Model Instruction Plan

ATTD 4120/5120 Rouh

Assign. 8/PB6

Lesson Plan
Course Title: Health Science Technology I
Session Title: Measuring Intake and Output
Lesson Duration: 2 90 minute class periods
Timeline of Instructional Sequence:
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.
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.
Performance Objective:
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.
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.
Preparation

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:
(A) review the structure and composition of client
records;
(B) compile and record client data; and
(C) demonstrate the ability to chart and graph.
12)The student knows the technology utilized in the
diagnostic, therapeutic, informational, and
environmental systems. The student is expected to:
(A) identify equipment utilized in each of the
four systems;
(B) utilize appropriate equipment in the delivery
of health care services;
(F) Knowledge and skills.
(1) The student applies math, science, English language
arts and social studies in health science. The
student is expected to:
(A) convert units between systems of measurements;
(B) use measurement functions for client
assessment;
(F) describe biological and chemical processes
that maintain homeostasis;
(13)The student demonstrates multi-competent health
care worker knowledge and skills. The student is
expected to:
(A) assess client status and accurately determine
vital signs;
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.
(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.
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)
Materials Needed: IV bag; bedpan; urinal; orange juice glass; milk glass; soup bowl; emesis basin; foley catheter bag; food coloring; urine cup; ice cubes;
Equipment Needed: calculators
Learner: HST I student
Introduction
Introduction :
Can any on tell me what fluid balance might be and why it is important in the human body?
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?
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.
Learning Style: Auditory
Outline
1. Fluid Balance
A. Homeostasis
1. define and discuss importance to good health
2. Fluid Imbalance
A. Define imbalance
I. Dehydration
A. Causes
1. Diarrhea
2. Vomiting
3. Bleeding
4. Excessive perspiration (diaphoresis)
5. Poor fluid intake
B. Symptoms
1. Fever is present.
2. There is a decrease in urine.
3. Urine is concentrated.
4. Weight loss occurs.
5. Membranes are dry and it is difficult to swallow.
6. Tongue is coated and thickened.
7. Skin becomes hard and cracks and is dry and warm
II. Edema
A. Causes
1. High salt intake
2. Infections
3. Injuries or burns
4. Certain kidney diseases
5. Certain heart diseases or heart inefficiencies
6. Sitting too long in one position
7. Infiltration of IV fluid
C. Symptoms
1. Decrease in urine output
2. Gain in weight
3. Puffiness or swelling
4. Sometimes shortness of breath / Learning Style: Auditory, Visual and Psychological.
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.
1. Notes for Objective 1
Have student think about how they feel when they get too thirsty or have exercised too vigorously? What makes
them feel better? Why?
Notes for Objective 2.
Have students give ideas on what they think the causes of dehydration might be. How rapidly can it occur for any person? Is there a particular group or groups that might be more susceptible to dehydration?
Briefly give examples and discuss why the different symptoms occur during dehydration. Have them think of any personal experiences they may have had with dehydration either through illness or perhaps heat and exercise in the summer.
Discuss why some of these things cause edema.
Give students examples of edema that they may have seen, such as an elderly relative with swollen feet.
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.
3.Show example of I&O chart on overhead

A. Describe methods used to fill out chart

1. define terms on chart
2. explain how IV fluids are measured

B. Practice filling in one row as a group

C. Have the students complete the chart. This
should be done as an individual task, not in a
group. / Learning style: Kinesthetic, Visual and Emotional.
The charts provide the students with hands-on interaction. The student also has to stay on task to complete the activity.
3. Notes for Objective 3
Do the first column of the chart together as a class. Make sure different students provide answers to each item.
4. Demonstrate equation to convert ounces to cubic centimeters (cc).
30 X (number of ounces) = number of cc’s / Learning Style: Visual
4. Notes for Objective 4
Show students several examples of this equation and work them together as a group.
5. Have students, working in pairs, measure various labeled body fluids as they fill out a second chart. / Learning style: Kinesthetic, Sociological and Physiological
Sections 5 allows for a great deal of 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.
5. Notes for Objective 5
Skills lab: provide a variety of “fluids“for students to measure and record.
6. Define any and all medical terms students are not
familiar to students. / Learning Style: Print and psychological
The student will have to use research sources 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.
Application
Guided Practice :
Complete one column of the Intake and output record as a group using the overhead projector.
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.
Summary
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?
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
Informal Assessment :
Discuss, as a group, the correct answer for each part of the chart. Have the student’s trade papers to grade them.
Learning Style: Visual
The student will observe the correct answers on an overhead chart and on their peer’s paper.
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.
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.
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.

Water intake
8AM- 2 Tbsp
2 PM- 1 Tbsp
5 PM- 3 Tbsp
12 MN- 2 tsp
2 AM - 1 tsp
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
Ice cubes (Note: 1 cube = 5 cc)
1 ice cubes at 9AM, 12N, 3PM, 11PM, and 3AM
IV
7AM -500 cc
2PM -450 cc
6PM -500 cc
10 PM- 400 cc
3 AM- 400 cc
6 AM- 500 cc
Emesis
6PM- 100 cc clear liquid
9PM- 130 cc reddish brown liquid
2AM- 200 cc golden green liquid
Urine
11 AM- 450 cc
4PM- 300cc
8PM- 250 cc
11PM- 300 cc
3AM- 200 cc
6AM- 300cc
Brown liquid stool
10AM- 750 cc
2PM- 200 cc
6AM- 200 cc
NG suction
2PM- 700 cc brown liquid
10PM- 650 cc brown liquid
6AM- 425 cc brown liquid
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

[Content Area]: [Lesson Title] Plan