 piece of construction paper2 Pipe cleanersGlueProject 3.2.2In this project, students will work in teams to research the components of the digestive system and design a model of this system on their manikens. Students will work in teams of four to formulate the design. They can either work together to build one completed model on one of the two manikens in the team or if time permits, each pair should build the digestive system on their own maniken. Provide clay in all available colors and encourage students to use additional modeling materials and materials from home to add texture or specific structure to the model. Stress that the materials that make up the structures of the digestive system are highly related to their function in the body. Check to make sure that the organs placed on the maniken are connected in an appropriate order and that placement is consistent with true anatomy. Provide reference textbooks or suggest helpful websites that display true digestive system anatomy. One basic assembly for the maniken digestive system is shown and described below. These building photographs are presented simply as a guideline. This activity should not be a teacher-led building activity. Students should customize the design using clay and other modeling materials and figure out connections and placement on their own. You may want to provide students with the hint that it may be easier to first sculpt all of the organs on the gastrointestinal tract and then go back and add any accessory organs. Students can build the palate, the roof of the mouth, above the mouth and below the nasal cavity. A projection of this tissue known as the uvula hangs down from the middle of the soft palate over the roof of the tongue. In this model, the palate and uvula are shown in white and the tongue has been constructed in terra cotta clay. Remind students that the tongue is a very powerful muscle. The tongue extends back to the hyoid bone, its bony attachment. Students may want to add salivary glands and teeth to the oral cavity. The pharynx directs food into the esophagus and sits directly behind the palate and the tongue (it is the open space you see when you open up and say “ahh”). The tube runs from the mouth and halfway down the neck where it becomes the esophagus. In this model, the pharynx and the esophagus are shown in pink. Make sure to hollow out a funnel at the top of the pharynx to show the opening of the cavity. Build the J-shaped stomach and attach the organ on the left side of the abdominal cavity. The esophagus pipes directly into the stomach. The pylorus, the region of the stomach that attaches to the duodenum, points over to the side under the rib cage. In this model, the stomach has been sculpted in pink clay. The duodenum, the first part of the intestine, attaches to the pylorus and forms a letter “C” so it can curve around the head of the pancreas. All of the organs of the GI tract can be constructed in the same color of clay to show the direct pathway of food. In this model, the small intestine has been constructed out of blue clay for emphasis. Mixed clay from the previous year also makes great intestines. Humans have approximately 18 - 20 feet of small intestine. Use a clay extruder or roll out thick spaghetti stands for the remainder of the small intestines. About 6-8 feet of intestine was used to construct the organ in the picture below. Consider having the students measure out this length and marvel and how it could possibly fit inside the abdominal cavity. Twist the long strand back and forth to create the remaining two parts of the intestine, the jejunum and the ileum. Attach the twisted intestine to the end of the duodenum and fill the abdominal cavity with the organ. Secure the intestine on the back support and on the ilium of the pelvic bone. Roll out a thicker tube to represent the large intestine. Approximately 14-16 inches of orange clay was used to create the intestine shown below. Attach the ileum of the small intestine to the cecum of the large intestine. The cecum is shown as a thicker pouch at the beginning of the large intestine. Wrap the intestine upward to represent the ascending colon, wind the clay across the abdominal cavity to form the transverse colon, and bend the clay downward to represent the descending colon. Bring the clay back behind the small intestine and next to the sacrum to represent the rectum and the anus. The pancreas is then constructed using yellow clay. The organ takes the shape of a sideways comma. Reinforce that this organ is part of the digestive system, supplying enzymes needed to break down food, and part of the endocrine system, producing the hormone insulin. The pancreas fits inside the “C” shape of the duodenum and extends across the abdomen. You may have to pick up the duodenum and hold the stomach in place to secure the pancreas. The liver is located in the upper abdomen under the diaphragm. This large organ is constructed using terra cotta clay. A small gallbladder is assembled using green clay and is placed in the hollowed-out underside of the liver. NOTE: The digestive system will most likely have to be removed from the maniken when assembling the urinary system. Challenge the students to figure out how these two systems are actually oriented in the human body. You may also want to discuss placement of the reproductive organs. Consider using plastic wrap to secure the entire digestive system and to help move the organs out of the way as needed. Remind students that this layer could represent the parietal peritoneum that holds the massive set of organs in place.Each group should be assigned a different “bite of food.” Use foods that are representative of different macromolecules. Possible items include bread, butter, steak or other protein, candy, or celery (to discuss hard to digest foods high in cellulose). As students give their presentations and trace the path of their bite of food, the class should see the fate of all types of macromolecules and begin to appreciate the specificity of enzymes in the digestive tract. Students may use toothpick flags to label the location and function of key digestive enzymes. These flags can be removed at the end of the activity or left in for further study. As a possible extension, each team could also be given a specific disease or disorder and asked to alter their model to show how this state occurs and can be remedied (if possible). Examples illnesses include ulcers, gallstones, heartburn, dehydration, anorexia, or various types of cancer. The Human X-ray Print Set includes great shots of food moving in the digestive system. X-ray 9 clearly shows the shape of the stomach. X-rays 10 and 11 show movement of a meal through the intestines over a four hour period. The teacher may want to show the class these X-rays as a wrap-up or as a conclusion to the activity. The teacher can either show these X-rays on an overhead or make copies of the documents and give them to student groups. Students should observe the anatomy and discuss what they see over time and/or should write about what they see in their lab journals. The discussion or the writing sample could serve as an informal assessment for the project. More information about what is visible in the X-rays is provided in the booklet that comes with the X-ray set. Project 3.2.3 (Optional Alternative to Project 3.2.2)This optional alternative to Project 3.2.1 covers the same concepts, but asks the students to working digestive system model that is not assembled on the maniken. The focus on the lesson is material science engineering and the students are asked to choose materials for the model that mimic the properties of actual digestive organs and structures. This project may take longer to complete and does not involve the manikens. In this project, students can use the Twelve Step Design Process to focus their overall design. They do not have to take detailed notes on each step in their lab journal, but they should follow the steps as a guide. Remind students of the steps that go into designing any sort of model or unique new product. Have the class brainstorm other potential uses for a working material science model of the human digestive system. Alternatively, instruct the students to follow through each step of the design process and take formal notes at each step. Focus should be placed on evaluating the materials that are picked for each area of the model. The teacher should have modeling materials available in the classroom, but the students will most likely be bringing in specific items from home. Some suggested materials to have in the classroom are modeling clay, foam, various types of hoses, tubing of different diameters, straws, scraps of material, plastic wrap, pillow stuffing, thread and needles, balloons of all sizes, bubble wrap, carpet scraps, tin foil, paint, markers, glue, string, pipe cleaners and wire. Dishwashing detergent would be a good way for the student to represent bile and its role as an emulsifier. Balloons or stretchy fabric would be a good material to demonstrate the elastic properties of the stomach. Additional possibilities are listed below, but allow students to really think outside of the box and come up with their own creative materials. Oral cavityStyrofoam ball, balloonPharynxStyrofoam ballSalivary glandTiny latex balloonsUvulaModeling clayTongueSponge, red clay with grape nutsTeethWhite Chicklets, small gravelEsophagus“animal making” balloons, tubingStomachHot water bottle, whoopee cushion, balloonSmall intestineSlinky (with tissue paper wrap), Twizzlers, white nebulizer hoseLarge intestineSoaker hose, vacuum hose, irrigation pipe, nerd rope, dialysis tubing, sausage casing, slinky in panty hosePancreasSponges, tubing, utility glove (finger portion), feather, FloamLiverPancake, open-cell foamgallbladderGreen balloonducts2-hole rubber stopper, aquarium tubing and Y-junctions, old electric cords/ mouse cordsEach group should be assigned a different “bite of food.” Use foods that are representative of different macromolecules. Possible items include bread, butter, steak or other protein, candy, or celery (to discuss hard to digest foods high in cellulose). As students give their presentations and trace the path of their bite of food, the class should see the fate of all types of macromolecules and begin to appreciate the specificity of enzymes in the digestive tract.Students can take this project as far as they want to go. They can add moveable parts. They can add texture and encourage those who “tour” their system to touch and experience the digestive system. The teacher may want to make the project a contest and bring in other teachers or classes to vote on the most engaging and factual model. If possible, have the students actually present their final products to a middle school class. Students should remember to tailor the presentation to the target audience.To make the project a bit more challenging, consider adding the requirement that a marble has to be able to pass through the mouth and out the other end just like food in real life. As a possible extension, each team could also be given a specific disease or disorder and asked to alter their model to show how this state occurs and can be remedied (if possible). Examples illnesses include ulcers, gallstones, heartburn, dehydration, anorexia, or various types of cancer. If you decide to complete the project in groups of 6, break up the questions for the large and small intestine and give each set to a different student. The same can be done for the stomach and the esophagus or the pancreas and the gallbladder. This may allow the project to be completed a bit faster, but groups of six may be a bit harder to manage effectively.Pictures of completed student projects from Adesha Armstrong and Alexandra Kloepper in Jadee Lauer’s class at Hazelwood Central High School are shown below.The Human X-ray Print Set includes great shots of food moving in the digestive system. X-ray 9 clearly shows the shape of the stomach. X-rays 10 and 11 show movement of a meal through the intestines over a four hour period. The teacher may want to show the class these X-rays as a wrap-up or as a conclusion to the activity. The teacher can either show these X-rays on an overhead or make copies of the documents and give them to student groups. Students should observe the anatomy and discuss what they see over time and/or should write about what they see in their lab journals. The discussion or the writing sample could serve as an informal assessment for the project. More information about what is visible in the X-rays is provided in the booklet that comes with the X-ray set. Project 3.2.4The Royal Society of Chemistry site available at contains a nice review of enzyme structure and action and also includes an online quiz on enzyme action. Solution PreparationPurified catalase enzyme should be purchased from an appropriate vendor. The concentration of enzyme varies from 2000–5000 units/mg and depends on the bottle. For this project you will need to mix up a stock solution of 1000units/1ml of water. For a step-by-step video on how to do this, visit . Store the catalase powder as instructed. Enzyme activity may decrease from year to year, but it will remain viable for up to three years.For the preliminary experiment, students should use 1 drop of 200 units/ml catalase solution. If students are investigating enzyme concentration as an independent variable, make 100 units/mL, 1000 units/mL, and 2000 units/mL enzyme solutions available for student use.Hydrogen peroxide is typically supplied as a 3% solution. Dilute the solution with distilled water to begin the preliminary experiment with a 1.5% solution. If students are investigating substrate concentration, begin with 6% H2O2. Use additional solutions of 3% and 1.5%. In a student investigation of pH, 1.5% H2O2 was prepared by mixing equal volumes of 3% H2O2 and the appropriate buffer. Prepared buffer capsules in pH 4, pH 7, and pH 10 are available from Vernier. (see the optional section of the PLTW purchasing manual for details). Additional buffers can be added to the experiment if desired.You can also prepare pH buffers using the following recipes: pH 4: Add 2.0 mL of 0.1 M HCl to 1000 mL of 0.1 M potassium hydrogen phthalate.pH 7: Add 582 mL of 0.1 M NaOH to 1000 mL of 0.1 M potassium dihydrogen phosphate.pH 10: Add 214 mL of 0.1 M NaOH to 1000 mL of 0.05 M sodium bicarbonate.Store the solutions in capped containers at 4°C. Buffer solutions are stable for weeks at this temperature.Data CollectionIn the preliminary activity, students will collect basic catalase data using the Gas Pressure Sensor and Vernier LoggerPro software. Sample results are shown below:Student answers will vary. The value shown in the example graph above is 0.0771kPa/s. Student Experimental DesignHelp students generate researchable questions as they consider factors that may change the rate of enzyme action. Suggested questions are listed below. Example graphs/data are provided for each of these research questions. Student results will vary based on experimental design.How does temperature affect catalase activity?How does pH affect catalase activity?How does enzyme concentration affect catalase activity?How does hydrogen peroxide concentration affect catalase activity?Additional, more detailed research questions include:What is the optimal temperature for the catalase catalyzed decomposition of hydrogen peroxide?What is the optimal pH for the catalase catalyzed decomposition of hydrogen peroxide?How does boiling the catalase affect catalase activity?How effectively does ethanol (methanol, ascorbate, formate) inhibit the catalase catalyzed decomposition of hydrogen peroxide?The students must get your approval before actually setting up their experiments. Go over safety concerns, especially the hazards of working with acids and bases and the need for safety goggles. Before students are given permission to design their experiments, review the terms independent and dependent variables. Identifying the independent and dependent variable is useful to help the researcher pinpoint the variables involved in the experiment. The independent variable is the variable that is varied or manipulated by the researcher. The dependent variable is the measurable effect, outcome, or response in which the researcher is interested. In other words, the independent variable is the presumed cause, whereas the dependent variable is the presumed effect. In an experiment, the independent variable is the variable that is controlled and manipulated by the experimenter; the dependent variable is not manipulated but instead is observed or measured for variations as a presumed result of the variation in the independent variable. If you graph the results of the experiment, the dependent and independent variables are the axes on a graph:The Effect of Temperature on Catalase ActivityTable 1: Temperature EffectTemperature (?C)Mean rate (kPa/s)50.0586150.0805250.1003350.1469450.1202550.1026center000Figure 1 - The relationship between catalase activity and temperatureThese results address the question, “How does temperature affect catalase activity?” Multiple trials at water bath temperatures of 5, 15, 25, 35, 45, and 55?C were used. Typically, a maximum rate of catalase activity is obtained at a temperature near 35?C. See the Tips section for water bath setup suggestions.The Effect of pH on Catalase ActivityTable 2: The Effect of pHpHMean rate (kPa/s)40.077870.1118100.1033center000Figure 2 The relationship between catalase activity and pHThese results address the question, “How does pH affect catalase activity?” A procedure similar to that outlined in the student handout was used. For the pH values tested, catalase activity was lowest at pH 4 and highest at pH 7.A Closer Look at the Effect of pH on Catalase ActivityTable 3: A Closer Look at the Effect of pHpHCatalase Activity Rate (kPa/s)5.10.06546.10.08267.20.08598.10.07398.70.0726center889000Figure 3 A closer look at rate of catalase activity vs. pHThese results address the question, “What is the optimal pH for the catalase catalyzed decomposition of hydrogen peroxide?” Student should prepare buffer solutions at each pH level. They will continue to refine their results as they prepare more specific buffers. The Effect of Enzyme Concentration on Reaction RateTable 4: Effect of H2O2 ConcentrationVolume of Yeast Suspension(?L)Catalase Activity(kPa/s)500.04601000.07701500.11612000.1578center889000Figure 4 The relationship between reaction rate and yeast concentrationThese results address the question, “How does enzyme concentration affect catalase activity?” Data were collected at 22?C using the procedure outlined in the Preliminary Activity and varying the enzyme concentration as described in Table 4. Under the conditions specified, reaction rate was found to vary directly with enzyme concentration, as evidenced by the linear fit shown in Figure 4 with a correlation coefficient of 0.9979 and with the line passing near the origin.The Effect of Substrate Concentration on Reaction RateTable 5: Effect of H2O2 ConcentrationVolume3% H2O2(mL)VolumeWater(mL)PercentH2O2(%)H2O2Concentration(mol/L)CatalaseActivity(kPa/s)1.049.00.060.0180.00185.045.00.30.0880.027410.040.00.60.1760.043620.030.01.20.3520.080230.020.01.80.5280.084340.010.02.40.7040.086450.00.03.00.8800.0695center000Figure 5 The effect of substrate concentration expressed in percentThese results address the question, “How does hydrogen peroxide concentration affect catalase activity?” Data were collected at 22?C using the procedure outlined in the Preliminary Activity while varying H2O2 concentration as described in Table 5. As can be seen in Figure 5, a natural exponent curve fit matches the data well. The rate of the reaction initially increased rapidly, but then approached a constant rate as the substrate concentration increased. General Tips1.Many different organisms may be substituted as sources of catalase in this investigation. Beef liver and beef blood are often used. To prepare a beef liver suspension, homogenize 0.5 to 1.5?g of beef liver in 100?mL of cold water. You will need to test the suspension before use, as its activity varies greatly depending on its freshness. The color of the suspension will be a faint pink. Keep the suspension on ice until used in an investigation. 2.If micropipettes are not available, dropper pipettes can be substituted with number of drops of catalase suspension delivered being counted.3.High concentration combinations that produce high pressure increase rates should be avoided in this investigation. Higher concentrations can cause significant temperature increases and greater apparent deviation from expected results. Stoppers tend to pop out of 125 mL Erlenmeyer flasks at pressures above 130 kPa, and greater concentration combinations tend to exacerbate this problem. 4.The two-hole stopper used in this investigation is one of the stoppers that comes with the Gas Pressure Sensor. The stopper is fitted with two Luer lock connections. Your students will use the clear tubing, which also comes with the Gas Pressure Sensor, to connect the two-hole stopper to the sensor. Remind your students that a 1/2 to 3/4 turn of the Luer lock is sufficient to tighten the connection. Tightening down the Luer lock too much can damage the fittings. The valve connected to the second Luer lock connection stays closed during this investigation. 5.A magnetic stirrer is used in this investigation to ensure uniform mixing, and, more importantly, to expel oxygen from the liquid phase. 3952875358775006.The water added to the reaction mixtures serves as a heat sink for the very exothermic reaction. It also serves to reduce the volume of the gas phase in the flask, and thus increase pressure readings.7.A water bath is needed in investigations of the effect of temperature on reaction rate. A water bath, similar to the one shown in Figure 9, can be made using a 1 gallon plastic bottle. Cut the bottle off at a height of 9?cm. Common beakers do not work because they do not simultaneously provide sufficient volume and allow the utility clamp-held flask to reach the bottom. Another option is to buy small aquarium heaters and “beta” chambers to use as heating/cooling baths. This option will provide better control over temperature. Alternatively, students could use a Vernier temperature probe to track and monitor temperature. 8.Emphasize to your students the importance of providing an airtight fit with all plastic tubing connections and when twisting the stopper into a flask.9.Vernier Software and Technology sells a pH buffer package for preparing buffer solutions with pH values of 4, 7, and 10 (order code PHB). Simply add the capsule contents to 100 mL of distilled water. You can also prepare pH buffers using the following recipes: pH 4: Add 2.0 mL of 0.1 M HCl to 1000 mL of 0.1 M potassium hydrogen phthalate.pH 7: Add 582 mL of 0.1 M NaOH to 1000 mL of 0.1 M potassium dihydrogen phosphate.pH 10: Add 214 mL of 0.1 M NaOH to 1000 mL of 0.05 M sodium bicarbonate.Store the solutions in capped containers at 4°C. Buffer solutions are stable for weeks at this temperature.10. Commercial hydrogen peroxide, purchased at any supermarket, is used for this investigation. If it is refrigerated, bring it to room temperature before use. It is sold as a 3% H2O2 solution by weight. Assuming a 3.0% concentration and a density of 1.00 g/mL, the concentration of this H2O2 is 0.88 M. The molar concentration of diluted H2O2 solutions can be calculated using this formula:[H2O2] = 0.88 M X (% H2O2/3% H2O2)For example, 2% H2O2 = 0.88 M X (2/3) = 0.59 M H2O211.Prepare 0.1 M sodium phosphate buffer stock solutions, used to examine the effect of pH on catalase activity, as follows: Monobasic sodium phosphate: Add 13.80 g of NaH2PO4?H2O to distilled water to make a total of 1 L of solution.Dibasic sodium phosphate: Add 26.81 mL of Na2HPO4?7H2O to distilled water to make a total of 1 L of solution.Store the solutions in capped containers at 4°C. Buffer solutions are stable for weeks at this temperature.Mix monobasic and dibasic sodium phosphate buffer solutions to prepare sodium phosphate buffer solutions with various desired pH values in the pH 4.8–9.0 range. Store the solutions in capped containers at 4°C. Such buffer solutions are stable for weeks at this temperature.SafetyHydrogen peroxide, 3% solution: Oxidizer and skin irritant. Many substances will cause hydrogen peroxide to decompose into water and oxygen gas. It deserves the instructor’s special handling and storage attention. Hazard code: C—Somewhat hazardous.Hydrochloric acid, 0.1 M solution: Toxic by ingestion or inhalation; severely corrosive to eyes and skin. Hazard code: C—Somewhat hazardous.Sodium hydroxide, 0.1 M solution: Corrosive liquid; skin burns are possible; very dangerous to eyes; wear gloves. Hazard code: B—Hazardous.Activity 3.2.5In this activity, students will assume the role of a nutritionist or dietician and complete a diet and exercise assessment for a fictional patient. Students should read the client information on the Student Resource Sheet. This client report is only partially complete. As the students complete their assessment and compute BMI, BMR, and TDEE, they should fill in appropriate sections of the report. A final conclusion section and recommendation to the patient should also be included on the completed client report. Encourage students to work on their client report on the computer and type information in the bulleted sections. Client reports for three patients, Jeremy Brown, Trisha Knowles, and Hans Spielman, are available. Split the class so a third is working with each client. Jeremy is slightly overweight. Calculations will reveal that he will not gain a huge amount of weight over the next month if his current eating habits continue. However, Jeremy’s poor food choices, his moderately high cholesterol, and his family history of heart disease all impact the need for a modified nutrition and health plan. Trisha is not consuming enough calories a day to support her energy expenditure. She will continue to lose weight over the next month. Her BMI already classifies her as underweight. She makes some wise food choices, however, she will need to increase her overall caloric intake as well as add in some healthy carbohydrates to maintain a healthy weight. She also needs to watch her iron consumption as she is anemic. This patient provides a good talking point about the development of eating disorders. Trisha is not anorexic, but she does exhibit many of the behaviors that could lead to an eating disorder. Hans is consuming too many calories in a given day and he is not getting enough exercise. If he continues on his current eating pattern, he will continue to gain weight. He is an obese young man and he wants a nutritionist to help him design a plan to help him safely lose weight. Students will return to their Client Report in Unit 4, when they create their training plan for a specific individual. As part of the project, they will have to use these resources to design an eating plan for their athlete. In 2011, the USDA refocused healthy eating from the food pyramid to the food plate . As an optional extension, consider holding a classroom discussion on the possible reasons for the switch and the pros and cons of using each system. As an optional extension, students can compile data as if they were their own client and compute their own BMI, BMR, and TDEE. If you choose to run this extension, students should complete a two to three day food log before beginning this project. Students should record the foods they eat, along with a calorie count. Provide appropriate websites if students do not know the amount of calories in specific food item. The United States Department of Agriculture computerized database found at offers a feature called Super Tracker that allows students to assess their own food intake and generate a daily report on calories, macromolecules, and vitamins consumed in the diet. Ask students to think realistically about their activity level during the day. This data will be vital when calculating BMR as well as estimating activity level to adjust the Harris-Benedict Equation. Encourage sensitivity in a discussion of weight. Make sure students keep personal information private and do not hold classroom discussions that may make overweight or underweight students feel like they are in the spotlight. Activity 3.2.6This activity serves as an introduction to the structure and function of ATP. You do NOT need to cover the process of cellular respiration in detail. In Unit 4, students will look deeper into the process of cellular respiration as they discuss energy supplies for the body during exercise and the difference between aerobic and anaerobic respiration. In this activity, you will informally assess students on their knowledge of ATP formation and breakdown through the use of the CellZone Molecular Puzzles kit. Prepackage small kits for the students in advance or place materials at a workstation in an area of the classroom. Each kit should include a ribose sugar, an adenine nucleotide, 2 phosphate groups, and 4 hydrogen and 4 oxygen. If you place materials at a workstation, do not worry about packaging kits. Just have the pieces out and available for the students to use. Completed puzzles are shown in the Activity 3.2.6 Answer Key available in the curriculum. Students should use their models to demonstrate how ATP is assembled and broken down to release energy. They should also demonstrate the role of water in these processes and be able to explain hydrolysis and dehydration. If you have purchased more than one of the Molecular Puzzles kits, you can assemble puzzle packs for each group. However, with one kit, there are only enough materials for 3 groups to assemble ATP at one time. By placing the build at the end of the research, you can stagger when groups need the materials. Lesson 3Activity 3.3.1In this activity, it is important for students to make the connections between the need for oxygen and the production of ATP by the process of oxidative respiration in the cells. If desired, spend a bit of time talking to the students about the process of cellular respiration and the production of ATP. Students have been introduced to the molecule, but they have not gone into detail about the production. In this activity, students will be introduced to a young girl, Melissa Martin, who is having trouble breathing. They will analyze her medical history to determine a possible diagnosis. Melissa’s symptoms indicate a high probability of asthma. She has a recurrent cough and has a wheeze often triggered by exercise, that is worse at night and flares up after viral infections. Student should also note that Melissa’s pulse oximetry data, which measures oxygen saturation in the blood, is slightly lower than normal. Normal values typically range from 95-99%. Encourage all student theories, but provide guidance to lead them closer to asthma. Additional tests should be completed to confirm the diagnosis. After students make an initial diagnosis for Melissa, they will explore lung structure and function. If desired, provide a quick demonstration of the inflation of the lungs. Show the YouTube video showing the inflation of a dissected cow’s lungs, accessible at or alternatively, purchase the inflatable lung kit described in the Purchasing Manual and allow student groups to inflate the reusable preserved specimens. If you have access to fresh lungs from a slaughter house or butcher’s shop, it would be helpful to have a class demonstration of lung anatomy. Be sure to ask the butcher for the heart, thorax, and lungs as a single piece. Then you can show the intimate relationship between the heart and the lungs, and you may be able to inflate the lungs with air or water using a straw inserted and sealed into the thorax. An extension of this activity is to have students view histology slides of lung tissues including the bronchioles and alveoli.The final steps of Part II will ask students to link what is happening in the lungs of an asthmatic to what is happening in the lungs of someone without breathing complications. Asthmatics often have swollen airways, which impairs normal ventilation. During a flare-up, this swelling gets worse, excess mucus is produced, and the muscles in the airways constrict, further restricting breathing. After an investigation of lung anatomy, students return to Melissa’s case and analyze peak flow data for their patient. Students will observe a graph of her values over one week and pair this information with a description of anything in her day that may have impacted her breathing. Students should begin to see a pattern of breathing issues related to exercise, weather, and stress. Additional information about a peak flow meter is available at the American Academy of Allergy Asthma and Immunology site . A simple Mayo Clinic video of how to use a peak flow meter is available at . A peak flow chart helps with a diagnosis but does not confirm asthma. Often the response to a bronchodilator is more indicative of a clinical diagnosis. Spirometry can be used to gain information about the condition, but it is important to remember that normal spriometry does not exclude asthma. An answer key is provided for the Activity 3.3.1 Medical History – Visit #2 Resource Sheet.Activity 3.3.2Open the lesson by discussing Melissa’s possible asthma. Consider opening the class with the video “Asthma on the Run” available at . This video provides a nice visual to how spirometry can be used to look at lung function, particularly in asthmatics. There is also a simple dissection of a lung sample that clearly shows the respiratory system anatomy. Please note that the images are graphic as the specimen is a fresh lung sample. Preview the video before you show it to your class and decide whether or not to show this part of the 13 minute video. This video also begins a discussion of drug treatment of asthma. This activity has students measuring lung capacity using a spirometer. It is strongly recommended that each student has his or her own bacterial filter and mouth piece. These supplies are available from Vernier Software and Technology. The simple animation shows the basic lung volumes tested in the spirometry experiment The activity will be completed using Vernier Logger Pro software. If you are using LabVIEW, please locate the LabVIEW version of the activity in the files in the curriculum.If a student has asthma, a cold, flu, or other respiratory ailment, do not allow him or her to use the spirometer. Instead, allow that student to use the data collected from a classmate to complete the calculations and to answer the questions. The spirometer filter that we use is manufactured by Microgard. It is designed to capture 99% of all aerosolized bacterial and viral pathogens. It is the same type of filter used in hospitals by respiratory technicians. If you are concerned about the spreading of pathogens, refer the section of the probe booklet that discusses cleaning/sterilizing the spirometer flow head. The information is also listed below. The manufacturer recommends three methods, in the following order, with which to sterilize the Flow Head. Wash the detachable Flow Head in a dishwasher. It is dishwasher safe. This method provides the longest life for the Flow Head and is the method most recommended by the manufacturer. Cold sterilize the Flow Head with a surface disinfectant such as Cidex? or Technical Tincture of Green Soap?. These are available from medical supply or janitorial supply companies. Autoclave the Flow Head. This method provides the shortest life span for the Flow Head. It is recommended that you sterilize the Flow Head using one of these methods after each school day, at the very least, and that you always use the Spirometer with a disposable mouthpiece. The nose clips should be wiped clean between uses and soaked in a mild detergent after each experiment.It is important that the spirometer is held steady and perpendicular to the floor. If it is tilted, the data collected will be affected. Keep the spirometer steady as the sensor is being zeroed and during data collection. Demonstrate for the students the proper way to hold and calibrate the spirometer. Also show them how to use the standardization tools in the analysis graph so the readings collected before the first inhalation are deleted and the normal exhalation values remain near zero or the baseline.Students should place their lips around the mouthpiece in a natural position. There is no need to tightly seal the lips around the tube (and this actually makes capturing the breaths quite difficult). If the student is seeing a graph that is less than ideal, suggest that he or she experiment with mouth placement. The Spirometer should produce decent results for classic tests of Lung Function. It is intended for qualitative data rather than quantitative measurements of lung volume and function. It may or may not be appropriate for exercise physiology. ? Lung capacities differ between individuals. Generally, a larger person will have a larger lung capacity; hence males generally have larger capacities than females. Also, someone who has conditioned his or her muscles for breathing more deeply will have a larger capacity, especially if he or she knows how to effectively use the abdominal muscles to increase the amount of air drawn into the lungs. This muscle conditioning is very common with singers, wind instrument musicians, and athletes. The following table displays the expected range of volume measurements for each data point:Volume Measurement (L)Expected Range (L)Tidal Volume (TV)0.4 – 0.5Inspiratory Reserve (IRV)2.5 – 3.5Expiratory Reserve (ERV)1.0 – 2.0Vital Capacity (VC)4.5 – 6.0Residual Volume (RV)1.5*Total Lung Capacity (TLC)5.0 – 7.0*Residual volume cannot be measured – a volume of 1.5L is provided for the purposes of this activity Provide data on expected lung volumes to the class or project the table on the board to help students determine if they are computing volumes correctly. Remind the class that there will be variation from student to student. The class should compute class averages for each volume measurement (broken down by gender) and discuss differences. On average, male lungs are larger than female lungs, even when controlling for height. Students should note that although Melissa spirometry results show lung capacities in the normal range, her Forced Expiratory Volume (FEV1) correlates to mild lung obstruction. This value converted to the normal range after the use of a bronchodilator, indicating a reversible condition such as asthma. Melissa also noted that she saw a marked reduction in symptoms during an incident of wheezing and shortness of breath when she used the inhaler she was provided. There is now sufficient evidence to make a diagnosis of asthma. Activity 3.3.3In this activity, students are introduced to basic pharmacology and discuss the designations on prescriptions. They will also begin to look at how medications work in the body to treat or manage disease. Begin by presenting the Pharmacology Basics presentation or allowing students to work through the presentation on their own. Note that they will need a copy of the Commonly Used Abbreviations Resource Sheet to analyze the prescription on the last slide of the show. This prescription is for Diovan, a blood pressure medication. The pharmacist should dispense 90 pills and the patient should take 1 every day by mouth – therefore this is a 3 month supply. Hold a discussion about medications that the students have been prescribed, discuss what it means to have side effects, as well as how the medications prescribed to Melissa Martin might treat and control her condition. Note that Melissa was prescribed two medications – one “rescue medication” to be used on the spot during flare-ups as well as a long term control medication. Albuterol is a short acting “rescue medication” used to treat asthma. It is in a class of medications called Beta2-adrenergic agonists. These medications produce bronchodilation by relaxing the muscles of the airways. This effect decreases airway resistance, facilitates the drainage of excess mucus, and increases overall vital capacity. Zafirlukast is a long-term control medication used for asthma. It is in a class of medications called leukotriene receptor antagonists (LTRAs). This class of medication works by blocking the action of certain natural substances called leukotrienes, that cause swelling and tightening of the airways, along with an increase of edema and mucus in the bronchioles. Blocking the receptors to these substances effectively blocks the tissue’s inflammatory response. If desired, students can be asked to show how these medications work, referencing the Respiratory System Graphic Organizer they completed in Activity 3.3.1. This can also be a task of the respiratory therapist in Activity 3.3.4 – to demonstrate to Melissa how exactly the two medications she has been prescribed affect her respiratory system. Activity 3.3.4In this career activity, students are asked to write a resume for a respiratory therapist. You can spend some time in class formally training the students on how to write an effective resume or you can allow the students to explore the examples and tutorials on the Purdue University – Online Writing Lab site site offers a very concise PowerPoint presentation on creating a simple resume. Students can view this presentation at their desks or you may want to review the presentation with the entire class.Discuss lung conditions that may warrant a visit to a respiratory therapist such as asthma, emphysema, COPD, or cystic fibrosis. Relate these conditions to the other body systems that are affected. Consider holding a discussion of how environmental toxins, such as pollution or cigarette smoke, can contribute to lung disorders and outline steps people can take to reduce pollution and the release of potentially hazardous contaminants to the atmosphere. Discuss how a “green lifestyle” or “green technology” can help safeguard the health of the public. By this point, students should be comfortable finding information about biomedical careers. Remind students of the National Institute of Health’s LifeWorks site for career information found at , but encourage them to synthesize information from a variety of sources. As an extension to this activity, you could ask each student to reflect on their own career aspirations and create a personal resume. You may want to work with the English department in your school to further explore this interdisciplinary project. Students should use all of the Medical History documents they have worked with in this lesson, to complete the asthma action plan for Melissa Martin. Hold a discussion about why Melissa might not have been compliant with her treatment as well as the consequences for poorly controlled asthma. Students should research additional steps Melissa could take to better control her disease and add additional recommendations to the final Medical History document. Lesson 4Activity 3.4.1Students will construct the kidney, ureter, bladder and urethra using clay. Dried kidney beans make great kidneys. Consider distributing these to the class. Also, the bladder may be hard to suspend from the ureters. Students may set the bladder on the pelvic floor, but remind them that this is not the case in human anatomy. Make sure that the urethra runs behind the pubic symphysis. Students may erroneously build this structure in the front. Care must be taken when building this system if the digestive system is already assembled on the maniken. As the students build their urinary system, make sure that the students understand that (especially in women) this system is independent of the reproductive system. Activity 3.4.2In this activity, students will learn the general structure of the kidney and begin to think about how urine is formed. Stress that the map they create be a simple representation of what they see in their dissected kidney. With one continuous arrow, they should show a simple path of blood/urine through the kidney. In the next activity, students will take a more detailed look at filtration at the nephron and study the way in which water, ions and wastes move in and out of the blood.Students can either label all of the structures listed on one side of the kidney, or they can split the labels up among both halves. If you decide to split the labeling, provide a list of which structures you would like to see identified on each half. There is a simple diagram of the kidney and the nephron on the “How Stuff Works” site, . If you find that students are having a tough time locating sufficient resources, you may want to suggest they begin at this site. There is also a 21 slide animation located at the Sumanas, Inc. – Science in Focus site that may help students with Activity 3.4.2 and Activity 3.4.3.Pig kidneys are similar in size to human kidneys. If you are ordering preserved kidneys, order specimens that have NOT been injected with latex dyes. The colors often confuse the students and they misinterpret the latex for items found in the kidney. However, you may want to order one that has been injected for demonstration purposes. As a class, students can observe the path of blood and urine in the organ.The Human X-ray Print Set includes a great shot of the urinary system. X-ray #12 clearly shows the pelvis of each kidney. In the kidney on the right, five of the minor calyces can be seen each forming a cup around the point where urine is excreted from the kidney. The pathway of the ureters can easily be followed from the kidneys to the urine filled bladder. The teacher can either show this X-ray on an overhead or make copies of the picture and give it to student groups. Students can observe the anatomy, discuss what they see and/or write about what they see in their lab journals. The discussion or the writing sample could serve as an informal assessment for the activity. More information about what is visible in the X-rays is provided in the booklet that comes with the X-ray set. Project 3.4.3Engagement ActivityA great way to get the students interested in the idea of water balance is to begin with a simple demonstration on volumes in the human body. Prior to class, fill four beakers with the following volumes of water.1200 mL125 mL1 mL1500mLOn the board or overhead, write the following situations and ask the students to make an educated guess about which volume represents each situation.the volume of blood passing through both kidneys in one minutethe amount of glomerular filtrate that is produced by both kidneys in one minutethe volume of urine that is produced by both kidneys in one minutethe volume of urine produced by an average adult in one dayThe teacher may need to provide the students with a simple definition of glomerular filtrate as they have most likely have never heard of this term. The water, waste products, salt, glucose, and other chemicals that have been filtered out of the blood at the glomerulus are known collectively as glomerular filtrate. The glomerular filtrate consists primarily of water, excess salts (primarily Na+ and K+), glucose, and urea. Encourage students to talk out their reasoning as well as write down their predictions in their lab journal. Once the class has generated their responses, add food coloring to the beakers, but do not say anything just yet. Allow the students to link the colors with the correct answers. 1200 mL – pink colored water = volume of blood125 mL – clear water = glomerular filtrate1 mL – yellow water = volume of urine (1 minute)1500mL – yellow water = volume of urine (1 day)Answer any questions or correct any misconceptions. Have the students think about how much blood goes through the kidneys in one minute and compare this to the amount of urine that is produced in the same time period. This demonstration gives the students a visual of what is occurring in the urinary system and will hopefully generate some discussion and enthusiasm that will lead into Part I of Activity 3.4.3In this project, students will diagram a nephron that shows a distinction between vessels containing blood and tubules containing the filtrate that will become urine. A helpful diagram of the nephron is provided on Project 3.4.3 Student Resource Sheet and should be distributed to the students. The diagram was used with permission of Life Sciences on File?. As this diagram only provides a starting point, students will have to research how substances move in and out of the tubules of the nephron. Glucose is reabsorbed back into the blood at the proximal convoluted tubule. Water is reabsorbed at both the descending loop of Henle and in the collecting duct and selected ions are reabsorbed in the ascending loop of Henle. Ammonia is secreted into the filtrate at the distal convoluted tubule. The teachers should help students see how what happens at the nephron directly influences the composition of urine and of the blood. Students need to understand what should be in urine before they can understand what should NOT be in urine. In the next activity, students will analyze urine and relate the composition of this waste to potential problems in other body systems. In the project, students are directed to complete their work directly on the Student Resource Sheet. If you have time, consider having the students create 3-D posters of the work. Provide each group with a half sheet of poster board. Follow the directions below to complete the model. All directions from Step 6 on in the project document would still apply. Students would simply complete their arrows and labeling on the poster board model rather than on the paper diagram. With your partner, discuss how to build the nephron. The nephron must be at least 35 cm in height and 15 cm in width and should be placed on a ? sheet of white poster board.Imagine how the 3-D structure of the nephron would appear. For example, the Bowman’s capsule is a cup-like chamber containing the glomerulus. The filtrate that occurs due to high pressure in the glomerulus empties into the Bowman’s capsule and drains into the proximal convoluted tubule. Form the nephron utilizing red clay to show all vessels containing blood and the yellow clay to form all tubules that would contain filtrate or urine. 0000If completed on poster board, students may wish to transfer information from their final product to their lab journal. They can complete sketches or even take a picture of their final poster. Alternatively, the teacher could ask students to complete this project on 8 ? x 11 pieces of paper. The final product could then be added to the student notebooks. However, a smaller version without the clay loses the dynamic nature of the project. Activity 3.4.4 In the lesson, students will add two endocrine glands to their Maniken?. The release of antidiuretic hormone (ADH) is controlled by the hypothalamus and the pituitary gland. ADH increases the permeability of the distal convoluted tubule and the collecting tubules to water. More water is directly reabsorbed back into the blood. Students can add the pituitary (in a new color) to the brain of their Maniken?. They may have already added the pituitary gland in Activity 3.3.2. Aldosterone is released by the adrenal glands. Aldosterone increases the reabsorption of sodium- thus more water is retained to dilute this ion. Students can create an adrenal gland that sits on the top of their kidney. Use each endocrine system/gland activity to review hormone action and to help build the student’s knowledge of this system. Stress the important role hormones play in maintaining and controlling specific functions in the body. Show connections between systems and between the function of each hormone. Activity 3.4.5Now that students have looked at how the kidney functions and at the composition of urine, they will be introduced to the way in which properties of urine relate to disease and overall health. This activity will serve as an introduction to diagnostics as a medical intervention. Students will explore many more diagnostics tests in the Medical Intervention course; however, given students’ knowledge of the kidney, this is a great place for them to start seeing the connection between function and dysfunction. Resources for this activity are found in the Wards Simulating Urinalysis Lab Activity kit. This kit includes four simulated urine samples (labeled Patient 1-4). The teacher should buy an extra bottle of normal simulated urine as it will be used in more than one case and for the control sample. In the lab kit, the normal urine sample is from Patient #4. Additional replacement bottles of simulated urine can be purchased through Ward’s Natural Science. Prepare urine samples for each of the six case studies. Specific directions are provided below. Urine for some of the case studies will come directly from the kit samples. Urine for the rest of the case studies will need to be altered to fit the scenario. Each lab station should be equipped with four labeled simulated urine samples in plastic cups (approximately 20mL per sample), one cup of control urine, test strips, paper towels, plastic 1mL pipettes, microscope slides and cover slips, and a microscope. A quick reference chart for sample preparation is shown after the full case descriptions. Case Study #140-year-old overweight pregnant woman comes in for her a routine appointment. She is 28 weeks pregnant and complaining that she is constantly thirsty and that she spends all of her time running to the bathroom. She has been feeling more lethargic than normal lately and she has lost some weight.The urine sample is simulated urine with glucose. This urine can come directly from the bottle labeled Patient #1. The woman has gestational diabetes. Urinalysis should reveal increased specific gravity (due to the presence of glucose), and a high level of glucose. Microscopic analysis should not show anything abnormal. Case Study #2An 18-year-old male comes in for his annual physical. He is a cross country runner who is currently training to run a marathon. He feels healthy and energized and has no complaints about his health. In fact, he just finished a rather strenuous training session.The urine sample is normal, simulated urine (Patient #4) mixed with a small amount of the simulated urine with proteins (Patient #2).This young man is healthy, but is pushing his body to the limit. Chemical tests should all be normal except for a small amount of proteins in the urine (from excessive exercising). Microscopic analysis should not show anything abnormal. Case Study #3A 23-year-old female comes in for an emergency appointment. She complains of a strong, persistent desire to urinate, a burning sensation during urination, lower back pain and, a low-grade fever.The urine sample contains white blood cells and crystals and should be cloudy. This urine can come directly from the bottle labeled Patient #3. The woman has a Urinary Tract Infection (UTI). Macroscopic analysis should reveal cloudy urine with some blood cells. Microscopic analysis should reveal the presence of leukocytes and crystals. NOTE: Blood and a small amount of proteins may also be found in the urine. If the teacher would like to simulate this effect, add a small amount of urine from Patient #2 to the final sample. Case Study #4A 15-year-old female comes in for her annual physical. Her mom informs you that she is worried because the girl has been on a strict diet and has lost a great deal of weight in the past few months. She has very little energy and does not seem interested in hanging out with her friends. The girl mentions that she has been losing some hair lately and she has not menstruated over three months.The urine sample is simulated urine with ketones. The urine sample used should be composed of the normal simulated urine (Patient #4) mixed with a small amount of glycine and water. Also add a drop or two of acetone for smell. Test the presence of ketones with a test strip. The woman is experiencing ketoacidosis secondary to anorexia nervosa. Urinalysis should reveal high level of ketones and low pH. Microscopic analysis should not show anything abnormal. Case Study #5A 9-year-old male is brought in by his mother because he is complaining of constant thirst and frequent urination. The problem is so bad that the boy is having trouble sleeping because he is constantly getting up to use the bathroom. A few times, he has even wet the bed. The mother suspects that something may be wrong with his pituitary gland as there is a family history of pituitary problems. The urine sample is a mix of normal simulated urine (Patient #4) and distilled water to give the urine a very dilute appearance and low specific gravity. The young man has diabetes insipidus caused by a problem with his pituitary gland. The urine of a person with diabetes insipidus is less concentrated than normal urine as the amount of water that is being excreted is high. Diabetes insipidus should not be confused with diabetes mellitus. Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH) or the insensitivity of the kidney to this hormone and results in the excretion of large amount of dilute urine. Diabetes mellitus involves maintenance of blood sugar and the action of insulin. Case Study #6A 60 year-old woman comes in for her annual physical. Even though she usually has a lot of energy, she has been unusually tired for the past few weeks. She occasionally feels dizzy and she is finding it harder to sleep through the night. Her ankles and feet are swollen and her face looks a bit puffy. She frequently feels a burning pain in her lower back, just below the rib cage. She has noticed that her urine is darker in color lately. Preliminary workup shows she has elevated blood pressure.The urine sample should contain high levels of proteins and some red blood cells. This urine should come directly from the bottle labeled Patient #2. Consider adding additional proteins to the sample. Albumin works nicely.The woman displays symptoms of chronic kidney failure. A person with kidney failure may have dark urine displaying excessive proteins along with red blood cell casts. Sample Preparation Quick Reference:Prepare approximately 50-100mL of each urine sample - depending on your class size and how many students will be testing each case. Case Study #1 – Patient #1 urine (urine with glucose)Case Study #2 – Patient #4 urine mixed with a small amount of urine from Patient #2 (urine with low concentration of proteins). Urine from Patient #2 should constitute approximately 10% of the total volume you are preparing. Case Study #3 – Patient #3 urine (cloudy urine with white blood cells and crystals)Case Study #4 – Patient #4 urine mixed with acetone (urine with ketones). Add acetone to the total volume you are preparing until you see a change on the urine test strips. If the urine becomes too light in color, consider altering the color with yellow food coloring. Case Study #5 – Patient #4 urine diluted with water (normal dilute urine)Case Study #6 – Patient #2 urine (urine with proteins and red blood cells)Control Urine – Patient #4 urine or additional normal urine purchased from WardsThe Wards kit comes with both Benedict’s solution (to test for glucose) and Biuret solution (to test for proteins). These reagents are NOT required in the urinalysis case studies. In this activity, students will test for protein and glucose, as well as pH, specific gravity and the presence of ketones using test strips. For ease sake, all chemical tests in this activity will be completed using one test strip per sample. Save unused Benedict’s and Biuret solution for use in PBS. The teacher should only buy the replacement urine kit in subsequent years. Students will not complete microscopic analysis of the urine. Blood cells and crystals are difficult to locate in the urine samples provided with the kit. If you choose to have the students look at the urine under a microscope, consider adding simulated red blood cells from the Blood Typing kit used in Activity 5.3.2 to any of the samples that are supposed to test positive for these cells. Another option is for you to focus a few microscopes on red or white blood cells or crystals in the urine before class. Students could then rotate around the microscopes to observe each potential finding. In the laboratory, medical technologists would first centrifuge the urine to concentrate any cells before looking at the sample under a microscope. Consider bringing this up as a discussion point as students complete the activity and explore a career as a medical technologist. Demonstrate each of the tests the students will complete. Students should refer back to the Urinalysis computer presentation if they have questions about their test results. The teacher should make sure that a copy of this presentation is on each student computer. The teacher should help the students research their findings along with the symptom information provided in each case. Provide some helpful hints for phrases they can put into a search engine if they are having trouble. Case Study 1: pregnant + “glucose in urine”Case Study 2: “strenuous exercise” + proteinuriaCase Study 3: bacteria and blood + urinalysisCase Study 4: ketones in urine + "extreme weight loss" + amenorrheaCase Study 5: “Excessive urination” + “pituitary disorder”Case Study 6: proteinuria + back painStress to student groups that the final computer presentation should clearly show how urinalysis data combined with patient history and symptoms led to the diagnosis. Students should describe the disease or disorder as well as talk about how this disorder affects human body systems other than the urinary system. The teacher should stress that clues in the urine can tell a story about dysfunction in other parts of the body. Additional information on urinalysis can be found on WedMD at and at the American Association for Clinical Chemistry’s Lab Tests Online site at . The urinalysis color test chart that is supplied with the test strips is shown below. As there is only one key provided with each bottle of test strips, consider printing out the following diagram in color and placing laminated copies at each lab station. URINALYSIS TEST STRIP KEY: ................
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