This investigative case module was prepared as part of a BioQUEST faculty development workshop. The cases, resources, and implementation strategies were developed by participants for use with their own students. We invite you to adopt and adapt the following materials.

The BioQUEST Curriculum Consortium is committed to the reform of undergraduate biology instruction through an emphasis on engaging students in realistic scientific practices. This approach is sometimes characterized as an inquiry driven approach and is captured in BioQUEST's three P's (problem-posing, problem-solving, and peer-persuasion). As part of this workshop groups of faculty were encouraged to initiate innovative curricular projects. We are sharing these works in progress in the hope that they will stimulate further exploration, collaboration and development. Please see the following links for additional information:

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Investigative Cases
   
The Case: Multiple Births - Multiple Problems

A young couple, Martha and Mike have one child. They both decided it was time for their little boy to have a sister or brother. Martha had some previous problems with uterine infections and was under antibiotic therapy. This seemed to affect her uterus and the ovary physiology some how. But they still want to have a baby!! Fertility hormones were prescribed for Martha by an endocrinologist, who assured them that she will have no chance of multiple births.

Luckily, Martha became pregnant and has had a very normal pregnancy for the the first four months. Mike was very eager to know more about this pregnancy and convinced his wife to have a sonogram. The shocking, but good, news was that she is pregnant with triplets. Martha was given all the medical advice and precautions about the possible complications of this type of pregnancy.

On the 23rd week of the gestation, Martha started to dilate and knew she was in the early stage of labor. She was rushed to the Emergency Room and was put under some medications to delay the labor, but two days later she began the second stage of labor. Soon after the first baby was delivered. Her medications were increased, but two hours later the second baby was delivered. A half hour afterwards, the third baby was delivered.

Each of the babies weighed approximately 500 grams and had to be rushed to the Neonate Intensive Care Unit. The babies were given oxygen and food through naso-tracheal and naso-gastric tubes respectively.

The first child, a boy, died suddenly during the first week. No clear symptoms of any infection could be detected.

The second child, a girl, had the following complications described by the attending neonatologist:

a- Chronic lung disability and has to depend on Oxygen supplement.
b- Interventricular Hemorrhage which later cause bulging of the fontanel and increasing the head circumference.
c- Sepsis.
d- Patent Ductus Arteriosis.
e- Cardiac vegetation.


The third child, a boy, had the following complications:

a- Respiratory distress of prematurity.
b- Brochopulmonary dysplasia and has to depend on oxygen supplement.
c- Patent Ductus arteriosis.
d- Cardiac vegetation.
e- Sepsis.


The most serious complications that the children exhibited were:

a- Lung Congestion, which led to low oxygen saturation.
b- Kidney malfunction, which resulted in very low urine volume.
c- Ventricular enlargement.
d- Anemia and Transient Thrombocytopenia which required a series of blood and platlets transfusion.

Case Author:
Mahmoud Bishr Labette Community College

Case Analysis

The differences in circulation between the premature and the full term baby.

The difference in the development of the brain, lungs and kidneys of both fetus and adult and how that affects their physiological functions.

What physiological changes occur in both of these organs after delivery.

How the blood culture results relate to the complications observed in the newborns.

Option: Include a know / need to know chart like the one below:

What do you know?
What do you need to know?
   

Learning Goals

Goal(s)

The students will learn the importance of metal ions in living organisms.

The students will learn that we can use chelating reagents to effectively remove metal ions in solution.

The students will be able to understand the chemistry (structure and function) of chelating reagents.

The students will be able to learn the thermodynamics of metal-ligand complexation.

The students will be able to do titration experiments to determine quantitatively the amount of divalent metal ions in solution.

Standards

 

Investigations and Activities

Apply information about the Circulatory, Nervous and Urinary system with respect to the Anatomy and Physiology.

As a result of group discussion and collaboration, students will teach each other.

Critical thinking skills are practiced by solving the case questions.

 

Resources

Harvard University - Vascular Anatomy
http://www.med.harvard.edu/AANLIB/vana.html

Harvard University - The Whole Brain Atlas
http://www.med.harvard.edu/AANLIB/home.html

The Franklin Institute Online - The Preview of the Heart
http://sln2.fi.edu/biosci/preview/heartpreview.html

What is Hydrocephalus?
http://www.asbah.org/whatishyd.html

Human Anatomy and Physiology textbook
Lab experience- Brain and heart dissection.
Microscopic examination of blood cells.

Students will usually obtain additional references or resources
to help answer or explore their questions.

Special Data Items

Lab Results of the newborns:

Very Low WBC, RBC and platelets count.

Blood culture showed :
Gram-positive oval and ovoid cells.
Gram positive cocci catalase positive.
Gram positive cocci catalase negative.

1. quadruplets.jpg
2. ovary.gif

 

Student Products

- Group Summary Report on their analysis of the newborns.

- Group presentation of finding.

-Individual summary and answers to questions.

-Individual protocol to isolate and identify the blood culture isolates.

Assessment and Evaluation Plan

Peer review of group presentation - 10%

Individual Summary - 20%

Answers to the questions and protocol development - 50%

 

Implementation

Day 1
The class will be split in 3 groups based on the student's course of study.

The first group, the premed students- write a short analysis of the newborns conditions from a doctors perspective.

The second group, Nursing student- write a short analysis from a nurse perspective.

The third group, non majors, write a short explanation of what is happening to the newborns, in the form of letters to the relative of the family.

Day 2

Each group presents a five minutes summary of their findings.

Day 3

Each student needs to write a summary explaining the reason(s) for all these complications. They should include why both of the surviving children have lung and kidney malfunctions.

Day 4

Each student needs to answer the following questions:

1. What is meant by Patent ductus arteriosis?

2. What is (are) the long-term effect of this condition if not corrected?

3. What is the function of the Ductus arteriosis and what is the fate of this ductus arteriosis in complete development of the newborn full term baby.

Day 6 and 7

Each student should answer these questions:

1. Define hydrocephalus and explain why those children had Hydrocephalus.

2. What is ( are) the long term effect of the Hydrocephalus?

3. Why do you think these children have low oxygen saturation in their blood?

4. What is (are) the most probable cause(s) of the first baby 's death? Explain.

Write down a protocol to isolate and identify the blood culture isolates.

Identify here the kinds of scientific investigations that you consider relevant to this question.

Describe at least one specific laboratory or field exercise, simulation, or investigative activity that would be useful for your students to do, that also relates to their case question and supports your learning objectives.

Course name:
Anatomy and Physiology
Likely sequence in syllabus:
After finish talking about the Nervous and Cardiovascular systems.
Time during term:
The fourth week ( Summer term ) and the eighth week ( fall and Spring term )
Duration:
One week ( summer ) 2 weeks ( fall and spring)
Setting:
Laboratory
Students in course:
Nursing, premed and non majors
Collaborative elements:
Work both individually and in groups. Share access to resources. Likely to discuss cases outside of class. Do dissection in pairs.
Additional notes:
Any Anatomy and Physiology Text

 

Credits

www.babyzone.com/parenting/twins/default.asp
www.angelfire.com/il/fatalbert/

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