¶ … blueprints remain an important aspect to any teaching practice similar to how architecture is to the construction industry. A significant reason for the use and development of test blueprints within the teaching profession is to allow interpretation and expression of the differences in understanding and viewpoints of the term test' by teachers and students alike. Furthermore, students and teachers alike become progressively likely to have opposing expectations and thoughts in regards to the contents of a test. It is because of this, teachers are tasked with averting such confusions over the nature of a test. Test blueprints are a valid and reliable tool to help teachers make sound judgments regarding test scores prior to administering a test. "It is a useful tool for guiding the work of the item writer so that sufficient items are developed at the appropriate level to test important content and objectives" (Oermann & Gaberson, 2013, p. 60). Introduction from the Lesson Plan

For this lesson plan on teaching electrolyte imbalance in ostomy patients, tests administered to students will be based on the development of a test blueprint to help ensure teachers make valid judgments. The students should have a deep understanding of the subject matters being discussed. The test contains 50 questions which are meant to test every aspect of the classroom experience taught.

Lesson Plan

An ostomy refers to the surgically formed opening in a person's body for the release of bodily wastes like feces. People have seen bags attached to patients with feces inside. That is called a colostomy bag or an ostomy pouching system. A stoma is the end of the ureter/small/large bowel that can be seen bulging through the abdominal wall. There are various ostomy procedures that will be covered briefly later on.

Ostomy management starts within the preoperative phase, continuing post-surgery. Aside from the various steps needed to keep the patient healthy, one important aspect of ostomy management is electrolyte imbalance. Electrolyte imbalance may happen due to high-volume ileostomy output. A nurse must learn to recognize the symptoms and signs of electrolyte balance/dehydration. They include:

1. Dry skin and oral mucous membranes.

2. Muscle cramps

3. Extreme thirst

4. Headache, dizziness

5. Decreased urine output

6. Shortness of breath

7. Weakness, fatigue

8. Orthostatic hypotension

9. Abdominal cramps, vomiting, and nausea (Lippincott., 2006).

Hot weather also plays a role in the risk for electrolyte imbalance and dehydration development due to fluid loss via sweating/perspiration. By telling patients to drink enough fluids (enough would equal to one quart of urine per day), proper hydration can be maintained.

Fluids are an important part of staying hydrated. Another is electrolytes themselves. Electrolytes consist of potassium, magnesium, and sodium (Mullen & McGinn, 2008). The body needs all three in order to function properly. High-potassium foods include bananas, white beans, and avocados. Salt is an easy additive to foods and magnesium exists in larger quantities in dark, leafy vegetables. By consuming a diet rich in dark, leafy greens, fruits, and legumes, the body has less chance of developing an electrolyte imbalance. Because perspiration involves the loss of fluid and mainly sodium, consuming extra sodium and fluid may help (unless contraindicated).

Ostomy care is important and fiber-rich foods can cause potential problems for a patient. Consuming them in small quantities may be advised when beginning ostomy care. This is what is known as a low-residue diet because it helps prevent food blockage through avoidance of difficult to digest or high-fiber foods. If food blockage is a concern, those undergoing ostomy care that wish to consume enough electrolytes can drink electrolyte rich sports drinks, or electrolyte tabs. They are convenient and can help alleviate dehydration.

To better understand these key terms, it is important to fully explore them. The first is dehydration. Dehydration often goes hand-in-hand with electrolyte imbalance. A person who is dehydrated experiences increased thirst, a sensation of dry mouth and dry skin. The patient has a decrease in urine output, may feel fatigued, and has stomach cramps. Some may also experience a shortness of breath.

Sodium loss is also a common occurrence with electrolyte imbalance. Patients experiencing sodium loss will have stomach cramps, a loss of appetite, fatigue, cold arms and/or legs, and may feel faint. Potassium loss also signals the possibility of a patient feeling muscle weakness, fatigue, a gassy, bloated feeling, ad decreased sensation in arms/legs. Treatment measures for these conditions are as follows.

Dehydration involves increasing fluids of any kind that do not act as a diuretic (juice, water, and milk). With sodium loss, patients can eat saltines, canned soups, pretzels, wieners, and tomato juices (Colwell & Carmel, 2015). With potassium loss, patients can eat oranges, bananas, avocados (highest available potassium per serving), carrots, potatoes, and nuts. Again, a sports drink has electrolytes...

As earlier mentioned, they are potassium, sodium, and magnesium. Electrolyte balance refers to combined levels of various electrolytes located within the blood. Proper balance of electrolytes allows for regulation of blood acidity, fluid amounts, muscle and never health, as well as other uses from fluid delivery to cells to oxygen distribution. When part of the large intestine is extracted, it impairs the body's ability to absorb and assimilate nutrients, especially electrolytes.
When an individual undergoes ostomy diversion surgery that includes urostomy, colostomy, and ileostomy, the probability of developing electrolyte deficiencies is higher. Those that have undergone an urostomy or an ileostomy are particularly inclined to develop electrolyte deficiencies because of persistent nausea, diarrhea, sweating, and high fever. Sports drinks are an option to replenish fluids and electrolytes, but only as a temporary boost. Homemade electrolyte drinks can easily be made with water, baking soda, salt substitute (potassium), and salt.

Learning Objectives or Outcomes in the Test Blueprint

The main objective is to test the knowledge that the students have been able to retain for the period of time taught. The goal of these exercises is to measure the student's understanding of the subject taught in the classrooms. This means understanding key terms and how to prevent complications. The learning goals are as follows:

1. Understanding the five main key terms: electrolytes, electrolyte imbalance, dehydration, ostomy, and sodium/potassium loss.

2. Understanding what sodium/potassium loss and dehydration does to the body i.e. Signs and symptoms.

3. Learning how to treat patients experiencing electrolyte imbalances via fluid and food recommendations.

4. Learning what may increase the risk of developing an electrolyte imbalance.

Multiple Choice Questions

1. What is the level of urine output needed to assess proper fluid intake for the day?

(a) 2 quarts

(b) Half a quart

(c) 2 cups

(d) 1 quart*

2. What electrolyte is lost most through perspiration?

a. Potassium

b. Sodium*

c. Water

d. Magnesium

3. What food is the best choice to help a patient raise their potassium levels?

a. Banana

b. Bread

c. Avocado*

d. Lemons

4. What ingredients can be used to make a homemade electrolyte drink?

a. Baking soda, water, salt, salt substitute*

b. Baking powder, water, salt, sugar

c. Baking powder, sugar, salt, salt substitute

d. Water, sugar, salt, baking soda

5. What is a symptom common with electrolyte imbalance?

a. Aggression

b. Lactation

c. Fatigue*

d. Depression

The five multiple choice questions try to cover recognition of symptoms of electrolyte imbalance and how to treat it. These questions help in understanding solutions to help patients experiencing electrolyte loss and recognize when appropriate intervention is needed. While the ostomy portion is not covered, the problems that come from the surgical procedure like dehydration and electrolyte imbalance are covered. For example, the homemade electrolyte drink can be something a patient learn to do at home to help provide an easy way to maintain electrolyte levels, helping to prevent potential problems with following an ostomy procedure (Pauly-O'Neill, Prion, & Nguyen, 2013).

Learning Scenario

Phillip is a 45-year-old man that underwent an ileostomy. During the operation, the surgeon made an opening in the abdomen called an ostomy, and pulled through a segment of the small intestine (also known as ileum) to make a stoma. In this instance, Phillip's colon was removed. The small intestine than remained to carry out the colon's function meaning it reabsorbs electrolytes and water. After the surgery had a rough recovery. He started to look pale with dry skin and always complained that he was thirsty and couldn't move much in the bed.

Phillip mentioned he felt tired all the time and when he tried to stand, collapsed back onto the bed in a seated position. He refused several meals claiming nausea and his urine output fell down to 3/4 a quart per day. He also expressed pain from muscle cramps. Before his symptoms developed, Phillip ate a diet high in processed foods with little fruits or vegetables. Each time he complained of thirst, he would drink juice or soda. In this scenario Phillip appears to complain about several things that are clear signs of dehydration and electrolyte imbalance.

The electrolyte imbalance can be seen from the fatigue and the muscle cramps as potassium helps with muscle cramps. Phillip may have gotten too much sodium from the processed food he was eating and not enough potassium or magnesium from lack of fruit and vegetables in his diet. Sugar depletes magnesium because magnesium is required to transform sugar into…