Conrad 1. Stanitski and Curtis T. Sears, Jr.
Georgio State University Atlanta, 30303
II
A New Chemistry Pr~grcllnfor Nursing and Allied Health Students
There were approximately 250,000 students in training for allied health professions in the United States during 1972. The majority of these students (213,000) were in nursing programs. A number of educational options are available to allied health students: (1) two-year associate degree programs; (2) four-year baccalaureate degree programs; additionally, (3) nurses can enter three-year diploma school programs. Regardless of the allied health or nursing program chosen, most of these students are required to successfully complete a t least one chemistry course; yet, few courses designed with an allied health orientation have been reported.'.= Generally, paramedical students are placed into courses ranging from the highly theoretical, principles oriented courses for chemistry and science majors to the fractionated, science-appreciation type courses for liberal arts students. The paramedical or nursing student is in a curious academic position-not a science major and yet certainly not a non-science major either. Typically, these students enterina the first chemistry course are science-shy with backgrounds in s e c o n d a ~ s c h o o lchemistry ranging from none to adequate. Health care students will use scientific knowledge and techniques during the execution of professional duties. Recognizing these features, we revised our course sequence for paramedical students (Chemistry 101 and 102) to better meet these students' needs. Input was obtained from nursing school administrators, professors of allied health sciences, and nursing educators. Due to the students' diverse backgrounds, the decision was made not to require a high school chemistry prerequisite for the revised Chemistry 101-102 sequence. Sources of students in these courses a t Georgia State University are: (1) students enrolled in the associate and haccalaureate degree programs; (2) students enrolled in the Georgia State University B.S. in Nursing degree program; (3) adjunct students from three Atlanta hospital R.N. diploma programs. These students presently account for the majority of the students enrolled in the two course sequence. For the 1971 through 1973 academic years, the yearly Chemistry 101 and 102 enrollment has been 425, 450, and 480 students. The thrust of the revision has been to use biochemically significant substances and phenomena as a framework to describe chemical principles. In both courses topics are introduced and discussed around the unifyine theme that chemical structure and biological functionsarerrelated. In Chemistry 101 we especiallv wanted to replace traditional inorganic examples- with biochemically and physiologically important ones. To do this required shifting the concepts of structure and functional groups in organic compounds from their usual second quarter placement into the generalized discussion of chemical honding presented early in the first course (see Table 1). The theme of electron transfer focuses on the relationships between ion formation, aggregation, and oxidation-
' Reoort of the Mt. Holvoke Conference: New Directions for the ~radi(ions1Curriculum, J: CHEM. EDUC., 50.23 (1973). 2Zubairi, M.Y., J. of Coll. Sci. Teach., 3,58, October, 1973. 226
/ Journal of Chemical Education
reduction. The latter is used preliminarily to discuss the electron transport system in biological organisms. Discussions involving electron sharing include coordinate covalent bonding. In addition to these bonding topics, the ideas and consequences of structural and geometric isomerism in organic compounds are brought forth. The establishment of this working background of bonding in organic compouuds makes possible the early introduction of biologically important examples into the study of reaction rates, catalysis, equilibrium, and acid-base interactions (see Table 2). Catalysis is described through enzyme action. This allows a logical lead-in to the actions of poisons and pharmaceuticals such as nerve gases, insecticides, and sulfa drugs. It also points out the structure-function relationship. Dialysis is studied via kidney action. The glycogen-glucose balance is used as a model for the discussion of reaction rates and equilibrium. Le Chatelier's Principle is applied to the glycogen-glucose balance relating physiological demands placed on this system. Beginning with Arrhenius acid-base concepts, the relationship between hydrogen ion concentration and pH is established. The discussion of Bronsted-Lowry theory and Table 1. Chemistry 101-Structure and Bonding Sequence I. Atomic Structure-Valenee Shell Model 11. Bonding and Structural Features A. Electron Transfer ion formation ionic bonding oaidation-reduction in biological systems including the electron transport smtem Covalent Bonding 1. e1eCtronegntivity 2. nonpolar and wlar covalent bonding 3. hydrogen ho"ding 4. coordinate covalent bonding-hemoglobin 6. strucLura1 isomerism 6. functional groups 7. .eo,etric isomerism 1.
2. 3.
B.
Table 2. Chemistry 101-Midcourse Topic Sequence I. Solution. A. B.
Qualitative Quantitative 1. weight/volume percent ,d m01atity 3. stoichiometry 4. osmo1sritv 11. Reaction ~ y n a m i i s A. Energetics of Reactions B. Factors Affecting Reaction Rates 1. concentration ~
~~
3. cat&& Enzymatic Reactions 1. structural features 2. action of enzymes a. ~ r n * i d . & b. urea= 3. control a. normal b. drum-1sulfa .. . d r u- d. c. poiaona 111. Introduction to Equilibrium A. Solubility B. osmosis C. Colloids and Dialyeikkidney function D. Le Chstelier's Principle-glyeogen/glumse C.
strengths of acids and bases uses biologically significant acids and bases, e.g. lactic, pyruvic, carbonic, and citric acids, and their conjugate bases. Thus, buffer action in biological systems can be dealt with. The overtaxing of body buffers is illustrated using diabetes mellitus for metabolic acidosis and respiratory action leading to acidosis or alkalosis. Le Chatelier's Principle is applied to the simultaneous hemoglobin oxygenation and blood pH equilibria. Since the concept of Bronsted acids and bases has been established, this allows amino acid structure and behavior to be presented. Zwitterion formation and the buffering action of amino acids evolve from this (see Table 3). The water solubilizing effect of forming the hydrochloride derivative of water-insoluble drugs containing amine groups is considered. Chemistry 102 builds upon the principles established in Chemistry 101 to present the chemical nature of additional biochemically significant moieties. It incorporates features of chemical structure and reactivity as they relate to metabolism, drug action, and hereditary diseases (see Table 4). The study of organic reactions is limited to those which will be used directlv throuehout the remainder of the course. These include: hydration, esterification, amide formation, anhydride formation, hydrogenation, hydrolysis, oxidation of alcohols, reduction of carbonyl comnounds, disulfide formation. hemiacetal and acetal formation. carbohydrate, lipid, and protein structures and metabolism are described within the context of these reactions. It is our intent that students not memorize the structures and reactioniof metabolites. Instead, during discussion of metabolism, emphasis is placed upon relating chances in metabolite functional groups . . with the general type reactions mentioned above. Hy initially associating the c~tricacid cycle w ~ t hhem oxidation o f ~ f a t s ,the subsequent discussion of carbohydrate metabolism naturally leads into the topic of diabetes mellitus. Other abnormalities such as galactosemia, sickle-cell anemia, and phenylketonuria are described a t the molecular level. Oxidation and reduction are amplified by describing the electron transport system in greater detail than before. The chemistry of respiration is treated again, this time in greater detail, to illustrate the internlav . . of .DH.. bufferine.-. and eauilibria adiustment in ohvsi." ological events. The coveraee of bodv fluids and electrolvte balance uses to advantage the previous discussion of hormones. Aldosterone and vasopressin are used to exemplify hormonal control in effecting electrolyte balance and kidney function. The revision has a sound basis in terms of chemical coherence and avoids the traditional and arbitrary division of bonding under the headings: inorganic, organic, and biological chemistry. The revision has allowed a chemistry-based discussion of physiologically related examples and phenomena to begin much earlier than is possible under the traditional format. In this way, the student sees the application of chemical principles and the reasons why health care personnel need to be familiar with them. Student interest and awareness have been heightened because of the revision. Class discussion has also in-
-
Table 3. Chemistry 101-Course Ending .Topic . Sequence Acid-Base Related Equilibria A. Arrheniua caneerrte
E.
2. amino acids Aksllosis and Acidosis
Table 4. Chemistry 102-Primary
Topic Sequence
I. Almhols and Their Derivatives A. Alcohols B. Aldehydes C. Ketones D. Hemiseetsls and Aeetsls E. Stereoisomerism F. Carbohydrates 1. Haworth pmiectiona 2. monosaccharides 3. disaccharides 4. po1ysaccharid.s 11. Acid-Base Derivatives A. Anhydrides B. Esters and Lipids C. A d d e s 1. Proteins a. structural features b. denaturation D. Chemistry of Respiration 111. Lipid Metabolism A. ADPIATP Structures and Energetics B. Catabolism 1. beta oxidation 2. citric acid cycle C. Anabolism IV. Carbohydrate Metabolism A. Glycolysis B. GlyeogenesisShort Term Storage C. Interaction with Lipid MetabolismLong Term Storage D. Abnormalities 1. ga1actosemia 2. diabetes meuitus V. protein Metabolism A. Degradation B. Trans and ueamination Related to Lipid and Carbohydrate Metabolism C. D N A and RNA
VI.
3. albinism Hormones
-....~ ...-
A.
B.
UrineISerum Ratios E k t r o l v t e Balance
creased. The revision has created an unexpected bonus in the form of curricular changes in the nursing programs. Deletion of certain topics and expansion of others have occurred because of the application emphasis given these in the revised chemistry courses. Pharmacology, nutrition, drugs, and solutions are among topics which have undergone redirection in the nursing programs. An accompanying laboratory program based upon qualitative and quantitative analyses of body fluids has been implemented. This work has been described e1sewhere.s 3Stanitski, C. and Sears, C. T., J. of Coll. Sci. Teach., 3, 263, April, 1974.
Volume 52, Number 4, April 1975
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