Feb 23, 2024 NR 439 Week 1 Discussion Question, Role of Research and the Importance of the Searchable Clinical Question
A Sample Answer For the Assignment: NR 439 Week 1 Discussion Question, Role of Research and the Importance of the Searchable Clinical Question
Hello, Profesor Joy and class.
The case study I chose is about the 57 y.o. female diabetic with episodes of hypoglycemia. Here is my PICO:
P – 57 y.o female diabetic with a 13-year history of diabetes and episodes of hypoglycemia. keyword-Hypoglycemia
I – Lifestyle and diet changes. Keyword– Lifestyle and diet
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C – No change in lifestyle and diet.
O – Modification of lifestyle and diet combination. Keyword-modification
T – No time frame
Search question: Does modification of lifestyle and diet prevent hypoglycemia? The focus of the question is “Teaching”
I used two sources to obtained my information to answer my search questions. The first one is base on the explanation
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of Herto(2011), in which he stressed the classic signs of hypoglycemia and how hypoglycemia is monitored. Patients with hypoglycemia, insulin levels fluctuate and this lead to temporary insulin resistance. The brain shows an attempt to avoid permanent damage, by the symptoms of hypoglycemia. Herto explained how diet and lifestyle can have an impact on hypoglycemia by strategy and tactics.
The major factor with strategy is to stress to patients “Their body is doing what it should be doing giving their lifestyle they are living” (the brain, which is highly sensitive to glucose level, directs the body to do what needs to be done to raise the glucose to an acceptable level).” Patients must understand this to practice lifestyle and diet changes” In other words, the patient’s glucose response reacts to the patient’s lifestyle. Good clinical outcomes result from patient understanding this concept.
The patient can be thought the tactics aspect after she understands that what she does (diet and exercise) can impact her glucose level. Tactics involve teaching healthy diet along with shorter time period of high energy exercise. Diet will include breakfast( high protein, low glycemic snacks, and no deserts). Encourage patient not to skip meals or go long periods without meals. When the patient understands her diet, and recommendations of the lever of activities and recommendation of her diabetic diet, the process can help reduce surges of insulin and temporary insulin resistance.
The U.S. Dept (NIH) emphasized healthy meal and active lifestyle prevent hypoglycemia, but there has to be a balance between the diabetic meal and active lifestyle. The NIH article stated patients need to be taught meal pattern and what the diet should compose off. NIH stressed patient should be thought that snack must be taken during active or strenuous activity.
These articles provide the answer to my search question and conclude that modification of diet and lifestyle changes have to be made and balanced by this 57 y.o. diabetic patient to allow efficient insulin therapy and prevent hypoglycemia.
Herto, S.( 2011 ). Hypoglycemia – Strategies and Tactics for Winning. Nutritional Perspectives: Journal of the Council on Nutrition (NUTR PERSPECT), Oct. 2011; 3u(4):5-8:5-8(4p).
U.S.Department of Health and Human Resources. National Institute of Diabetic and Digestive and Kidney Disease. Health Information. Retrieved from: https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes
NR 439 Week 1 Discussion Question, Role of Research and the Importance of the Searchable Clinical Question
According to CCN 2017 week 1 lesson, evidence can form the basis of best practices for the nursing process (assessment, diagnosis, planning, implantation and evaluation). As we consider the who, what, where, when, why and how of the situation, we begin to formulate a clinical question that addresses these queries. The PICOT format is a way to develop a clinical question that leads itself to searching for evidence. PICOT is an acronym for:
P= Population of interest
I= Intervention of interest
C= Comparison of interest
O= Outcome of interest
T Time
The case study of a 57 year old female with a 13 year history of diabetes who presented to the hospital due to failure of oral hypoglycemic agents (OHAs) in controlling her sugar levels, for the last 3 years, and was using biphasic insulin aspart 30/70 for treatment. She is a regular swimmer and socially very active, which led to her to have irregular meals and so often goes into frequent hypoglycemia. Her lifestyle, eating habits, and the use of biphasic insulin are the contributing factors of her uncontrolled diabetes and hypoglycemia. In addressing this case study, I will formulate the PICOT as follows:
P= 57 year old female with 13 years history of diabetes
I=Teaching regarding diabetic management
C=No teaching regarding diabetic management
O=Improvement in diabetic management and reduction of diabetic crisis
T=Daily monitoring of fasting blood-sugar and postprandial blood-sugar levels x 3 months and monitoring HA1C levels every 3 months. Assessment of knowledge about diabetic management.
Clinical question after PICOT format:
Etiology and assessment: Does lifestyle (irregular meals )and biphasic insulin aspart 30/70 causes hypoglycemia on the female.
Treatment and Prognosis: With lifestyle modification(regular meals), teaching on diabetic management and insulin degludec help in controlling the ladies diabetes by maintaining her blood-sugar levels and HA1C within normal limits?
References
CCN (2017). Week 1 Lesson. NR-439 RN Evidence-Based Practice. Online lesson. Downers Grove, IL: DeVry Education. Group.CCN (2016).
It is a very accurate observation you have made regarding the patient’s perspective of a liberated diet with the use of insulin, and I agree with you as I have seen this myself.
I have to say though, one of the endocrinologists that I work with almost, inadvertently, leads patients to practice this in that he has them count their carbs for every meal and give a sliding scale accordingly with any additional amount for every 25 mg/dl above 100 mg/dl reading in their blood sugar. I don’t think that is his intention because he still gives nutritional education and encourages limited, consistent carbs, but I can almost see that’s why they start to think that way.
This conversation has helped me to identify this trend and now I will be sure to implement in my diabetic education for my patients as we have many diabetic patients!!!
Choose onecase study, and formulate one searchable, clinical question in the PICO(T) format. There are several potential questions that could … asked.
Identify whether the focus of your question is assessment, etiology, treatment, or prognosis.
Remember to integrate references.
Throughout nursing there are many situations where we come to think that evidence is needed in order to provide safer and improved care to our patients; along with effective and efficient nursing. Evidence based practice research has allowed for many improvements to occur in the health field. As our Week 1 Lesson explains, PICO (T) is a format used to help develop a clinical question which ultimately helps search for evidence.
The acronym PICO (T) stands for P = population of interest, I = intervention of interest, C = comparison of interest, O = outcome of interest, and lastly T = time (Week 1 Lesson). Sometimes while using the PICO(T) format not all elements are used in each clinical question. Our Week 1 Lesson gives the example of how time may not always be relevant and there also may not always be a comparison of interest (Week 1 Lesson).
In the article, What is your research question? An introduction to the PICOT format for clinicians, the authors further explain how “The PICOT format is a helpful approach for summarizing research questions that explore the effect of therapy” (John J. Riva, 2012). This article allowed me to better understand how to formulate a PICO(T) question. Population, implies the people you want to recruit for your study.
Intervention, the treatment you will provide to those enrolled in your study. Comparison, what exactly you plan on using as a reference to compare your treatment to. Outcome, what results you will measure to determine the effectiveness of your intervention. Time, the time frame for your data collection (John J. Riva, 2012).
For this week’s discussion, I have looked over the assigned article, Type 1 diabetes mellitus‑common cases, by Surender Kumar. This article focuses on 3 different cases studies involving individuals who have been diagnosed with diabetes. I have decided to focus on case study #2, the 57 y.o female with a history of diabetes. This patient’s problem seems to have to do a lot with irregular meals.
Seeing that the patient tried using OHA’s with no success, and that she is very active which leads to irregular meals and does not like using the insulin pump I would focus on educating her on the importance of eating small frequent meals regularly while using only one blood glucose medication. Seeing that degludec has been working for the patient besides the one episode of minor hypoglycemia I would stress the importance of education.
I would educate her on what foods would benefit her and that it is important to have small frequent meals. I would educate on how her medication degludec works and possible side effects to look for, along with educating on signs and symptoms of hypo and hyperglycemia to look for. My question would be: How does small frequent meals vs. irregular meals effect active middle aged women with diabetes who are receiving medications to help control blood glucose?
P = Active middle aged women diagnosed with diabetes
I = small healthy meals regularly.
C = Irregular meals
O = Hypoglycemic events
T = 2 months
Chamberlain College of Nursing. (2017). NR-439. Week 1: Introduction to Evidence-Based Practice: Basic concepts. [Online lesson]. Downers Grove, IL: DeVry Education Group
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. Journal of the Canadian Chiropractic Association, 56(3), 167-171. Click to retrieve the article: http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=awh&AN=88935392&site=eds-live&scope=site
Kumar, S. (2015). Type 1 diabetes mellitus-common cases. Indian Journal of Endocrinology & Metabolism, 19, S76-S77. Click to retrieve the article: http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102354944&site=eds-live
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