Transcript Active-Learning Techniques

IMPLEMENTATION AND OPERATIONALIZATION
OF AN ACTIVE CLASSROOM
Nancy Schoofs, PhD, RN
Sue Harrington, PhD, RN
Melodee Vanden Bosch, PhD, RN
LEARNING OBJECTIVES
 Outline the process of implementation and operationalization of an
active classroom
 Describe three active classroom techniques for application in the nursing
education classroom:
 Backchanneling
 Wordles
 Case studies (exemplar: Diabetes, Acid-Base Balance)
 Discuss how group learning and testing can be used as an innovative
strategy to increase student confidence and clinical reasoning skills
 Explain the usefulness of exam wrappers by increasing students’ reflection
of exam preparation and assessment in the active classroom
ACTIVE LEARNING
HISTORY
Professor Reg Revans (1907 – 2003)
Learning = programmed knowledge +
questioning insight
1980’s: Patricia Cross, Arthur Chickering, Zelda Gamson and other leaders in higher education
urged university faculty to actively involve and engage students in the process of learning
1991: Charles Bonwell and James Eison published
Active learning: Creating Excitement in the Classroom (1991)
Association for the Study of Higher Education (George Washington University)
I. Kokcharov
Classroom approaches that engage students in “active learning” improve retention of
information and critical thinking skills, compared with a sole reliance on lecturing, and
increase persistence of students in STEM majors. (President’s Council of Advisors on Science and
Technology, (2012). Engage to Excel: producing one million additional college graduates with degrees in Science,
technology, engineering, and mathematics)
ACTIVE LEARNING
DEFINITION
Model of instruction that focuses the responsibility of
learning on the learners
 Three learning domains: knowledge, skill, application
 Constructivism
A method of learning in which students are actively or
experientially, not passively, involved in the learning process
 Different levels of active learning
 Enhancement to a lecture
 Different levels of student involvement
ACTIVE LEARNING CONTINUUM
RESEARCH
OUR BEGINNINGS
Flipped Classroom: a term used to designate an intentional shift
of information delivery to a place outside of the classroom (active
learning method)
The goal is to free up face-to-face interactions in the classroom for the purpose
of individualized instruction, remediation, review, and/or application of
knowledge
Responsibility of learning is placed back with the students: the ownership of
scholarship is reassigned to the student
Mixed Method Study (Randomized)
Quantitative Results
Qualitative Results
No significant difference between semester
grades in two groups (flipped / inverted
format and traditional lecture
“In-class time more efficient/effective than
traditional lecturing”
‘Moderate resistance to new methodology
from students’ ‘Expectations and
assignments were very clear to students’
PROCESS FOR
OPERATIONALIZATION
OF AN ACTIVE CLASSROOM
1. Begin with review of course objectives, topics, concepts
2. Determine information/skills students need for effective
participation in your active learning classroom
3. Assign readings, articles, videos (in appropriate
quantity/amount) to best deliver this knowledge to the
students prior to coming to class
4. Consider dividing your class into teams of 4: assign team roles
for most effective group participation
5. Research active learning strategies at the levels (active
learning and student engagement) to incorporate into the
classroom
ACTIVE CLASSROOM DESCRIBED
Characteristics
Barriers (for faculty)
Student involvement
Cannot cover as much course content
Student engagement
Preparation of active learning strategies
is time intensive
Less emphasis on information
transmission: and more emphasis on
application (basic and advanced
objectives)
Large class sizes require innovation to
implement active learning strategies
Students receive immediate feedback
from instructors
Most instructors have a comfort level
with delivering good lectures
Students are involved in a higher order
thinking
Resources for active learning
approaches are not abundant
LEARNING OBJECTIVES
 Outline the process of implementation and operationalization of an active
classroom
 Describe three active classroom techniques for application in the nursing
education classroom:
 Backchanneling
 Wordles
 Case studies (exemplar: Diabetes & Acid/Base)
 Discuss how group learning and testing can be used as an innovative
strategy to increase student confidence and clinical reasoning skills
 Explain the usefulness of exam wrappers by increasing students’ reflection
of exam preparation and assessment in the active classroom
INTERACTIVE LECTURE
LARGE GROUP DISCUSSION
Backchanneling is a digital conversation that runs
concurrently with a face-to-face activity or event.
 Use of social media / online rooms to engage
students and give them a voice
 Chat room so that students can spontaneously
post questions / leave comments
 Opportunity to share ideas / thoughts during a
class
 Creative use of postings as discussion prompts
 Capturing curiosity at moment of inquiry:
ubiquitous opportunity
http://today.io/1gkh6
BRAINSTORMING
Word Cloud Generators
Discussion starter / words relevant to the topic
Pre and post discussion assessment
Reflections of text readings as a
summary
Self-assessment / list attributes into generator
Clarification: text / rubric / criteria
Short written essays into generator and
compare
Classroom / team / course expectations into
generator
Metacognitive self-reflection
WHAT DOES PATIENT SAFETY MEAN TO YOU?
(ACTUAL EXAMPLE)
CASE STUDY: DIABETES
 Unfolding Case study – scaffolding of content
 Clickers – immediate feedback
 NCLEX-style Questions – need practice
 Hyperlink – quickly moves from 1 part of scenario to another
NURSING RESEARCH
 Design: retrospective chart audit of 210 hospitalized
patients who experienced hypoglycemia
 Purpose: examine adherence to 5 steps of expected
behaviors derived from practice manual:
1) administer 15 g. carbs
2) retest BG in 15 min
3) retest BG in 1 hour
4) notify physician
5) document event
Anthony, M. (2007). Treatment of hypoglycemia in hospitalized adults: A
descriptive study. Diabetes Educator, 33, 709-715.
NURSING RESEARCH
 Findings: 484 episodes of hypoglycemia (BG
< 70 mg/dL) in 115 patients at 2 hospitals
 Adherence to guidelines was low
 Not 1 case where all 5 steps were followed
 2.1% performed the 1-hour retest
 70.9% documented in the EMR
CASE STUDY:
ARTHUR HARRIS
•
•
•
•
•
59-year-old
African American male
history of Type 2 diabetes
directly admitted from provider's office
infected sacral wound, developed several
months ago while on bed rest following an ankle
sprain
• history of depression, currently exacerbated by
the death of wife 6 months ago
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
CASE STUDY (CONTINUED)
 Since admission, Arthur has received wound
care, antibiotic therapy, and IV pain
medications.
 He receives correction scale (bolus) insulin
coverage with meals, though his appetite has
been poor and he has not been eating well.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
CASE STUDY (CONTINUED)
 At 1800, Arthur received 5 units of Humalog
insulin and ate 25% of his meal.
 It is now 1900, and when you enter the room,
Arthur says (with slurred speech), “My feet and
hands are numb and tingly. Who are you? Why
am I here?”
 What is your priority response?
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
IF YOU ARE THE ONLY PERSON AVAILABLE TO
ASSIST, WHAT IS YOUR PRIORITY RESPONSE?
1.
2.
3.
4.
Call the physician.
Assess blood glucose
level 1. 2.
Conduct patient
safety check, move 3
side rails from down
to up position.
Conduct a focused
assessment.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS NEXT YOUR PRIORITY RESPONSE?
1.
2.
3.
4.
Call the physician.
Assess blood glucose
level 1. 2.
Conduct patient
safety check, move 3
side rails from down
to up position.
Conduct a focused
assessment.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY RESPONSE?
1.
2.
3.
4.
Call the physician.
Assess blood glucose
level 1. 2.
Conduct patient
safety check, move 3
side rails from down
to up position.
Conduct a focused
assessment.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY RESPONSE?
1.
2.
3.
4.
Call the physician.
Assess blood glucose
level 1. 2.
Conduct patient
safety check, move 3
side rails from down
to up position.
Conduct a focused
assessment.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY RESPONSE?
1.
2.
3.
4.
Call the physician.
Assess blood glucose
level 1. 2.
Conduct patient
safety check, move 3
side rails from down
to up position.
Conduct a focused
assessment.
0%
1.
0%
2.
0%
3.
0%
4.
1. CALL THE PHYSICIAN.
 Physician response:
 What is patient’s BP, T, RR, HR and blood
glucose level?
 What is your response, would you like to
choose a different intervention?
2. ASSESS BLOOD GLUCOSE LEVEL.
 When you return with the glucometer, you find
the patient on the floor having fallen out of bed
while trying to get to the bathroom.
 Would you like to choose a different priority?
3. CONDUCT PATIENT SAFETY CHECK, MOVE SIDE
RAIL FROM DOWN TO UP POSITION.
Good priority, now your patient is safe
just in case he would try to get out of
bed or have a seizure in this confused
state. What would be the second
highest priority?
4. CONDUCT FOCUSED ASSESSMENT.
 T = 99.2 F (37.3 C) BP = 140/88
 P = 118 RR = 20
 O2 Sat = 93% (room air [RA])
 • Heart sounds: Regular
 • Lung sounds: Clear
 • Bowel sounds: Present
 • Pulses: 2+ right foot; 1+ left foot;
 3+ upper extremities
 • Pain: 3/10
 Would you like to choose a different intervention?
2. ASSESS BLOOD GLUCOSE LEVEL.
 Blood glucose: 55 mg/dL
 Is this BG within the normal range? What is the
normal range?
 What symptoms might patient have with this
BG?
 What will you do next?
WHAT IS YOUR NEXT PRIORITY?
1.
Provide
individualized
teaching.
2. Use therapeutic
communication with
patient and family.
3. Call provider for
orders.
4. Assess patient’s
ability to swallow.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY?
1.
Provide
individualized
teaching.
2. Use therapeutic
communication with
patient and family.
3. Call provider for
orders.
4. Assess patient’s
ability to swallow.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY?
1.
Provide
individualized
teaching.
2. Use therapeutic
communication with
patient and family.
3. Call provider for
orders.
4. Assess patient’s
ability to swallow.
0%
1.
0%
2.
0%
3.
0%
4.
WHAT IS YOUR NEXT PRIORITY?
1.
Provide
individualized
teaching.
2. Use therapeutic
communication with
patient and family.
3. Call provider for
orders.
4. Assess patient’s
ability to swallow.
0%
1.
0%
2.
0%
3.
0%
4.
1. PROVIDE INDIVIDUALIZED TEACHING.
 While providing teaching is important, now is
not the correct time. Remember that “client
readiness to learn” is the first assessment you
must perform. This client is not ready to learn
since hypoglycemia makes it difficult for client
to think or remember.
 Would you like to choose a different
intervention?
2. USE THERAPEUTIC COMMUNICATION
WITH PATIENT AND FAMILY.
 Using therapeutic communication with patients and
their families is always an important nursing
intervention. However, on Maslow’s hierarchy of
needs, communication would be higher as a
psychological needs versus physical need. This
patient has physical needs that need to be met first.
Would you like to choose another intervention?
3. CALL PROVIDER FOR ORDERS
 Provider asks:
 What is BG level?
 Are you following the hypoglycemia
protocol on the MAR?
 Is the patient conscious?
 Would you like to choose another
intervention?
4. ASSESS PATIENT’S ABILITY TO SWALLOW
 Good job!
 If patient is unconscious and unable to
swallow.
 If patient is conscious and able to swallow.
 If patient is conscious and unable to
swallow.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR A PATIENT WHO CAN SWALLOW
1.
2.
3.
Administer orders
of: 1 amp of %5
Dextrose IVP.
Administer 4 oz (1/2
cup) juice.
Administer 4 oz (1/2
cup) low-fat milk.
33%
1.
33%
2.
33%
3.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR A PATIENT WHO CAN SWALLOW
1.
2.
3.
Administer orders
of: 1 amp of %5
Dextrose IVP.
Administer 4 oz (1/2
cup) juice.
Administer 4 oz (1/2
cup) low-fat milk.
0%
1.
0%
2.
0%
3.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR A PATIENT WHO CAN SWALLOW
1.
2.
3.
Administer orders
of: 1 amp of %5
Dextrose IVP.
Administer 4 oz (1/2
cup) juice.
Administer 4 oz (1/2
cup) low-fat milk.
0%
1.
0%
2.
0%
3.
PRIORITIZE THESE INTERVENTIONS FOR A PATIENT WHO
CAN SWALLOW BUT WHOSE BLOOD GLUCOSE IS 45
1.
2.
3.
Administer orders
of: 1 amp of %5
Dextrose IVP.
Administer 4 oz (1/2
cup) juice or low-fat
milk.
Administer both
dextrose IVP &
juice/milk.
0%
1.
0%
2.
0%
3.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR PATIENT WHO IS UNABLE TO SWALLOW
1.
2.
3.
Administer order
of: 1 amp of 5%
Dextrose IVP.
Administer order
of Glucagon 1 mg
subcutaneous.
Administer 4 oz
(1/2 cup) juice.
0%
1.
0%
2.
0%
3.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR PATIENT WHO IS UNABLE TO SWALLOW
1.
2.
3.
Administer order
of: 1 amp of 5%
Dextrose IVP.
Administer order
of Glucagon 1 mg
subcutaneous.
Administer 4 oz
(1/2 cup) juice.
0%
1.
0%
2.
0%
3.
PRIORITIZE THESE INTERVENTIONS TO CORRECT
HYPOGLYCEMIA FOR PATIENT WHO IS UNABLE TO SWALLOW
1.
2.
3.
Administer order
of: 1 amp of 5%
Dextrose IVP.
Administer order
of Glucagon 1 mg
subcutaneous.
Administer 4 oz
(1/2 cup) juice.
0%
1.
0%
2.
0%
3.
IF IV GLUCOSE IS ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20
O2 Sat = 96% (room air)
 Blood glucose level 5 minutes after IV glucose
is 85 mg/dL.
 Blood glucose level 15 minutes after IV glucose
is 123 mg/dL.
 Is this a safe blood glucose for this patient?
 Continue to case scenario.
IF IV GLUCOSE IS ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20
O2 Sat = 96% (room air)
 Blood glucose level 5 minutes after IV glucose
is 80 mg/dL.
 Blood glucose level 15 minutes after IV glucose
is 123 mg/dL.
 Is this a safe blood glucose for this patient?
 Continue to case scenario.
IF GLUCAGON SUBQ IS ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20 O2
Sat = 96% (room air)
 Blood glucose level 5 minutes after Glucagon is 70
mg/dL.
 Blood glucose level 15 minutes after IV glucose is
100 mg/dL.
 Is this a safe blood glucose level for this patient?
 Would you like to choose a different intervention?
IF JUICE/MILK IS ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20
O2 Sat = 96% (room air)
 Blood glucose level 5 minutes after intake of
juice is 65 mg/dL.
 Blood glucose level 15 minutes after intake of
juice/milk is 72 mg/dL.
 Is this a safe blood glucose for this patient?
 Would you like to choose a different
intervention or continue to case scenario.
3. IF JUICE IS GIVEN
 Your patient aspirates on the juice and stops
breathing.
 Would you like to choose a different
intervention?
IF JUICE/MILK IS ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20
O2 Sat = 96% (room air)
 Blood glucose level 5 minutes after intake of
juice is 52 mg/dL.
 Blood glucose level 15 minutes after intake of
juice/milk is 68 mg/dL.
 Is this a safe blood glucose for this patient?
Would you like to choose a different
intervention?
IF BOTH JUICE AND IV GLUCOSE ARE ADMINISTERED
 T = 99.2 F (37.3 C) BP = 138/82 P = 108, RR = 20
O2 Sat = 96% (room air)
 Blood glucose level 5 minutes after juice/milk
and IV glucose is 90 mg/dL.
 Blood glucose level 15 minutes after juice/milk
and IV glucose is 125 mg/dL.
 Good Job! Patient’s blood glucose is definitely in
the safe range. Continue to case scenario.
FOLLOW-UP ON ARTHUR
 T = 99.2 F (37.3 C) BP = 128/76
 P = 138 RR = 8
 O2 Sat = 92% (room air)
 • Arthur says, “I don’t have any appetite. I
just want to take a nap and not to be
disturbed. Just let me rest.”
 What is your next priority?
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
PRIORITY DECISION. PLEASE
MAKE YOUR SELECTION...
1.
2.
3.
Allow Arthur to rest
since hypoglycemia
causes fatigue.
Wait 60 minutes and
recheck blood
glucose.
Give Arthur a snack
of a turkey and
cheese sandwich.
0%
1.
0%
2.
0%
3.
PRIORITY DECISION. PLEASE
MAKE YOUR SELECTION...
1.
2.
3.
Allow Arthur to rest
since hypoglycemia
causes fatigue.
Wait 60 minutes and
recheck blood
glucose.
Give Arthur a snack
of a turkey and
cheese sandwich.
0%
1.
0%
2.
0%
3.
PRIORITY DECISION. PLEASE
MAKE YOUR SELECTION...
1.
2.
3.
Allow Arthur to rest
since hypoglycemia
causes fatigue.
Wait 1 hour and
recheck blood
glucose.
Give Arthur a snack
of a turkey and
cheese sandwich.
0%
1.
0%
2.
0%
3.
1. ALLOW ARTHUR TO REST SINCE
HYPOGLYCEMIA CAUSES FATIGUE
 In 30 minutes, you check on Arthur and discover
him to be unresponsive with his IV pulled out.
 What will you do now?
 What would have prevented this from occurring?
 Would you like to choose a different intervention?
2. WAIT 1 HOUR AND RECHECK BLOOD GLUCOSE.
 Blood glucose level is now 28 mg/dL
 What would have prevented this from
occurring?
 Would you like to choose a different
intervention?
3. GIVE ARTHUR A SNACK OF A TURKEY AND
CHEESE SANDWICH
 Best intervention since a turkey and cheese
sandwich provides Arthur with enough carbs
and protein to stabilize his blood glucose so
that rebound hypoglycemia does not occur.
 Blood glucose 1 hour after snack is 140 and
peaks at 168 in 2 hours.
 When will you check his next blood glucose
level?
REFERENCES
 http://www.diabetes.niddk.nih.gov/dm/pubs/hypo
glycemia/
 http://www.mayoclinic.org/diseasesconditions/hypoglycemia/basics/treatment/con20021103
ACID BASE BALANCE
THREE MAJOR BUFFERING SYSTEMS:
Chemical buffers such as bicarbonate-carbonic acid buffer system,
phosphate, or protein systems; these work in seconds and work to buffer
or neutralize acids
Lungs buffer by controlling carbon dioxide and carbonic acid (H2CO3) by
adjusting ventilation.
Kidneys buffer by excreting acids or retaining hydrogen ions. HCO3 is a
base controlled by the kidneys. Renal compensation is slower than lungs
and may take days.
Acidosis – Increased hydrogen concentration or decreased
bicarbonates
Alkalosis – Decreased hydrogen concentration or increased
bicarbonates
If basic failure is pulmonary – Respiratory
If basic failure is renal - Metabolic
METABOLIC ACIDOSIS
Causes:
 Increase in acids as in diabetic ketoacidosis
 Decrease in bicarbonate as in severe diarrhea and prolonged
vomiting, tissues anoxia
Method of Compensation: Increased rate and depth of respirations
causing excretion of CO2 by lungs. Increased formation of bicarbonate
ions in kidneys.
Clinical Manifestations: Headache, Kussmaul’s respirations,
hypercalcemia, cardiac arrhythmias from hyperkalemia.
Treatment: treat underlying condition, sodium bicarbonate IV, F & E
replacement
METABOLIC ALKALOSIS
Causes:
 Bicarbonate excess from carbonated drinks or retention of
bicarbonate, potassium depletion, diuretic therapy, loss of acid such
as hydrochloric acid in severe emesis or drainage.
Method of Compensation: Decreased rate and depth of respiration
causing conservation of CO2 in lungs and increasing carbonic acid.
Kidneys excrete bicarbonate, excrete potassium and sodium, but
conserve hydrogen.
Clinical Manifestations: confusion, seizures, dizziness, numbness &
tingling with low calcium, shallow, slow respirations, nausea, vomiting,
muscle cramps, hypertonic muscles
Treatment: treatment of underlying condition, F & E replacement.
RESPIRATORY ACIDOSIS
Causes:
 Pulmonary embolism, atelectasis, pneumothorax, overdosage of
sedatives, sleep apnea, pneumonia, Adult Respiratory Distress
Syndrome
Method of Compensation: Kidneys get rid of acids and H+ and reabsorb
more bicarbonate. High CO2 stimulates breathing.
Clinical Manifestations: Dyspnea, disorientation, tachycardia,
dysrhythmias, dizziness, headache, warm flushed skin, hypercalcemia (leads
to decreased tendon reflexes).
Treatment: improve respiration function, watch for tetany and CO2 narcosis
(from O2 administration)
RESPIRATORY ALKALOSIS
Causes:
 Regular or mechanical hyperventilation (excessive CO2 excretion
caused by hypoxia), anxiety, fear, pain, increased exercise
Method of Compensation: Kidneys slow reabsorption of bicarbonate
and decrease H+ secretion, lungs decrease respirations.
Clinical Manifestations: Nausea (from irritation of brain’s emetic
center), vasoconstriction of cerebral blood vessels (causes dizziness,
faintness), decreased calcium ionization (causes spasms of fingers and
hands).
Treatment: treat underlying cause, breathing into paper bag (helps
bring in CO2 which combines with H2O to make H2CO3 which buffers
alkalosis), sedative.
ARTERIAL BLOOD GASES (ABGS)
Measured in terms of partial pressures of CO2
or O2 arterial, NOT venous blood
pH - 7.35-7.45
PCO2 - 35-45 mm Hg
PO2 - 80-100 mm Hg
HCO3 - 22-26 mEq/L
RULES FOR CONDITION
ROME: RESPIRATORY OPPOSITE, METABOLIC EQUAL
 If pH is abnormal and pCO2 goes in opposite
direction, it’s a respiratory problem
 If pH is abnormal and HCO3 goes in the
same direction, it’s a metabolic problem
 If low pH – acidosis
 If high pH – alkalosis
RULES FOR COMPENSATION
 In uncompensated conditions – pH is always abnormal
 In uncompensated respiratory conditions, pCO2 is
abnormal, HCO3 is normal
 In uncompensated metabolic conditions – pCO2 is
normal, HCO3 is abnormal
 In partial compensation – all three (pH, pCO2, HCO3)
are abnormal
 In full compensation, pH is normal, pCO2 is abnormal,
HCO3 is abnormal
ACTIVITY #1
LET’S TRY A FEW EXAMPLES
 pH 7.34 pCO2 50 HCO3 28
Respiratory acidosis partial compensation
 pH 7.48 pCO2 52 HCO3 30
Metabolic alkalosis partial compensation
 pH 7.30 pCO2 55 HCO3 24
Respiratory acidosis uncompensated
NOW YOU TRY IT
 pH 7.56 pCO2 20
HCO3 20
 pH 7.47
pCO2 48
HCO3 30
 pH 7.40 pCO2 45
HCO3 26
 pH 7.32 pCO2 60
HCO3 32
 pH 7.20 pCO2 65
HCO3 38
 pH 7.35
HCO3 30
pCO2 50
ACTIVITY #2
MATCH THE ACID-BASE IMBALANCES WITH CAUSES
(ANSWERS MAY BE USED MORE THAN ONCE)
_____a. Prolonged vomiting
_____b. Renal failure
_____c. Response to anxiety, fear, pain
_____d. Respiratory failure
_____e. Baking soda use as antacid
_____f. Severe shock
_____g. Diabetic ketosis
_____h. Mechanical overventilation
_____i. Sedative or opioid overdose
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
ACTIVITY #3
CASE STUDY
Frieda, a 74-year old woman who lives alone, is admitted to
the hospital because of weakness and confusion. She has a
history of chronic heart failure and chronic diuretic use.
Objective Data:
Neurologic: Confusion, slow to respond to questioning,
generalized weakness
Cardiovascular: BP 90/62, HR 112 and irregular, peripheral
pulses weak; EKG indicates sinus tachycardia
Pulmonary: Respirations 12/min and shallow
Additional findings: Decreased skin turgor; dry mucous
membranes
SIGNIFICANT LABORATORY RESULTS
Serum electrolytes
Na+ 141 mEq/L
K+
2.5 mEq/L
Cl⁻
85 mEq/L
HCO3⁻ 43 mEq/L
BUN 42 mg/dl
HCT 49%
Arterial Blood Gases
pH
7.52
PaCO2 55 mmHg
PaO2 88 mmHg
HCO3⁻ 42 mEq/L
QUESTIONS
1. Evaluate Frieda's fluid volume and electrolyte status. Which
physical assessment findings support your analysis?
2. Explain the reasons for Frieda's EKG changes.
3. Analyze the blood gas results. What is the etiology of the
primary imbalance? Is the body compensating for this
imbalance?
4. Why has Frieda's advanced age placed her at risk for her
fluid imbalance?
5. Discuss the role of aldosterone in the regulation of fluid and
electrolyte balance. How will changes in aldosterone affect
Frieda's fluid and electrolyte imbalances?
CASE STUDY #1
JERI
 Jeri’s been on a 3-day party binge.
 Friends are unable to awaken her.
 Assessment reveals level of consciousness difficult to
arouse.
 Respiratory rate of 8
 Shallow breathing pattern
 Diminished breath sounds
1. What ABGs do you expect?
2. What is your treatment?
CASE STUDY #2
MAYNA
 Presented to the ED after a sexual assault
 Examination reveals hysteria and emotional
distress.
 Respiratory rate of 38
 Lungs clear
 O2 sat 96%
1. What ABGs do you expect?
2. What is your treatment?
CASE STUDY #3
GLEN
History of fever, aches, and chills
Generally feeling ill
Cough productive (yellow, thick sputum) for the past 4
days
Examination reveals temp 38.4° C
Respiratory rate of 20
Lungs with crackles in left lower lobes
1. What ABGs do you expect?
2. What is your treatment?
CASE STUDY #4
ALAN
17 years old
History of
Feeling bad
Fatigue
Constant thirst
Frequent urination
1. What ABGs do you expect?
2. What is your treatment?
Blood sugar is 484 mg/dL.
Respirations are 28 and deep.
Breath has a fruity odor.
Lungs are clear.
LEARNING OBJECTIVES
 Outline the process of implementation of an active classroom, preparation
to review
 Describe three active classroom techniques for application in the nursing
education classroom:
 Backchanneling
 Wordles
 Case studies (exemplar: Diabetes)
 Discuss how group learning and testing can be used as an innovative
strategy to increase student confidence and clinical reasoning skills
 Explain the usefulness of exam wrappers by increasing students’
reflection of exam preparation and assessment in the active classroom
GROUP LEARNING
IN THE SAME BOAT
 Cooperative learning in the form of cooperative testing
 Active implementation of peer-mediated, peer-reviewed
learning (social activity)
 Learning through implementation of problems solving and
defense of individual positioning/answers
 Cooperative testing research in higher education
 Decreases test anxiety
 Improves critical analysis of complex situations
 Improves the promotion of teamwork
 Greater retention
 Improved transfer of knowledge
 Increased comprehension of complex material
GROUP LEARNING
IN THE SAME BOAT, CONTINUED
Qualitative research (focus groups) results:
 Overall, students found group testing favorable and liked
it
 Any negatives outweighed by positive aspects of group
testing
 Strategies to improve logistics of group testing suggested
Three main themes:
1. group testing promoted deeper learning
2. group testing fostered collaboration among the
students
3. group testing turned stress into learning
GROUP LEARNING
IN THE SAME BOAT, CONTINUED
Quantitative test results demonstrated an overall
improvement in scores.
LEARNING OBJECTIVES
 Outline the process of implementation of an active classroom, preparation
to review
 Describe three active classroom techniques for application in the nursing
education classroom:
 Backchanneling
 Wordles
 Case studies (exemplar: Diabetes)
 Discuss how group learning and testing can be used as an innovative
strategy to increase student confidence and clinical reasoning skills
 Explain the usefulness of exam wrappers by increasing students’
reflection of exam preparation and assessment in the active classroom
EXAM WRAPPERS
Exam wrappers are short activities that direct students to
review their performance (and the instructor's feedback)
on an exam with an eye toward adapting their future
learning
Exam wrappers ask students three kinds of questions:
1. How did they prepare for the exam?
2. What kinds of errors did they make on the exam?
3. What could they do differently next time?
Lovett, M. (2013). Using Reflection and Metacognition to Improve Student Learning Across the Disciplines, Across the
Academy, M. Kaplan, N. Silver, D. LaVaque-Manty, & D. Meizlish. (Ed.) Sterling, Virginia: Stylus Publishing, LLC.
1. HOW STUDENTS PREPARED FOR THE EXAM
Asking students to reflect on how they prepared for the
exam forces them to confront the choices, explicit or
implicit, they made about their studying. This prompts
students to consider issues such as whether they studied
enough or sufficiently in advance.
Similarly, asking students which of various study
strategies they employed (e.g., reviewing notes, solving
practice problems, rereading the textbook) highlights that
there are many options they could have taken.
2. WHAT KINDS OF ERRORS STUDENTS MADE
Once they have received a grade, students do not always
think carefully about their performance on an exam. If
they did well, they might mark it as a success without
much further thought; if they did poorly, there's a strong
temptation to leave the painful event behind.
Thus, the second set of questions posed in exam wrappers
is designed to encourage students to analyze their
performance in greater depth, giving students something
constructive to do with the feedback a graded exam
offers.
3. HOW STUDENTS SHOULD STUDY FOR NEXT EXAM
Students can use their responses to the first and
second types of exam-wrapper questions to think
about how they should approach the next exam.
A key goal of the third type of exam-wrapper
question is to help students see the association
between their study choices and their exam
performance so they can better predict what study
strategies will be effective in the future.
BENEFITS OF EXAM WRAPPERS
1. Impinge minimally on class time
2. Easily (efficiently) completed by
students
3. Adaptable
4. Repeatable yet flexible
5. Exercise self-assessment skills
EXAM WRAPPER STEPS
 Step 1: Students prepare for and take the first exam using their
typical study strategies.
 Step 2: The instructor gives students the exam wrapper
instrument when the graded exams are returned and asks
students to complete the exam wrapper as soon as possible
upon seeing their exam performance.
 Step 3: The instructor collects the exam wrappers.
 Step 4: At the time when students should begin studying for
the next exam, the instructor returns the completed exam
wrappers (from the previous exam) to students and allows
time for reflection.
(Lovett, as cited in Kaplan, Silver, LaVaque-Manty, & Meizlish)
ACTIVE LEARNING
RECOMMENDED READINGS
Atkinson, C. (2010). The Backchannel. Berkeley, California: New
Riders
Barkley, E. (2010). Student Engagement Techniques. San Francisco,
California: Jossey-Bass
Bretzmann, J. (2013). Flipping 2.0. Berlin, Wisconsin: The
Bretzmann Group, LLC.
Brookfield, S. (2015). The Skillful Teacher (3rd ed.). San Francisco,
California: Jossey-Bass.
Johnson, D., Johnson, R., & Smith, K. (1998). Active Learning:
Cooperation in the College Classroom. Edina, Minnesota:
Interaction Book Company.
Weimer, M. (2013). Learner-Centered Teaching (2nd ed.). San
Francisco, California: Jossey-Bass.
GRAND VALLEY STATE UNIVERSITY

Nearly 25,000 students

Students from all Michigan
counties, dozens of other states,
and many foreign countries

81 undergraduate and 32
graduate degree programs

Campuses in Allendale, Grand
Rapids, and Holland, with regional
centers in Muskegon and Traverse
City