OLIVAREZ COLLEGE TAGAYTAY

E. Aguinaldo Highway, Barangay San Jose Tagaytay City

Tel. Nos: (046) 8602301 Loc 120
www.olivarezcollege.edu.ph
1ST SEM, AY 2020-221

COLLEGE OF NURSING

Rotation 5

Clinical Area: INTENSIVE CARE UNIT

Agency: TMC, GEAMH AND CTGMC

Clinical Instructor: C.GATPANDAN, J.MARTINEZ, & M.BALSOMO

Group: BSN 411

Inclusive Date: Nov 16 -17 NOV 23-24, 2021

Methodology: Problem Based Learning

Formative Assessment: Use of Rubrics for PBL

Summative Assessment: Case Analysis

CASE STUDY:

Mrs. V. Pangilinan, 30-year-old pregnant woman brought to Emergency Room by her husband
with the chief complaint of snake bite on the left foot 4 days earlier. She had severe local pain,
followed by swelling and bruising of the foot. She was initially treated at a local hospital where
she had progressive swelling of the left leg and ecchymosis around the fang marks. She developed
hematuria and decreased urine output, and was referred to our hospital on fifth day. There was
history of generalized abdominal pain but there was no history of bleeding from gums, epistaxis,
hemoptysis, hematemesis, melena, vaginal bleeding, breathing difficulty, focal neurological
deficit, or unconsciousness. She was a multigravida in 33rd week of gestation. On examination
she was conscious and oriented. She was hemodynamically stable with a pulse rate of
100/minute, blood pressure of 120/70 mmHg, and a respiratory rate of 20/minute. There was
pallor but no cyanosis, clubbing, lymphadenopathy, edema, and the jugular venous pressure was
not elevated. Her left leg was swollen up to the knee and had ecchymosed around the fang marks.
On abdominal examination, the height of uterus was 28–30 weeks and fetal heart sounds were
present. The other systemic examination was unremarkable. Obstetric consultation was
performed; ultrasonographic examination showed a 32-week-old live fetus demonstrating
normal biometry and anatomy and a normal placenta. Fetal movements were normal at
ultrasonography, and there were no uterine contractions at fetal cardiotocography.
The investigations were as follows:

hemoglobin 5.5 g/dL,

white blood cell count 16.2 × 103/mm3 with
differential count of 86%
neutrophils, 10%
lymphocytes, 2%
eosinophils,
monocytes 2%,
platelet count 80 × 103/mm3,
erythrocyte sedimentation rate 20 mm first hour,
20-minute whole blood clotting test (20WBCT) > 20 minutes,
fibrin degradation products > 15 μg/mL,
D-dimer 2.9 mg/L,
serum urea 213 mg/dL,
creatinine 8.9 mg/dL,
sodium 134 mEq/L,
potassium 5.9 mEq/L,
chloride 108 mEq/L,
calcium 6.1 mg/dL,
phosphorous 5.8 mg/dL,
uric acid 7.2 mg/dL,
protein 5.5 g/dL,
albumin 2.9 g/dL,
bilirubin 1.6 mg/dL,
aspartate aminotransferase 724 IU/L,
alanine aminotransferase 534 IU/L,
alkaline phosphatase 432 U/L,
cholesterol 130 mg/dL,
random blood sugar 89 mg/dL,
serum creatine phosphokinase 18,000 U/L,
and lactate dehydrogenase 2,412 IU/L.
Arterial blood gas revealed pH 7.35,
paO2 83.3 mmHg,
paCO2 23.6,
HCO3 12.7 mEq/L,
and SaO2 92.2%.
Urine examination showed albumin 2+,
sugar nil,
pus cells 6–8 per high power field, the culture was sterile, and
24-hour urine protein was 0.4 g.
Viral serology for hepatitis B, hepatitis C, and human immunodeficiency virus were negative.
Electrocardiogram was normal.
Ultrasound examination showed intrauterine pregnancy with a single living fetus.
Patient was diagnosed as __________________ secondary to ________________due to
exposure to a poison sting. She was treated with polyvalent anti-snake venom (ASV) serum
injection manufactured by the Haffkine Institute (Mumbai, India), which neutralizes four most
important venomous species in India (Indian cobra, Naja naja; common krait, Bungarus
caeruleus; Russell's viper, Daboia russelli; saw-scaled viper, Echis carinatus). It was administered
as an intravenous infusion over 1 hour after reconstituting 10 vials of lyophilized ASV in 250 mL
of isotonic saline. No adverse reaction to its administration was observed. The coagulation
abnormality was corrected as observed by a repeat 20WBCT done at 6 hours. She was transfused
four units of blood and provided other supportive treatment. She received four sessions of
hemodialysis. The course of renal function tests, hemodialysis treatment, and urine output are
shown in Figure 1 . The fetal well-being was confirmed by ultrasound examination at discharge.
The renal functions had normalized on follow-up at 2 weeks. She delivered a live healthy male
baby at 40 weeks of gestation.

Figure 1
Renal function test, urine output and hemodialysis treatment graph
 TEACHING AND LEARNING ACTIVITIES

Day 1

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session
Problem • Orientation • Forging • Develop an
PBL tutorial 1 encounter • Individual reading, professionalism environment of
(2 hours) Induction into reflection and • Notes and mind learning, sharing,
collaborative inquiry map (concept map) collegiality and
learning • Commitment to of discussion professionalism
Problem team roles and to • Journal (list) of through appropriate
clarification group problem statement ice-breaking
• Brainstorming and activities
articulation of • Present problem
probable issues situation
• Consensus on • Facilitate
problem statement communication,
problem inquiry,
clarification,
identification,
definition and
delimitation

Self-Directed • Deliberation of problem scenario and statements

learning • Initiation of problem analysis
(2 hours)

Day 1 (Continuation)

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session
PBL tutorial 2 Problem • Brainstorming and • Journal of • Facilitate and guide
(2 hours) analysis and analysis of problem problem inquiry identification of key
learning issues (e.g generation of • List of inquiries, learning objectives
possible explanation, ideas • Ensure learning and
explanation, and hypothesis ownership of
hypothesis etc) • Statement of learning objectives
• Identification of learning issues • Provide guidance on
learning issues and and objectives possible sources of
formulation of • Statement of information for
learning objectives learning contract reading and
• Assignment of self- on self-directed research
directed learning learning and peer
and peer teaching teaching roles

Self-Directed • Identification of sources of information; reading, studying and research with a view to
learning offering informed explanation for the problem and teaching peers on topic
(2 hours) • Preparation of pointers and notes for sharing and teaching
 Day 2

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session
PBL tutorial 3 Discovery and • Report on self- • Evidence of • Probe and question
(2 hours) reporting directed learning integration and to facilitate learning
• Peer teaching consolidation of of key concepts,
information as a principles and
group and as theories
individual • Provide
• Statement on comprehensive and
sources of learning, critical evaluation
information and and statement of
research research resources

Self-Directed
learning • Further self-study and research
(2 hours)

Day 3

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session
PBL tutorial 4 Preparation of • Synthesis of findings • Evidence of • Probe and question
(2 hours) solution for presentation integration and to facilitate
presentation consolidation of learning of key
information as a concepts, principles
group and as and theories
individual (Initial • Provide
Draft of concept comprehensive and
map and other critical evaluation
templates)

• Written Reports
have In-text and
post text citation
or statement on
sources of learning,
information and
research
Self-Directed
learning • Further self-study and research
(2 hours) (As needed)
 Day 3 (Continuation)

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session

PBL tutorial 5 Solution • Group presentation • Presentation • Facilitate and

(2 hours) presentation of findings package and or assess quality of
and reflection • Learning from other other Concept Map independent and
groups group work

Self-Directed
learning
• Compilation of group report and portfolio (Pathophysiology/Health Assessment
(2 hours) Report/Nursing Care Plans/Drug Study etc.

Day 4

Tutorial
Learning Stage Learners’ Activity Learners’ Deliverables CI’s Role
Session

PBL Tutorial Presentation , • Continuation of • Learning Portfolios, • Facilitate and

6 overview and group presentation reports of group assess quality of
(2 hours) evaluation of findings and individual independent and
• Group evaluation of reviews and group evaluation
process and learning evaluation
experiences • Summarize key
• Summary and learning theories
integration

Annex:

a. Rubrics for grading PBL

b. KNL Template
c. Template for NCP
d. Template for Drug Study
e. Template for Health Teaching Plan
f. Template for Discharge Plan
g. RLE Grade Sheet
h. Others (Specify)
 OLIVAREZ COLLEGE TAGAYTAY
COLLEGE OF NURSING

NCM 118 | RLE

RLE-PBL GRADING SHEET

Inclusive Dates: ROTATION No. & Place:

Requirements
Final
Name Remarks
Grade

Performance Peer
Assessment
Evaluation Evaluation
60% 20% 20%

Submitted by:

Name and Signature of Clinical Instructor

 OLIVAREZ COLLEGE-TAGAYTAY
College of Nursing and Health Related Sciences
E. Aguinaldo Highway, San Jose, Tagaytay City
NCM 118 | RLE
PROBLEM BASED LEARNING CRITERIA
Components Learning Document/ Process Assessment Highest Actual
Marks Mark
Problem and Problem Problem statement Clarity and definition 5
learning encounter and of problem
issues development of List of inquiries and Thinking skills as
(10 marks) learning generation of evident by quantity
objectives hypotheses and quality of ideas 5
and hypotheses
Formulation of
learning objectives Comprehensiveness
and quality of
learning objectives
Group work Reporting, peer Reporting and peer Peer evaluation 5
(20 marks) teaching teaching
Group Quality of solution 15
presentation Group presentation (ideas and research)
and presentation
Learning to Writing of Individual portfolio: Integration of group 10
learn portfolio and your learning and presentation and
(30 marks) reflective essay learning from others individual work
(1,500- 2,000 words)
20
Reflection on learning Criteria reflection and
and the learner understanding of
learning and the
(2,500- 3,000 words) learner. Articulation
of solution and
personal view and
belief underpinned by
informed knowledge,
theories and
contextualization
Total 60

Clinical Area: SKILLS ENHANCEMENT Date:

Year level/Group: BSN 4th | Group A Total Grade:

Name and Signature of Clinical Instructor

 College of Nursing and Health Related Sciences
E. Aguinaldo Highway, San Jose, Tagaytay City
NCM 118 | RLE
PROBLEM BASED LEARNING CRITERIA
Components Learning Document/ Process Assessment Highest Actual
Marks Mark
Problem and Problem Problem statement Clarity and definition 5
learning encounter and of problem
issues development of List of inquiries and Thinking skills as
(10 marks) learning generation of evident by quantity
objectives hypotheses and quality of ideas 5
and hypotheses
Formulation of
learning objectives Comprehensiveness
and quality of
learning objectives
Group work Reporting, peer Reporting and peer Peer evaluation 5
(20 marks) teaching teaching
Group Quality of solution 15
presentation Group presentation (ideas and research)
and presentation
Learning to Writing of Individual portfolio: Integration of group 10
learn portfolio and your learning and presentation and
(30 marks) reflective essay learning from others individual work
(1,500- 2,000 words)
20
Reflection on learning Criteria reflection and
and the learner understanding of
learning and the
(2,500- 3,000 words) learner. Articulation
of solution and
personal view and
belief underpinned by
informed knowledge,
theories and
contextualization
Total 60

Clinical Area: SKILLS ENHANCEMENT Date:

Year level/Group: BSN 4th | Group B Total Grade:

Name and Signature of Clinical Instructor

 OLIVAREZ COLLEGE-TAGAYTAY
College of Nursing and Health Related Sciences
E. Aguinaldo Highway, San Jose, Tagaytay City
NCM 118 | RLE

Clinical Area: _______________________________ Date: __________________

Year level/Group: _________ Total Grade: __________________

PEER EVALUATION FORM

Direction: Please assess the work of you and your colleagues by using the following criteria. We
will consider your feedback in assigning the grade for the output. Please try to be as honest and
fair as possible in your assessment. Encircle the corresponding score for each criterion.

Legend: 10 – excellent, 8 - very good, 6- sufficient, 4 - insufficient, 2- little or weak

Name of Group Leader: Name: Name: Name:

Members

Attitude
(Positive and
helpfulness)
Participation
(Commitment and
sharing)
Communication
(clarity and sensitivity)
Enthusiasm
(motivate self and
others)
Resourcefulness
(quality and
comprehensiveness of
contribution)

__________________________________
Name and Signature of Clinical Instructor

PREPARED BY: SUBMITTED TO:

CLINICAL INSTRUCTOR CLINICAL COORDINATOR