LifeLines OnLine
2002 Summer Faculty Workshop
The Case: The Salty Brow  

Case Scenario Part One:

  "Just one more push Sandra and we'll have a baby here" the midwife said and with that Julia entered the world.  Julia was a healthy 7lb 2oz baby girl complete with 10 toes and 10 fingers.  Sandra and Jim took their new daughter home and besides being short on sleep, they settled into being a family.   

Julia was a good eater but at her 6 month checkup her doctor noticed that Julia's weight gain was not keeping pace with the growth charts.    In the months that followed she began to get fussier and she seemed to have a runny nose constantly.  Sandra knew all babies gets colds, but when Julia developed a bad cough Sandra got concerned and called Julia's pediatrician.  

"Hello Dr. Miner, I'm concerned about Julia.  She started coughing yesterday and it's getting worse."

"Is she coughing up any mucus?"  

"Yes, the mucus is thick and has a greenish color"  Sandra replied.

"Sounds like I should have a look"  Dr. Miner responded.   "Bring her in."

Dr. Miner checked Julia's weight and carefully listened to Julia's lungs.  "Have either or you noticed any changes in her eating or bowel habits?"  

"Her stools appear kind of greasy now that she is eating some solid foods"  Sandra recalled.

"I swear they are more frequent then they used to be too" added Jim.

Before handing Julia back to her parents, Sandra noticed that Dr. Miner gently kissed Julia on the forehead.   "I'm going to start her on some antibiotics for her cough and order some tests to see what is going on.  My nurse will be right in to draw some blood.  I'm also going to schedule Julia for a sweat test.  If her cough doesn't get better let me know.   I'll give you a call after the test results come back" 

Case Scenario Part Two:

A week later Dr. Miner received the results of the sweat test.  They confirmed her fears.  Julia has cystic fibrosis.  This explains her very thick mucus and other symptoms.  Dr. Miner schedules an appointment for Jim and Sandra to meet Cathy the new Nurse Educator.   This will be Cathy's first consultation and she has a lot of work to do before she's ready!         

 

Case Author: Katie Morrison-Graham
Lane  Community College, morrison-grahamk@lanecc.edu, http://sliunix.lanecc.edu/~katiemg/

Case Analysis

This case is about cystic fibrosis and the ramification of a missing chloride channel in epithelia cells.  To analyze the case students will need to ask

  • What is cystic fibrosis?

  • What do we know about the case and about cells already

  • What do we need to know to understand this disease

Students will 

  • underline the important clues in the case
  • fill out the following table (divide into a part one and part two)
What do you know?
What do you need to know?
   

Learning Goals

  • To reinforce student understanding of membrane structure and  concept of selective permeability and concentration gradients
  • To understand the concept and importance of osmolarity 
  • Ability to relate the symptoms of cystic fibrosis to the underlying cellular abnormality
  • Ability to relate the current treatments for cystic fibrosis to the underlying cellular abnormality 
  • Develop expertise in web research 
  • Develop critical thinking, collaboration and communication skills

Investigations and Activities

Part One Activities:

  • read the case out loud

  • underline the important points

  • fill out part one of the "what do you know, what do you need to know" table   

Part Two Activities:

  • read the case out loud

  • underline the important points

  • fill out part two of the "what do you know, what do you need to know" table 

  • conduct an osmolarity lab to determine the effect of various salt concentrations on water movement 

  • research the cause, symptoms and treatments for cystic fibrosis on the Web  

  • develop a draft brochure to explain cystic fibrosis to Julia's parents (to include the cellular basis of the disease and how that relates that to the symptoms and treatments) 

  • share brochure materials to one other group   

  • complete an inter-group critique 

  • use critique to refine brochure

  • submit final brochure

  • evaluation of intra-group participation  

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

Resources

General Resources:

http://www.nhlbi.nih.gov/health/public/lung/other/cf.htm

http://www.people.virginia.edu/~rjh9u/cfsciam.html

http://kidshealth.org/parent/medical/lungs/cf.html

Diagnosis:

http://www.noah-health.org/english/illness/respiratory/cystic.html#DIAGNOSIS

http://.pediatrics.wisc.edu/childrenshosp/sweat/sweat.html

http://www.cf-web.org/info-zone/med-compl.html

http://www.cysticfibrosis.co.uk/diagnosi.htm

Sweat Glands:

http://www.howstuffworks.com/sweat2.htm

Special Data Items

Link to an osmolarity lab 

 

Student Products

"What do you know, what do you need to know" table submitted by group reporter 

Individual osmolarity lab report

A "mock brochure" on white butcher paper to be used by the Nurse Educator.  The brochure needs to contain

  • Column 1:  the cell biology of cystic fibrosis 

  • Column 2:  disease symptoms related to the underlying cell biology 

  • Column 3: explanation for the treatments for the disease

  • List of references (minimum of 4)

Inter-group critique 

Intra-group evaluation of participation

Assessment and Evaluation Plan

"What do you know, what do you need to know" table (5%)

Individual student lab report on osmolarity (15%)

Group "mock brochure" (55%)

Credibility and usefulness of brochure references (10%)

Usefulness and depth of inter-group critique (10%)

Peer evaluations (5%) 

 

Implementation

Course name:
 Cell Biology for Health Occupations (Bi112)
Likely sequence in syllabus:
 Following cell structure and discussion/activities on membrane structure and function.  
Time during term:
 Middle of the quarter
Duration:
 Over two class periods
Setting:
lab/lecture classroom
Students in course:
Prerequisite course for Anatomy and Physiology
Collaborative elements:
Primarily Group Work

Will also involve independent Web research.

Additional notes:
Part one will be completed and part two begun on the same day.  Students will divide up the research tasks and report back during the next class meeting.  During this class meeting they will create their brochure.

This case could be extended in the following ways:  

  • examination of the cystic fibrosis mutation (i.e. F508) to determine how the mutation effects protein production using the Biology Student Data Bank
  • add to the scenario Sandra and Jim decide to have another child and use  Case It  to investigate the genotype of Sandra and Jim's fetus.   

 

Credits: 

Images were obtained at the following sites:

baby:  http://csgrad.cs.vt.edu/~gradcoun/social/coffeeHaus.html

nurse:  http://ccc.commnet.edu/nursing/nursing.htm

students:  http://www.york.ac.uk/admin/uao/ ugrad/studying

 


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