WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF NURSING
ZAMBOANGA CITY

Name : Mojica, Noah Kent Date: September 19, 2020

TRY THIS !

Activity No. 3 Applying Evidence Based Process

Instruction: Read the given case scenarios below,

1. Formulate clinical questions using PICOT format.

2. Acquire evidence based practice using applicable resources.
3. Formulate one appropriate nursing care plan from the problems presented in any of the
given
scenarios.

CASE SCENARIOS PICOT

Case Scenario 1 P= School aged children with gum
and dental problems.
Most school age children suffers gum and dental problems as a result
of frequent eating of sweets and candies. These children often uses I= Periodontal toothpaste.
saline gargle as dental hygiene regimen because it’s readily available
while others emphasizes the use of periodontal toothpaste as it does not C= Saline gargle.
only reduces gum swelling but also cure other dental problems when
constantly use for 6 months. However, the use of periodontal toothpaste O= Reduces gum swelling but also
is costly and most mothers wants to find out if it is really worth to use. cure other dental problems

T= Within 6 months

P = In school age children suffers

with gum and dental problems due to
sweets and candies, I = Does the use
of periodontal toothpaste. C =
compared to use of saline gargle O =
worth it to use as dental hygiene
regimen T = when constantly use for
6 months?

Case Scenario 2 P= Middle aged patients with central

or epigastric chest pain
Most middle- aged  patients who comes to cardiac unit presents with
central or epigastric chest pain radiating to the arms, shoulders, neck, I= Series of 12 lead ECG.
or jaw. The pain is described as substernal pressure, squeezing, aching,
burning, or even sharp pain. With this findings, you suspect the patient C= One ECG reading.
to suffer from myocardial infarction and that a series of 12 lead ECG is
O= Diagnose Myocardial infraction.
done to help diagnosing MI than a one ECG reading.
P = In middle-aged patient with
central or epigastric chest pain I =
does a series of 12 lead ECG C =
compared to one ECG reading O =
can help diagnosing Myocardial
 Infarction?

Case Scenario 3 P= A 30 year old female with

periodontitis
A 30 year old female visited your clinic complaining of bleeding gums
for 3days and has been taking oral prophylaxis. A week after she found I=Oral Prophylaxis
out that she is pregnant and been taking prenatal vitamins. On your
assessment reveals that she has periodontitis. The patient verbalized to C= those who don’t take oral
you that she is worried that her periodontitis made her more at risk for Prophylaxis
miscarriage within the third trimester.
O= at risk for miscarriage

T= Third trimester

P = In patients with suspected

periodontitis, I = that are taking oral
prophylaxis C = compared to those
not taking it O = at risk for
miscarriage T =within the third
trimester?

Prepared by:

NERISSA C. MARIGA, MAN, RN

BSN 3-D Instructor

Evidence Based Practice

Case Scenario 1

Children usually start losing their baby teeth around six years of age. From 6-12 years,
children have a mixture of adult and baby teeth. The baby teeth at the back are replaced around
10-12 years of age. By this age, most children have all their adult teeth except for the third molars
(wisdom teeth). The adult teeth don’t get replaced, so you have to look after them. If your child’s
baby teeth came late, the adult teeth will probably be late too. If you’re concerned about your
child’s teeth development, see your dentist. When adult teeth are coming through: Your child
might find chewing is more difficult when teeth are loose or missing. Encourage your child to eat
a variety of healthy foods. Keep up your child’s teeth-brushing routine, taking extra care around
the loose teeth or sensitive areas. Allow loose teeth to fall out on their own. If you try to pull out a
tooth before it’s ready to fall out, it can break. This can cause pain and infection. Sometimes an
adult tooth will come through before the baby tooth has fallen out. If the baby tooth hasn’t fallen
out within 2-3 months, see your dentist.

Gum disease is caused by plaque bacteria that builds up around, on and in between your
teeth. If this bacterium is not removed by regular brushing and flossing it can irritate gums,
leading to red, swollen and bleeding gums, which are all symptoms of gum disease, known as
gingivitis.

Regularly gargling with salt water can assist in removing bacteria from the gums, which
helps in cleaning and preventing the buildup of plaque and tartar. A buildup of bacteria in the
mouth can lead to gum disease and tooth decay.
Citations: Dental care for school-age children. (n.d.). Retrieved September 21, 2020, from
https://www.healthyfamiliesbc.ca/home/articles/dental-care-school-age-children

How to treat gum disease. (n.d.). Retrieved September 21, 2020, from
https://www.corsodyl.co.uk/advice/how-to-treat-gum-disease/

A guide to salt water gargles: Sore throat, other conditions, and recipe. (n.d.).
Retrieved September 21, 2020, from https://www.medicalnewstoday.com/articles/325238

Case Scenario 2

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide.
Early diagnosis is of pivotal importance for patients with cardiac arrhythmias and ischemia to
minimize the consequences like strokes and myocardial infarctions. The chance of capturing
signals of arrhythmias or ischemia is substantially high when a 12-lead electrocardiogram (ECG)
can be recorded at the moment when a patient experiences the symptoms. However, until now,
available diagnostic systems (Holter monitors and other wearable ECG sensors) have not enabled
patients to record a reliable 12-lead ECG at home.

The heart requires its own constant supply of oxygen and nutrients, like any muscle in the
body. The heart has four main arteries, two of them large, branching arteries that deliver
oxygenated blood to the heart muscle. If one of these arteries or branches becomes blocked
suddenly, a portion of the heart is starved of oxygen, a condition called "cardiac ischemia." If
cardiac ischemia lasts too long, the starved heart tissue dies. This is a heart attack, otherwise
known as a myocardial infarction -- literally, "death of heart muscle." Most heart attacks occur
during several hours -- so never wait to seek help if you think a heart attack is beginning. In some
cases, there are no symptoms at all, but most heart attacks produce some chest pain.

Citations: Steijlen, A., Jansen, K., Albayrak, A., Verschure, D., & Van Wijk, D. (2018, July
30). A Novel 12-Lead Electrocardiographic System for Home Use: Development and
Usability Testing. Retrieved September 21, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090173/

Steinbaum, S. (2019, July 02). Myocardial Infarction (Heart Attack) Causes and
Warning Signs. Retrieved September 21, 2020, from https://www.webmd.com/heart-
disease/understanding-heart-attack-basics.

Case Scenario 3

Periodontitis is a serious infection of the gums. It’s caused by bacteria that have been
allowed to accumulate on your teeth and gums. As periodontitis progresses, your bones and teeth
can be damaged. However, if periodontitis is treated early and proper oral hygiene is maintained,
the damage can be stopped.

Maternal periodontal disease is a highly prevalent condition that has been studied
extensively in relation to adverse pregnancy outcomes, including preterm delivery, preeclampsia,
and low birth weight. Investigators speculate that hematogenous transport of bacteria and/or pro-
inflammatory mediators from sites of periodontal infection into the placenta, fetal membranes, and
amniotic cavity induces pathological processes that lead to these adverse outcomes. Preliminary
observational studies supported this hypothesis, but more recent work by our group and others do
not demonstrate an increased risk of adverse pregnancy outcomes among women with periodontal
disease, and most randomized trials fail to demonstrate improved perinatal outcomes following
treatment of periodontal disease in pregnancy.
 Oral prophylaxis has gained tremendous popularity in recent years due to the introduction of
ultrasonic scaling instruments and other high-tech devices. This is a procedure in which bacterial
plaque and tartar is removed from the surface of the teeth with the help of scaling and polishing. It
is not the same as teeth whitening or coronal polishing because it is mainly performed to prevent
decay and other oral complications rather than for aesthetic reasons; however, it does satisfy the
patient greatly. Your dentist will be able to tell you whether you are a candidate for oral
prophylaxis or not depending on the severity of stains on your teeth.

Citations: Cafasso, J. (2017, May 23). Periodontitis: Symptoms, Causes, and Treatments.
Retrieved September 21, 2020, from https://www.healthline.com/health/periodontitis

Srinivas, S., & Parry, S. (2012, February). Periodontal disease and pregnancy
outcomes: Time to move on? Retrieved September 21, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270055/

What Is Oral Prophylaxis And How Does It Prevent Disease? (n.d.). Retrieved
September 21, 2020, from https://drqdental.net/what-is-oral-prophylaxis-and-how-does-it-
prevent-disease/
 NCP for Case Scenario 1

Assessment Nursing Planning Nursing Rationale

Diagnosis Intervention
1.) Provide a mouth care routine  Cleaning of teeth with a
Objective cues: The children After 1 hour of nursing interventions, including toothbrushing at regular toothbrush and
 Bad breath suffer gum and the patient will be able to
intervals with a soft-bristle toothbrush fluoride-containing
 Swelling of gums dental problems toothbrush/perform proper hygiene toothpaste prevents the
as a result of properly. And the patient will state and fluoride toothpaste.
 Damaged teeth build-up of plaque.
 Missing teeth frequent eating lessen the suffer of their gums and  
of sweets and dental problems.
 These measures help
candies.
 Brushing teeth in an up-and- promote oral hygiene.
Impaired down manner
dentition related  Regular brushing of
 Brushing of teeth at least
to ineffective teeth especially every
twice a day
oral hygiene. after meals is vital to
 Including the gums and prevent the build-up of
tongue in oral care bacteria.

 Replacing the toothbrush as  Right knowledge helps

bristles wear down
 Advise an ultrasonic
toothbrush as an alternative
for patients with dexterity
problems
prevent possible dental
problems.
 Checkups help identify
dental problems early.

2.) Instruct the patient to rinse the mouth

with warm saline or an antiplaque mouth
rinse.

3.) Assist the patient in performing oral

hygiene every after meal and as often as
needed.

4.) Educate patient about the importance

of oral hygiene.

5.) Educate the patient regarding the

importance of dental checkups and follow-
ups.