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A healthy 50-year-old woman comes to her primary care physician’s office. She has early osteoarthritis in her knees, hips, and feet. She has been taking ibuprofen with some relief, but is reluctant to be on long-term medication. She asks if acupuncture could be an effective treatment for her arthritis. Her primary care physician asks you to research this and let him know what you find before the patient’s next appointment.

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I Have practice PICOT questions that I would like to see if my answers are close to correct. Read the scenario, choose the one form of PICOT question that fits the scenario. state if its INTERVENTION ETIOLOGY, DIAGNOSIS OR DIAGNOSTIC TEST, PROGNOSIS/PREDICTION, or MEANING

PICOT Scenarios

1. The patient is a 73-year-old white woman admitted to the hospital with heart failure. She is compliant and seldom misses her medications. On admission, her medications were furosemide 40 mg po qd, enalapril 20 mg po bid, simvastatin 10 mg po qd, and aspirin 325 mg po qd. She usually functions at a NYHA class II level. She now has had two admissions for congestive heart failure in the past 4 months. On this admission, a myocardial infarction has already been ruled out and she remains in sinus rhythm. She has normal renal function with a serum creatinine of 0.7 mg/dL. The patient is particularly concerned about staying out of the hospital because she is very active in her community, lives alone, and has no one to care for her pets and plants. The primary care provider asks the team if digoxin would help shorten her hospital stay or keep her from being readmitted. You are asked to do a PubMed search and bring the answer to morning rounds.

2. Patient is a 73-year-old female in good health with normal cholesterol levels and no chronic diseases. She comes to the clinic because she is starting to notice that she is forgetting things more often and having problems balancing her checkbook and playing brain teaser games with her grandchildren. Her husband says he hasn’t notice anything different about her. But she’s fearful that she might be “getting Alzheimer’s Disease”. She said her neighbor told her that Lipitor is supposed to help with the symptoms or maybe even prevent Alzheimer’s disease. She wants your advice. Would this help? You recall a few patients complaining about memory problems while on statins but don’t know the data on reducing the risk of AD or associated cognitive symptoms. You tell her you’ll get back to her. You ask her about any other medications she might be on and she tells you that she is taking Sporanox for a toe nail infection.

3. The patient is a 68-year-old African American male who has well-controlled hypertension, hyperlipidemia (on a statin) and GERD. He has a h/o MI 2 years ago with a reduced ejection fraction (EF) of 30% (i.e. left ventricular dysfunction). His functional status is NYHA Class III CHF. He is on aspirin, Atenolol, and an ACE-Inhibitor at the time of admission. He expresses concern that, given the state of his heart, he will not survive to see his grandson graduate from law school in 3 years. However, he also states that the quality of his life is important to him, specifically he does not wish to spend time in the hospital or live his life if he cannot be active and interact with his family. The cardiologist tells you that the implantation of a cardiac defibrillator can decrease all causes of mortality in these kinds of patients. However, the cardiologist says that ICD have significant costs and risk associated with them. They both turn to you and ask you to gather the current evidence so they can help the patient make a good decision.

4. AB is a 16-year-old female who was diagnosed with a rare, highly aggressive cancer last year. She has been undergoing intensive chemotherapy for several months and seems to be in remission. But the treatment has left her overwhelmed and depressed. It will take the insurance company 6 weeks to approve visits to a psychiatrist. In the meantime, she is feeling worse and falling into a deep funk. Her parents ask you for help and suggest that Prozac might help her. They tell you they have seen this advertised in magazines. You, however, are aware of the controversy with SSRIs and need to carefully review the evidence before responding to her parents.

5. You are a nursing student rotating in the ED. This is the first day of your rotation. The first case is a 34-year-old male complaining of lower abdominal pain, nausea and vomiting. The team suspects appendicitis and asks you as the new student which is the better diagnostic tool – a scan or an ultrasound? You are overcome with a feeling of uncertainty and a strong urge to review the literature and find some impressive evidence to bring back to your preceptor.

6. You are assessing a 27-year-old female who has trouble with migraines. She has daily headaches and is known to overuse pain medications. She currently uses ibuprofen and if that doesn’t work she uses Imitrex. She has tried nortriptyline 25mg before bedtime for the past month without success for prevention. She has no other medical problems and is not taking other medications & is not pregnant. Her vital signs are normal.

7. You are a recent graduate of the School of Nursing and are being oriented to your new position on a cardiothoracic stepdown unit at another hospital. In hopes of improving patient outcomes, bringing down postoperative complication and mortality rates, and decreasing length of stay in the hospital, the unit is investigating changing its practices in order to improve glycemic control in cardiac surgery patients. There has been growing concern among nurses and physicians over the association between poor glycemic control and poor outcomes following cardiac surgery (in non-diabetic as well as diabetic patients). The nurse manager has asked you to do a literature search on the topic and give a presentation at the next in-service conference.

8. A healthy 50-year-old woman comes to her primary care physician’s office. She has early osteoarthritis in her knees, hips, and feet. She has been taking ibuprofen with some relief, but is reluctant to be on long-term medication. She asks if acupuncture could be an effective treatment for her arthritis. Her primary care physician asks you to research this and let him know what you find before the patient’s next appointment.

9. A 46-year-old male had been moving rocks for his rock garden when he felt a twinge and his low back became excruciatingly painful. He’s come into the Emergency Room and is extremely unhappy and demanding an MRI. You thought CT was the standard for diagnosis. Is there data to support this?

The post A healthy 50-year-old woman comes to her primary care physician’s office. She has early osteoarthritis in her knees, hips, and feet. She has been taking ibuprofen with some relief, but is reluctant to be on long-term medication. She asks if acupuncture could be an effective treatment for her arthritis. Her primary care physician asks you to research this and let him know what you find before the patient’s next appointment. appeared first on Academicheroes.com.

 
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