Model Instruction Plan



Lesson Plan | |

|Course Title: Health Science Technology I |

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|Session Title: Measuring Intake and Output |

|Lesson Duration: 2 90 minute class periods |

|Timeline of Instructional Sequence: |

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|Day 1: 10 min.-Introduction to Intake and Output |

|25 min.- Presentation using lecture, white board and overhead projector to inform |

|students about fluid balance and imbalance and how it is monitored. |

|25 min.- Introduce I&O chart using overhead and do whole group practice to fill in the |

|first column on the chart. |

|30 min.- Students will work individually or in small groups of 2-3 to complete the rest of |

|the I&O chart. Teacher will circulate around the room to check for accuracy |

|and to insure that the students understand the lesson. |

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|Day 2: 10 min. - Quick review of I&O. |

|15 min. - Allow student to finish I&O charts. |

|40 min.- Students will be given another I&O chart and directed to proceed to each of |

|the stations in the lab area and use the information to complete the chart. |

|Student will do this activity in pairs. |

|20 min.- Students will exchange first chart with another student and the teacher will |

|provide the correct answers on a chart using the overhead projector. Students |

|mark any incorrect answers. Charts from the lab portion will be turned into the |

|instructor for grading. |

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|Performance Objective: |

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|Upon completion of this lesson, the student will be able to describe the importance of maintaining fluid balance as it is relates to a |

|patients health and wellness. The student will also be able to accurately measure and record a patient’s fluid intake and output from a |

|variety of sources using equipment and charts similar to those used at various medical facilities. |

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|Specific Objectives: The student will be able to: |

|Objective 1: define fluid balance and imbalance |

|Objective 2: differentiate between dehydration and edema. |

|Objective 3: chart the fluid intake and output in the appropriate category. |

|Objective 4: convert ounces to cubic centimeters using the proper equation. |

|Objective 5: measure fluids using a variety of techniques and tools. |

|Objective 6: define various medical terms used to describe body fluids. |

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|Preparation |

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|1.TEKS Correlations: |

|Health Science Technology I |

|121.3A,B,C; 12A,B,C,F; 13A |

|(3) The student documents and archives client records. |

|The student is expected to: |

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|(A) review the structure and composition of client |

|records; |

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|(B) compile and record client data; and |

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|(C) demonstrate the ability to chart and graph. |

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|12)The student knows the technology utilized in the |

|diagnostic, therapeutic, informational, and |

|environmental systems. The student is expected to: |

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|(A) identify equipment utilized in each of the |

|four systems; |

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|(B) utilize appropriate equipment in the delivery |

|of health care services; |

|(F) Knowledge and skills. |

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|(1) The student applies math, science, English language |

|arts and social studies in health science. The |

|student is expected to: |

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|(A) convert units between systems of measurements; |

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|(B) use measurement functions for client |

|assessment; |

|(F) describe biological and chemical processes |

|that maintain homeostasis; |

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|(13)The student demonstrates multi-competent health |

|care worker knowledge and skills. The student is |

|expected to: |

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|(A) assess client status and accurately determine |

|vital signs; |

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|Interdisciplinary Correlations: |

|TEKS: Algebra I 111.32. b1A; b4B; |

|b) Foundations for functions: knowledge and skills and performance descriptions. |

|(1) The student understands that a function represents a dependence of one quantity on another and can be described in a variety of ways. |

|Following are performance descriptions. |

|(A) The student describes independent and dependent quantities in functional relationships. |

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|(4) The student understands the importance of the skills required to manipulate symbols in order to solve problems and uses the necessary |

|algebraic skills required to simplify algebraic expressions and solve equations and inequalities in problem situations. Following are |

|performance descriptions. |

|(B) The student uses the commutative, associative, and distributive properties to simplify algebraic expressions. |

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|Instructor/Trainer: Donna Skates |

|References: Texas HSTE Curriculum web site |

|I& O charts from hospital rotation sites |

|Webster’s Medical Dictionary |

|Instructional Aids: I&O chart on overhead transparency |

|I&O worksheet (Attachment A) |

|I&O charts for class completion (Attachment B) |

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|Materials Needed: IV bag; bedpan; urinal; orange juice glass; milk glass; soup bowl; emesis basin; foley catheter bag; food coloring; urine |

|cup; ice cubes; |

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|Equipment Needed: calculators |

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|Learner: HST I student |

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|Introduction |

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|Introduction : |

|Can any on tell me what fluid balance might be and why it is important in the human body? |

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|Imagine your 2- year old sister has been ill for two days with diarrhea and vomiting. She becomes very lethargic and has a high temperature. |

|Your mother takes her to the hospital emergency room where they begin IV therapy with D5/NS and medication to control the vomiting and |

|diarrhea. Within just a couple of hours her fever has dropped and she is again full of energy. What happened? How could this happen so fast? |

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|For the next two class periods we will be discussing the causes of both dehydration and edema. You will be able to tell me in detail why your |

|little sister got so sick. |

|As medical professionals, we all need to know a great deal about fluid balance and imbalance. To care for our patients we have to know how to |

|monitor and accurately measure the various fluids that go in and out of a patient. In this lesson, we will explore the causes of fluid |

|imbalance and how it is monitored. You will learn how to record the intake and output of your patients. We will also be learning how to |

|accurately measure the different body fluids that you may encounter during your hospital rotations. |

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|Learning Style: Auditory |

|Outline |

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|1. Fluid Balance |Learning Style: Auditory, Visual and |

|A. Homeostasis |Psychological. |

|1. define and discuss importance to good health |This first part of the lesson uses auditory |

| |and visual learning modalities. There are |

| |several questions being asked and places for |

| |class discussion to bring in the interactive |

| |mode to the lesson. |

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|2. Fluid Imbalance |1. Notes for Objective 1 |

|A. Define imbalance |Have student think about how they feel when |

|I. Dehydration |they get too thirsty or have exercised too |

|Causes |vigorously? What makes |

|Diarrhea |them feel better? Why? |

|Vomiting | |

|Bleeding | |

|Excessive perspiration (diaphoresis) | |

|Poor fluid intake |Notes for Objective 2. |

|Symptoms | |

|Fever is present. |Have students give ideas on what they think |

|There is a decrease in urine. |the causes of dehydration might be. How |

|Urine is concentrated. |rapidly can it occur for any person? Is there|

|Weight loss occurs. |a particular group or groups that might be |

|Membranes are dry and it is difficult to swallow. |more susceptible to dehydration? |

|Tongue is coated and thickened. | |

|Skin becomes hard and cracks and is dry and warm | |

|II. Edema | |

|A. Causes |Briefly give examples and discuss why the |

|High salt intake |different symptoms occur during dehydration. |

|Infections |Have them think of any personal experiences |

|Injuries or burns |they may have had with dehydration either |

|Certain kidney diseases |through illness or perhaps heat and exercise |

|Certain heart diseases or heart inefficiencies |in the summer. |

|Sitting too long in one position | |

|Infiltration of IV fluid | |

|Symptoms | |

|Decrease in urine output | |

|Gain in weight | |

|Puffiness or swelling |Discuss why some of these things cause edema.|

|Sometimes shortness of breath | |

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| |Give students examples of edema that they may|

| |have seen, such as an elderly relative with |

| |swollen feet. |

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| |Relate hospital experience of how sometime |

| |patients that are overloaded will literally |

| |leak fluid through their skin. |

| |Give examples of why these things happen and |

| |how doctors attempt to correct them with |

| |medication. Discuss shortness of breath due |

| |to fluid in the lungs and how it is drained |

| |out. |

| |Learning style: Kinesthetic, Visual and |

|3.Show example of I&O chart on overhead |Emotional. |

|A. Describe methods used to fill out chart |The charts provide the students with hands-on|

|1. define terms on chart |interaction. The student also has to stay on |

|2. explain how IV fluids are measured |task to complete the activity. |

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|Practice filling in one row as a group |3. Notes for Objective 3 |

|C. Have the students complete the chart. This |Do the first column of the chart together as |

|should be done as an individual task, not in a |a class. Make sure different students provide|

|group. |answers to each item. |

| |Learning Style: Visual |

|4. Demonstrate equation to convert ounces to cubic centimeters (cc). |4. Notes for Objective 4 |

|30 X (number of ounces) = number of cc’s |Show students several examples of this |

| |equation and work them together as a group. |

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| |Learning style: Kinesthetic, Sociological |

| |and Physiological |

|5. Have students, working in pairs, measure various labeled body fluids as they fill out a |Sections 5 allows for a great deal of |

|second chart. |hands-on learning by the students. The small |

| |group interactions allow them to talk about |

| |what is happening to reinforce the learning. |

| |They have a great deal of mobility during |

| |this section as well. |

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| |5. Notes for Objective 5 |

| |Skills lab: provide a variety of “fluids“for |

| |students to measure and record. |

| |Learning Style: Print and psychological |

|6. Define any and all medical terms students are not |The student will have to use research sources|

|familiar to students. |available to them and find the information. |

| |6. Notes for Objective 6. |

| |Some of the terms might be edema, IV, |

| |infiltration. Have students ask about those |

| |they don’t know. Have students use their |

| |Medical dictionaries to research the terms |

| |and share them with the class. |

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|Application |

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|Guided Practice : |

|Complete one column of the Intake and output record as a group using the overhead projector. |

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|Independent Practice : |

|Have each student complete the Intake and Output Practice worksheets. |

|Set up a lab area with different examples of intake and output fluids. Have students, in pairs, rotate through the lab area and record the |

|various fluids on a second I&O record chart. |

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|Summary |

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|Review : |

|Briefly review fluid balance and imbalance. Define dehydration and edema. |

|As a group, review the charts the students completed. |

|Discuss how the patient in the case study may be affected by the intake or output of the various body fluids. Ask the students, is the patient|

|in the case study dehydrated or suffering from edema? How did they reach their conclusion? |

|Emphasize the importance of good record keeping. Ask students, what could have happened to this patient if the volumes had been incorrectly |

|recorded? Have them give examples of mistakes that could be made. Can the students identify whether the patient will be dehydrated or |

|edematous depending on the error that is made? |

|Have students consider experiences they or family members may have had with fluid imbalances. Could these have been avoided? How? |

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|Learning Style: Auditory, Visual and Interactive. |

|The students will what they learned, use their charts to help focus on the lesson and participate in oral discussions about the content of the|

|lesson. |

|Evaluation |

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|Informal Assessment : |

|Discuss, as a group, the correct answer for each part of the chart. Have the student’s trade papers to grade them. |

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|Learning Style: Visual |

|The student will observe the correct answers on an overhead chart and on their peer’s paper. |

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|Formal Assessment : |

|Provide the students with a different case study and I&O chart for them complete on an individual basis during another class period. This will|

|be part of a test, on various types of record keeping, at the completion of the unit. |

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|Learning Style: Visual ,Kinesthetic and Psychological |

|The student is using the chart and recording the information. They will also be analyzing the data and determining the correct placement of |

|the information onto the chart. |

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|Extension/Enrichment :The student will research a disease or disorder that affects fluid balance and predict how intake and output may be |

|affected. |

ATTACHMENT A:

Recording Intake and Output Practice

Mrs. Jane Black is a client who had a gastrectomy (removal of the stomach). A nasogastric tube is in site to drain all fluids. It is connected to suction and irrigated at times. Intake is limited to sips of Sprite and ice cubes.

Instructions: Chart the following information on the I and O record. Record all 8 hour and 24 hour totals.

1. Water intake

8AM- 2 Tbsp

2 PM- 1 Tbsp

5 PM- 3 Tbsp

12 MN- 2 tsp

2 AM - 1 tsp

2. Sprite

2 AM- 1 tsp

8AM- 1 water glass

11AM- ½ juice glass

4PM -1 cup

8PM -1 ounce

12 MN- 2 ounces

2 AM- 1 tsp

3. Ice cubes (Note: 1 cube = 5 cc)

1 ice cubes at 9AM, 12N, 3PM, 11PM, and 3AM

4. IV

7AM -500 cc

2PM -450 cc

6PM -500 cc

10 PM- 400 cc

3 AM- 400 cc

6 AM- 500 cc

5. Emesis

6PM- 100 cc clear liquid

9PM- 130 cc reddish brown liquid

2AM- 200 cc golden green liquid

6. Urine

11 AM- 450 cc

4PM- 300cc

8PM- 250 cc

11PM- 300 cc

3AM- 200 cc

6AM- 300cc

7. Brown liquid stool

10AM- 750 cc

2PM- 200 cc

6AM- 200 cc

8. NG suction

2PM- 700 cc brown liquid

10PM- 650 cc brown liquid

6AM- 425 cc brown liquid

9. NG irrigation

8AM- 30 cc

10AM- 30 cc

2PM- 30 cc

6PM- 45 cc

1AM- 60 cc

4 AM -25 cc

ATTACHMENT B:

Intake and Output Record

| |Measurements |Large glass 240cc |Coffee pot 240cc |

| | |Water glass 180cc |Cup 120cc |

|Patient’s Name __________________________________ | |Juice glass 100cc |Soup bowl 200cc |

| | |Small bowl 120cc |Jell-O 120cc |

|INTAKE |OUTPUT |

Time |Oral |  IV  |Irrigation |Remarks | BM  |Emesis |Urine |Irrigation |Remarks | |7 AM |  |   |   |   |   |   |   |   |  | |8 |  |  |  |  |  |  |  |  |   | |9 |  |  |  |  |  |  |  |  |  | |10 |  |  |  |  |  |  |  |  |  | |11 |  |  |  |  |  |  |  |  |  | |12N |  |  |  |  |  |  |  |  |  | |1PM |  |  |  |  |  |  |  |  |  | |2 |  |  |  |  |  |  |  |  |  | |3 |  |  |  |  |  |  |  |  |  | |TOTAL |  |  |  |8 Hr 

Intake |  |  |  |  |8 Hr

Output | |4PM |  |  |  |  |  |  |  |  |  | |5 |  |  |  |  |  |  |  |  |  | |6 |  |  |  |  |  |  |  |  |  | |7 |  |  |  |  |  |  |  |  |  | |8 |  |  |  |  |  |  |  |  |  | |9 |  |  |  |  |  |  |  |  |  | |10 |  |  |  |  |  |  |  |  |  | |11PM |  |  |  |  |  |  |  |  |  | |TOTAL |  |  |  |8 Hr 

Intake |  |  |  |  |8 Hr

Output | |12MN |  |  |  |  |  |  |  |  |  | |1AM |  |  |  |  |  |  |  |  |  | |2 |  |  |  |  |  |  |  |  |  | |3 |  |  |  |  |  |  |  |  |  | |4 |  |  |  |  |  |  |  |  |  | |5 |  |  |  |  |  |  |  |  |  | |6AM |  |  |  |  |  |  |  |  |  | |TOTAL |  |  |  |8 Hr 

Intake |  |  |  |  |8 Hr

Output | |TOTALS |  |  |  |24 Hr 

Intake |  |  |  |  |24 Hr

Output | |

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