First official day of the semester today. I had a two hour lecture for my Clinical Assessment & Decisions subject which was about Health Assessment Frameworks and Clinical Nursing Processes. This is also one of the topics I've been reading up on over the last week.
A few of the main points are (this is my own summary btw, not directly copied):
When assessing a patient nurses consider not only physical variables to health but also things such as psychosocial, sociocultural, developmental, spiritual, environmental, etc.
The assessment generally begins with an interview about biographical data, current general health and reason for seeking care, health history, family health history, current medication, drug use (incl. alcohol, caffeine and cigarettes), family/roles/relationships/support network, work, leisure, nutrition and elimination, sleep, exercise and mobility, stress, and the list goes on. This is all subjective data because it is given by the patient.
After that, a physical examination by the nurse will reveal some objective data. The focus of the physical examination will depend on the perceived problem. One the nurse has collected enough information they can make diagnoses and start planning and implementing treatment.
Nursing diagnoses are about human reactions to health issues, which is different from a medical diagnosis. For example, rather than diagnosing emphysema (which would be the doctor's diagnosis), a nurse would diagnose "difficulty breathing" and plan and implement ways to help the patient breathe more easily. Medical diagnoses are relatively the same from person to person whereas nursing diagnoses are based on the patient's physical, sociocultural, psychological and spiritual response to an illness or health problem. The can be actual problems that need to be treated right away or potential problems that need to be prevented/monitored for. The responses vary from person to person depending on their state of being.
The last step is evaluation before the whole process is repeated again.
The lecturer was in Bendigo and it was by video teleconferencing. There were actually two lecture theatres at my campus due to the number of students, as well as ones in Shepparton, Mildura, and Albury-Wodonga. You could see all the different people up on the screen. It was kind of strange but I guess I'll get used to it.
I also did some reading today on Perioperative nursing (preparing a patient for surgery) and Pharmokinetics (the study of the factors determining the amount of a drug at a site where it can exert a biological effect at various times afer its administration into a biologic system).
Sunday, February 28, 2010
Wednesday, February 24, 2010
Shopping
Yesterday at uni I purchased my stethoscope and sphygmomenometer and watch clip. They come in lots of different colours, like ipods which is cute. I chose 'sea foam' for the stethoscope, green for the sphygmomenometer and purple for the watch. It would have been nice to have all the same colour but they're all different brands and not all colours were available, so that wasn't possible. I have to make sure I put name tags on all my equipment. I will put up photos. Can't wait to start using them. I think my first patient will be my cat Manny, I'll check his heatbeat, lol.
Have started printing out my subject guides and materials that are online. They don't give out paper copies anymore, you have to read it online or print it out yourself. I'm printing it out so I can take it with me to classes and so I don't spend more time starting at a computer screen than I already do!
SOOOOO much reading to do OMG!! But I'm trying not to let it overwhelm me, just go through it bit by bit. They keep telling us not to stress out and feel like we have to know everything when we're just beginning. However, there is A LOT to learn and do to get through and do well in the course. As well as lectures, group workshops, labs and clinical practice sessions, there is a pretty huge amount of reading, exercies and audiovisual material that we have to do in our own time and organise time with other students.
This afternoon I have to buy another black printer cartridge. I bought one yesterday and used the entire thing printing out about 100 pages of course materials.
Next on my shopping list will be a digital thermometer and a pen torch . . . Manny should be worried, lol.
Have started printing out my subject guides and materials that are online. They don't give out paper copies anymore, you have to read it online or print it out yourself. I'm printing it out so I can take it with me to classes and so I don't spend more time starting at a computer screen than I already do!
SOOOOO much reading to do OMG!! But I'm trying not to let it overwhelm me, just go through it bit by bit. They keep telling us not to stress out and feel like we have to know everything when we're just beginning. However, there is A LOT to learn and do to get through and do well in the course. As well as lectures, group workshops, labs and clinical practice sessions, there is a pretty huge amount of reading, exercies and audiovisual material that we have to do in our own time and organise time with other students.
This afternoon I have to buy another black printer cartridge. I bought one yesterday and used the entire thing printing out about 100 pages of course materials.
Next on my shopping list will be a digital thermometer and a pen torch . . . Manny should be worried, lol.
Sunday, February 21, 2010
Self-directed Learning
Orientation is almost finished. I have to go in on Wednesday for a few hours but besides that I have this week free. However, there's a lot of self-directed learning I need to get through before classes start on March 1.
I borrowed a pile of books from the uni library and the main topics I'll be reading up on this week are:
1. Overview of professional nursing practice
2. Communication
3. Hygeine
4. Observation & Monitoring (including Vital Signs)
If I have time I'll also do a bit of the following:
5. Review of anatomy & physiology
6. Study skills
I've already done a bit of reading this weekend and this morning. I'm about to go get a massage now.
Ciao.
Tuesday, February 16, 2010
Vitals Assessment
This morning's lectures were about how to communicate with patients, use a mixture of open and yes or no questions, and how to do physical assessment. Tomorrow we will get a chance to practice our interviewing skills on each other.
At lunch time I went to order my uniform which I will wear during clinical placements. I ordered two 3/4 sleeve shirts which were $55 each and a name badge which was $10. Closer to the time I'll also need to get the following:
Stethoscope with ID tag $106
Fob Watch $20
Sphygmomenometer (Blood Pressure Kit) $48
Titanium Scissors $15
Titanium Forceps $15
Thermometer $10
Safety Glasses $10
Pouch with Strap $15
If I have to have all these things I guess we're going to be taking vitals a lot. Once I have all this stuff I'm going to start taking the vital signs of everyone who comes to my house, to practice . . . you have been warned, lol.
The afternoons prac demonstrated taking of vital signs and urine analysis as part of patient assessment.
At lunch time I went to order my uniform which I will wear during clinical placements. I ordered two 3/4 sleeve shirts which were $55 each and a name badge which was $10. Closer to the time I'll also need to get the following:
Stethoscope with ID tag $106
Fob Watch $20
Sphygmomenometer (Blood Pressure Kit) $48
Titanium Scissors $15
Titanium Forceps $15
Thermometer $10
Safety Glasses $10
Pouch with Strap $15
If I have to have all these things I guess we're going to be taking vitals a lot. Once I have all this stuff I'm going to start taking the vital signs of everyone who comes to my house, to practice . . . you have been warned, lol.
The afternoons prac demonstrated taking of vital signs and urine analysis as part of patient assessment.
Thursday, February 11, 2010
Timetable
Got my timetable today. We weren't able to choose our own groups for labs and workshops, which is usually the case. Apparently this semester the website that does the allocations wasn't ready or something so they chose our groups for us and said "DON'T TRY TO CHANGE YOUR TIMETABLE, IT'S NOT NEGOTIABLE". I'm happy I didn't get put in a group that has to start at 7 in the morning, but I'm disappointed that there are no breaks between any of my classes. This means I'll have to be really organised about making time to review lecture notes, go the library and eating. There's no way I'll have to time to buy something to eat between lectures and I generally need to eat something every 3 hours otherwise I can't concentrate, so i'll be preparing my own lunch and snacks (something healthy, like a banana or sandwich) that I can quickly chow down in the ten minute break we get between classes. I hope that'll be enough and I won't need coffee too.
Monday
1:00 – 3:00 Clinical Assessment Lecture
3:00 – 5:00 Medications Workshop
5:00 – 7:00 Medications Lab
Tuesday
12:00 – 2:00 Clinical Assessment Workshop
2:00 – 4:00 Acute Care Lecture
Wednesday
10:00 – 12:00 Clinical Assessment Lab
12:00 – 2:00 Acute Care Lab
2:00 – 3:00 Acute Care Lecture
Thursday
2:00 – 3:00 Medications Lecture
3:00 – 5:00 Acute Care Workshop
Friday
9:00 – 11:00 Medications Lecture
11:00 – 12:00 Clinical Assessment Lecture
12:00 – 2:00 Acute Care Workshop
If we're able to listen to the lectures online, it'll be possible for me to be available to work on Monday or Thursday mornings, just missing the first lecture and catching up on it later. For the last month or so I haven't worked and I don't have anything lined up in the near future either, but that's because it's hard to get work when your availability changes every week. Also I can only do teaching on weekdays which is when I have uni. Ideally I would like to work in my uni holidays which there will be plenty of (as long as I'm not doing clinical at that time - clinicals will be 40 hours a week!)
Monday
1:00 – 3:00 Clinical Assessment Lecture
3:00 – 5:00 Medications Workshop
5:00 – 7:00 Medications Lab
Tuesday
12:00 – 2:00 Clinical Assessment Workshop
2:00 – 4:00 Acute Care Lecture
Wednesday
10:00 – 12:00 Clinical Assessment Lab
12:00 – 2:00 Acute Care Lab
2:00 – 3:00 Acute Care Lecture
Thursday
2:00 – 3:00 Medications Lecture
3:00 – 5:00 Acute Care Workshop
Friday
9:00 – 11:00 Medications Lecture
11:00 – 12:00 Clinical Assessment Lecture
12:00 – 2:00 Acute Care Workshop
If we're able to listen to the lectures online, it'll be possible for me to be available to work on Monday or Thursday mornings, just missing the first lecture and catching up on it later. For the last month or so I haven't worked and I don't have anything lined up in the near future either, but that's because it's hard to get work when your availability changes every week. Also I can only do teaching on weekdays which is when I have uni. Ideally I would like to work in my uni holidays which there will be plenty of (as long as I'm not doing clinical at that time - clinicals will be 40 hours a week!)
Manual Handling
After handwashing we were shown two ways to move a patient in bed and out of bed. The first was the slide sheet. I couldn't find a video showing the whole slide sheet process but basically it requires two nurses to do it and it's function is to move the patient up in bed when they've slid down too far, without using your back muscles.
This family's solution was inventing their own machine one carer could use at home to move their son up in bed.
http://www.youtube.com/watch?v=gKSGXMeNl6U&feature=related
After that we were shown how to move a patient out of bed using a lifting machine with a body sling.
These machines require two nurses and can lift patients who weight up to 175kg. There are special machine for extremely large patients:
This is good representation of what we watched.
http://www.youtube.com/watch?v=ZXzSG9rCLHw&feature=related
We are allowed to and expected to book the clinical learning unit to practice these skills in our own time.
This family's solution was inventing their own machine one carer could use at home to move their son up in bed.
http://www.youtube.com/watch?v=gKSGXMeNl6U&feature=related
After that we were shown how to move a patient out of bed using a lifting machine with a body sling.
These machines require two nurses and can lift patients who weight up to 175kg. There are special machine for extremely large patients:
This is good representation of what we watched.
http://www.youtube.com/watch?v=ZXzSG9rCLHw&feature=related
We are allowed to and expected to book the clinical learning unit to practice these skills in our own time.
Handwashing
In today's afternoon session we went to the clinical learning unit which looks like a real clinic with about 8 beds and areas where nursing students can practice their clinical skills such as manual handling of a patient.
First we learned about handwashing. It was mainly the proper way to do it, they didn't really touch on the importance of it. It can be taken for granted but when handwashing was first introduced as a minimum hygeine standard in maternal wards, the number of mother and infant deaths went down by more than half. The ten steps of clinical handwashing (there is a different procedure for surgical) is :
http://www.youtube.com/watch?v=rrNJt73BG_8&feature=related
http://www.youtube.com/watch?v=mzmYGifo5To&feature=related
When we did it first we had to cover our hands with a lotion called Verify that would make our hands glow under UV light if we didn't wash it off sufficiently. This was how we could tell if our hands were still "contaminated" or clean.
First we learned about handwashing. It was mainly the proper way to do it, they didn't really touch on the importance of it. It can be taken for granted but when handwashing was first introduced as a minimum hygeine standard in maternal wards, the number of mother and infant deaths went down by more than half. The ten steps of clinical handwashing (there is a different procedure for surgical) is :
- Remove jewellery such as rings or a watch
- Wet hands with warm water (not hot or cold)
- apply soap (2 pumps) and rub palms together until soap is foamy
- rub each palm over the back of the other hand
- rub between your finger on each hand
- rub your finger tips on the palms of each hand
- rub around each of your thumbs
- rub in circles on your palms, covering the whole area
- rub all around each wrist and down at least five centimetres of your arm
- Rinse hands clean under warm running water
- Use a towel, elbow or foot (depending on type of sink) to turn of the tap. Do not use your hand.
- Pat your hands clean with paper towels, then dispose.
http://www.youtube.com/watch?v=rrNJt73BG_8&feature=related
http://www.youtube.com/watch?v=mzmYGifo5To&feature=related
When we did it first we had to cover our hands with a lotion called Verify that would make our hands glow under UV light if we didn't wash it off sufficiently. This was how we could tell if our hands were still "contaminated" or clean.
Ethics
Today's morning lectures were supposed to be on Nursing Ethics, however the teacher was sick and instead we were given the lecture notes and also sent of in groups to research the codes of conduct on on the internet and discuss them.
We read through what was on the Nurses Board of Victoria website and the Australian Nursing and Midwifery Council. We were told that in about six months time the state nursing associations will be absorbed into the national one.
We also did some library research for our UTI group project before lunch. I had lunch with another student who had done first year nursing at another uni and said after the first semester's clinicals around half the students did not come back the next semester, because they were that turned off by the physical and dirty work they had to do. I think if people are really turned off by that it is fair enough and it probably means that nursing is not the right career for them. I hope for that doesn't happen, if I find it really unpleasant I hope it just motivates me to specialise in some area of nursing where I will be doing other things that are more enjoyable and interesting.
We read through what was on the Nurses Board of Victoria website and the Australian Nursing and Midwifery Council. We were told that in about six months time the state nursing associations will be absorbed into the national one.
We also did some library research for our UTI group project before lunch. I had lunch with another student who had done first year nursing at another uni and said after the first semester's clinicals around half the students did not come back the next semester, because they were that turned off by the physical and dirty work they had to do. I think if people are really turned off by that it is fair enough and it probably means that nursing is not the right career for them. I hope for that doesn't happen, if I find it really unpleasant I hope it just motivates me to specialise in some area of nursing where I will be doing other things that are more enjoyable and interesting.
Group Research - Urinary Tract Infection
Yesterday's lectures were about the learning methods of the course including lectures, clinical workshops, clinical practice, self-directed learning, group work and applying the principle of Evidence Based Practice which means using the best precedent commonly used methods and doing appropriate research to ensure that is what's being practiced. In a way that is very similar to the study of law, except that nursing seems to involve A LOT more interaction with people, including the study of it. I've met a lot of people in the last two weeks and I haven't even started my classes yet.
We were put into groups after lunch and given a case study of an immobile patient admitted for two weeks of respite care. We have to come up with care plan that will address his pressure ulcers (bedsores), constipation and a urinary tract infection, as well as signs of anxiety and depression. My group got the urinary tract infection and now we are researching the nursing process for that to present to the rest of the groups next week.
The nursing process is an individualised problem-solving approach that involves these four stages:
We were put into groups after lunch and given a case study of an immobile patient admitted for two weeks of respite care. We have to come up with care plan that will address his pressure ulcers (bedsores), constipation and a urinary tract infection, as well as signs of anxiety and depression. My group got the urinary tract infection and now we are researching the nursing process for that to present to the rest of the groups next week.
The nursing process is an individualised problem-solving approach that involves these four stages:
- Assessment (of the patient's health and problems). As for diagnoses, they have to be made by a doctor, while nurses diagnose issues and risk factors.
- Planning (for treatment of the problems, this may mean referring them to a doctor or specialist for certain things)
- Implementation (of the plans)
- Evaluation (of their success)
Tuesday, February 9, 2010
Results are in!
Yesterday was the first day of the Orientation for my course. The night before it was so hot (35) and humid I couldn't get to sleep till about 3am. I did not feel fresh at all when I woke up at about 7 and ended up sneaking in a bit of extra sleep. Consequently I missed the morning session which was an intro lecture, overview of the faculty or some such thing. I did about half an hour of dancing to my So You Think You Can Dance fitness DVD* (see review below) after I got up and I felt heaps better. I wish I could exercise in the morning more often. I made it to the afternoon lectures which were about our clinical placements and study skills, and found out from other students what information I had missed in the morning. Very little luckily!
After I got home I went to the gym and did some more fitness (cardio) and popped into the supermarket to stock up on bananas. When I got home I checked my email and there were my results from Anatomy & Physiology - 89%! I'm very pleased with that. I got 58/60 for the practical work and 31/40 on the test. So I was right about how many answers I knew! The scores for everyone ranged from 74 - 94. Overall I'm happy with the result and what I learned in that one week.
Last night there was a documentary on SBS called "The Children's Ward" which I watched. It was about an Italian medical NGO called Emergency which has set up free children's wards in Afghanistan and Sudan. All the children in the Afghanistan ward were victim of exploding landmines and had horrific injuries to their hands and/or legs. In many cases they had to amputate. It was really harrowing, I think it would be very sad to do this kind of pediatric medicine. In Sudan, the main patient was a 15 year old boy with rheumatic heart disease which if left untreated would mean he only had about 6 months to live. They gave him open heart surgery and repaired his heart.
After I got home I went to the gym and did some more fitness (cardio) and popped into the supermarket to stock up on bananas. When I got home I checked my email and there were my results from Anatomy & Physiology - 89%! I'm very pleased with that. I got 58/60 for the practical work and 31/40 on the test. So I was right about how many answers I knew! The scores for everyone ranged from 74 - 94. Overall I'm happy with the result and what I learned in that one week.
Last night there was a documentary on SBS called "The Children's Ward" which I watched. It was about an Italian medical NGO called Emergency which has set up free children's wards in Afghanistan and Sudan. All the children in the Afghanistan ward were victim of exploding landmines and had horrific injuries to their hands and/or legs. In many cases they had to amputate. It was really harrowing, I think it would be very sad to do this kind of pediatric medicine. In Sudan, the main patient was a 15 year old boy with rheumatic heart disease which if left untreated would mean he only had about 6 months to live. They gave him open heart surgery and repaired his heart.
*DVD Review - So You Think You Can Dance: Tone & Groove
I bought this DVD a couple of months ago with a JB Hifi birthday gift voucher for about $20. It's also available on Amazon for about $12 and you get 3 dance workouts plus a separate warm up and cool down. So works out cheaper than going to a class and of course if you like it you can do it again and again. The instructors are contestants from the American series of the show. I've now done all three so here's what I thought of them:
Jazz with Katee
· This got my heart pumping. It’s a bit like an aerobics/jazzercise lesson with a few of the basic jazz steps thrown in. Katee seems like a good teacher but overall I found this routine and the music it goes with a bit boring. The house also shook quite a lot while I did this one so I probably won’t do it again. The warm up is a great body loosener for the morning. Together this took about 30 minutes.
Cha Cha with Dmitry
· I really liked this one. I’ve always wanted to try the cha cha because it looks like fun and it is! The steps are uncomplicated and from then on it’s all about style and making it smooth. I love Dmitry too and there wasn’t any jumping around so the house didn’t shake. That means I’ll be able to do this one as a morning workout. I also did the cool down this time. All up it took 30 minutes and I’ll definitely do this one again.
Hip Hop with Twitch
· Out of the 3 Tone & Groove workouts this one was the easiest for me to learn and probably my favourite. The steps were easy but still “hip hop” and energetic. Twitch is so awesome, I love his personality and his dance style. I can tell he’s a great teacher too. I’ll definitely being doing this workout again.
I also have another SYTYCD workout DVD which has contemporary, hip hop and disco!Today I am excited about:
- doing gymnastics (I haven't been to a class in over 3 years)
- Ellen's debut on the judging panel of American Idol
Time to jump in the shower now and get ready for another day of Orientation.
Thursday, February 4, 2010
Day 5 Finished!
Anatomy & Physiology Bridging course over! We had lectures on the Digestive System and Reproductive System today and then the exam after lunch. It was 50 multiple choice questions and I felt confident about my answer for about 40 of the questions. The rest I just made an educated guess. I'll get my results next week, Monday or Tuesday, and Tuesday's also my next day that I have uni. Next is a two week orientation specifically my course. Thankfully the orientation is only on Tuesdays, Wednesdays, and Thursdays.
If you're interested in looking or want to try the online quizzes I did yourself this is a link to the website. It also has course content on there which I had a look at, and it's pretty similar to my course, only more comprehensive.
http://lrn.org/Content/Quizzes/Quizlist.html
If you're interested in looking or want to try the online quizzes I did yourself this is a link to the website. It also has course content on there which I had a look at, and it's pretty similar to my course, only more comprehensive.
http://lrn.org/Content/Quizzes/Quizlist.html
Day 4 Anatomy & Physiology
Today we learned about the Respiratory System and Urinary System. For the Prac we measured pH levels of various liquids including coffee and coke (both very acidic). We also did some practice multiple choice questions for the test tomorrow. I've done quite a bit of review this week and I know I won't get 100% on the test, nor do I need to, but I'm sure I will pass and hopefully get quite a few answers right.
I did the quizzes for:
One of the biggest challenges this week has actually been getting up early (6am) and also getting to sleep because it's been so hot and humid. Tonight it's a lot cooler though because we've just had some rain.
This week feels like it's gone really slowly, but it's been enjoyable nonetheless.
Good night :-)
I did the quizzes for:
- Respiratory System - 40%
- Urinary System - 80%
One of the biggest challenges this week has actually been getting up early (6am) and also getting to sleep because it's been so hot and humid. Tonight it's a lot cooler though because we've just had some rain.
This week feels like it's gone really slowly, but it's been enjoyable nonetheless.
Good night :-)
Wednesday, February 3, 2010
Immunity
Yay! I don't have to get anymore vaccinations because I've just been informed by my doctor that I'm immune to Hepatitis A, Hepatitis B, Measles, Mumps, Rubella, Pertussis (whooping cough), and Varicella (Chickenpox).... Woo-hooooooo!!
Tuesday, February 2, 2010
Random
By the way, I don't know why the date on these blog posts is coming up as the day before. Must be on US time or something. Anyway, right now it is Wednesday Feb 3rd and it's 5:10pm~!
Day 2 and 3 Anatomy & Physiology
Tuesday
Nervous System & Endocrine System, both fascinating topics. Also paid a visit to the library and had a look at the nursing collection. Borrowed the Anatomy and Physiology book we are using for this course. So glad I didn't buy it because it's about $100 but there were HEAPS of copies in the library, like 20. But it's far too big for a one-week course and too heavy to carry around, so I also borrowed the simplified version by the same author which is specially for 'Short courses' (like mine), and I'm taking that to classes each day and keeping the big book at home.
Wednesday
Blood, Cardiovascular System and Lymphatic System were today's topics. Blood and the Cardiovascular system were both really interesting, but they rushed over the Lymphatic system so maybe they don't expect us to know as much about that, although in most of books I've looked at a whole chapter is devoted to it. The afternoon Practical Session included disecting a mammalian heart (sheep), measuring the electrical activity of the heart on the computer, and measuring blood pressure using a sphygmometer. We did these things in small groups of 4 or 5 students.
When I got home I did a couple more online quizzes and these were my results:
Cardiovascular System - 90%
Blood - 50%
Lymphatic System - 60%
The review questions in the textbooks cover too many details. A lot of them ask about things we haven't learned in this course and there are so many questions. On the final test there will only be 50 questions though. Also, 60% of the assessment is our answer book from the practical sessions. There are about 3 or 4 topics to write about or draw each day and we hand those in each day. The last days lecture topics which are the Digestive system and the Reproductive system won't be on the test and I don't think we have Practicals for those either, so tomorrow will be the last day of assessable material, which is the Respiratory system and the Urinary system.
Nervous System & Endocrine System, both fascinating topics. Also paid a visit to the library and had a look at the nursing collection. Borrowed the Anatomy and Physiology book we are using for this course. So glad I didn't buy it because it's about $100 but there were HEAPS of copies in the library, like 20. But it's far too big for a one-week course and too heavy to carry around, so I also borrowed the simplified version by the same author which is specially for 'Short courses' (like mine), and I'm taking that to classes each day and keeping the big book at home.
Wednesday
Blood, Cardiovascular System and Lymphatic System were today's topics. Blood and the Cardiovascular system were both really interesting, but they rushed over the Lymphatic system so maybe they don't expect us to know as much about that, although in most of books I've looked at a whole chapter is devoted to it. The afternoon Practical Session included disecting a mammalian heart (sheep), measuring the electrical activity of the heart on the computer, and measuring blood pressure using a sphygmometer. We did these things in small groups of 4 or 5 students.
When I got home I did a couple more online quizzes and these were my results:
Cardiovascular System - 90%
Blood - 50%
Lymphatic System - 60%
The review questions in the textbooks cover too many details. A lot of them ask about things we haven't learned in this course and there are so many questions. On the final test there will only be 50 questions though. Also, 60% of the assessment is our answer book from the practical sessions. There are about 3 or 4 topics to write about or draw each day and we hand those in each day. The last days lecture topics which are the Digestive system and the Reproductive system won't be on the test and I don't think we have Practicals for those either, so tomorrow will be the last day of assessable material, which is the Respiratory system and the Urinary system.
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