WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF NURSING
Zamboanga City

Name: DEMAYO, EDSON JOHN C. Date: MARCH 16, 2021

Year & Section: BSN – 3A

TRY THIS!
Activity No. 1 EVIDENCE -BASED PROCESS

Instruction: Read the given case scenarios below,

1. Formulate clinical questions using PICOT format.

2. Apply evidence -based practice in research in each scenario.
3. Formulate one appropriate nursing care plan from the problems presented in any of the given scenarios.
 CASE SCENARIO PICOT Clinical Question Evidence Based Research Nursing Care Plan

Case Scenario 1 Intervention Oral wound cleaning is best

In school aged children (P), accomplished by rinsing the mouth
Most school age children suffers gum and dental problems how does saline gargle (I) with saline solution. It's also a
as a result of frequent eating of sweets and candies. These compared with periodontal cost-effective and non-toxic
children often uses saline gargle as dental hygiene toothpaste (C) is more approach to aid wound healing. In
regimen because its readily available while others effective in reducing gum primary culture of human gingival
emphasizes the use of periodontal toothpaste as it does not swelling and treating dental fibroblasts, sodium chloride
only reduces gum swelling but also cure other dental problems (O) within 6 solution facilitates migration,
problems when constantly use for 6 months. However, the months of use (T)? which is an important mechanism
use of periodontal toothpaste is costly and most mothers during recovery. Also after a brief
wants to find out if it is really worth to use. exposure to hypertonic solution,
sufficient sodium chloride doses
(0.9–1.8%) are needed promoted
hGFs cell migration and
extracellular matrix. (Everts,
Leethanakul, et. al., 2016)

Fluoride is one of the most

common ingredients in toothpaste,
according to Dental (2019). It
hardens the teeth and encourages a
healthier mouth, preventing
cavities and dental problems.
Saline gargles are used to heal
gum swelling and other oral
wounds, while toothpaste
strengthens teeth and prevents
dental complications using both of
 these will still be benefit to the
school aged children but using
saline solution is not expensive
than the toothpaste.
Case Scenario 2 Diagnosis According to the study of Din,
In middle aged patients (P), Adil, et. al. (2013), Their goal was
Most middle- aged patients who comes to cardiac unit presents
is 12 lead ECG (I) compared to see whether a 12-lead ECG
with central or epigastric chest pain radiating to the arms,
shoulders, neck, or jaw. The pain is described as substernal to just ECG reading (C) could accurately diagnose acute
pressure, squeezing, aching, burning, or even sharp pain. With more accurate in diagnosing posterior myocardial infarction
this findings, you suspect the patient to suffer from myocardial Myocardial Infarction (O)? after confirmation by a 15-lead
infarction and that a series of 12 lead ECG is done to help ECG. After validation with 15
diagnosing MI than a one ECG reading. traces, the accuracy of a 12-lead
ECG for detecting posterior MI
was 55%.

It is crucial to re-evaluate the

overall approach to diagnosis as
serum biomarkers continue to
supplant the use of ECG in the
diagnosis of acute MI. In the
absence of unequivocally positive
results, it may be useful in
diagnosing ischemia or infarction,
particularly when used in
conjunction with an ECG.
(Mendoza, 2006)

12 leads ECG is more accurate in

detecting Myocardial Infarction
than the ECG readings because 12
leads ECG has a wide coverage in
electrical activity of the heart.
Case Scenario 3 Etiology Maternal periodontal disorder is a
Are 30 year old females (P) common problem that has been
A 30 year old female visited your clinic complaining of
who have periodontitis (I) thoroughly researched in relation
bleeding gums for 3days and has been taking oral prophylaxis.
A week after she found out that she is pregnant and been taking compared with those without to breastfeeding. While the
prenatal vitamins. On your assessment reveals that she has (C) are at an increased risk biological plausibility and scope
periodontitis. The patient verbalized to you that she is worried for miscarriage (O) within for therapy to minimize the
that her periodontitis made her more at risk for miscarriage the third trimester of likelihood of preterm birth and
within the third trimester. pregnancy (T)? other negative effects previously
seemed promising, there is
substantial proof that periodontal
disorder is not linked to preterm
birth or other pregnancy
complication outcomes. (Srinivas
& Parry, 2012)

(Parihar, Katoch et. al., 2015)

Several tests have shown that
pregnant mothers with
periodontitis are more likely to
give birth to preterm, low-birth-
weight babies. Inflammatory
mediators that are involved in
periodontal disorders are also
involved in the onset of labour.
Since cytokines can cross human
fetal membranes, it's conceivable
that high levels of these cytokines,
which are released at chronic
periodontitis sites and tested at
higher levels in the plasma of
patients with periodontitis, could
impact the fetoplacental unit.
 There is no proof that periodontitis
raises the risk of miscarriage in the
third trimester of pregnancy.

References:
Everts, Leethanakul, et. al., (2016). Rinsing with Saline Promotes Human Gingival Fibroblast Wound Healing In Vitro. Retrieved March 14, 2021 from Plos One:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956236/#__ffn_sectitle
Dental, A. (2019). The importance of toothpaste. Retrieved March 14, 2021 from Altima Dental: https://www.altimadental.com/the-importance-of-toothpaste/
Din, Adil, et. al. (2013). Accuracy of 12 lead ECG for diagnosis of posterior myocardial infarction. Retrieved March 14, 2021 from Applications:
https://applications.emro.who.int/imemrf/J_Postgrad_Med_Inst/J_Postgrad_Med_Inst_2014_28_2_145_148.pdf
Mendoza, M. (2006). How accurate is the use of ECGs in the diagnosis of myocardial infarct?. Retrieved March 14, 2021 from MD Edge:
https://www.mdedge.com/familymedicine/article/62227/cardiology/how-accurate-use-ecgs-diagnosis-myocardial-infarct
Srinivas, S. & Parry, S. (2012). Periodontal disease and pregnancy outcomes: Time to move on?. Retrieved March 14, 2021 from Journal of Women’s health:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270055/#__ffn_sectitle
Parihar, A. Katoch, V. et. al. (2015). Periodontal Disease: A possible risk factor for adverse pregnancy outcome. Retrieved March 15, 2021 from Journal of
International Oral Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513769/

Total points = 60

Prepared by:
NERISSA C. MARIGA, MAN, RN
NCM 116-A Instructor

NURSING CARE PLAN

SCENARIO 1
Cues Nursing Diagnosis Analysis Goals and Objectives Nursing Interventions Rationale Evaluation
Independent: GOAL MET
Subjective Cues: Impaired Oral Tissue inflammation Goal  Inspect the oral cavity  Oral inspection can
 “Nung naadmit ako Mucous Membrane in the oral mucosa  After 5 days of at least once daily reveal signs of oral  The client’s oral
nung Monday related to Infection or gums nursing and note any disease, symptoms of mucosal
meron na akong as evidenced by interventions, the discoloration, lesions, systemic disease, condition
singaw eh” as mouth sores patient’s oral edema, bleeding, drug side effects, or improved.
 stated by the client
 “Kumikirot sya Redness, ulceration,
tapos mahapdi” as and fissures in the
stated by the client
 “Nahihirapan nga
akong kumain dahil
dito eh” as stated
by the client. Mouth Ulcers
 “Hindi talaga sya
makakain dahil sa
singaw nya,
humahapdi. Yan
ngang lugaw di nya
maubos eh dahil
masakit daw” as
stated by the
client’s wife.
 “Nagsisipilyo
naman ako 3 beses
sa isang araw” as
stated by the client
 “Oo naninigarilyo
ako” as stated by
the client.
Objective Cues:
 Small, round,
crater shaped
sores in the oral
cavity
 Open sores in the
mouth
 Pain in the mouth
mucosal condition exudate, or dryness. trauma of the oral
will improve as Refer to a physician cavity. (Gonsalves
evidenced by or dental specialist as WC, Chi, AC, Neville
mouth moist and intact appropriate. BW: Common oral
tounge and lips, lesions: part I.
and absence of Superficial mucosal
pain and lesions. lesions, Am Fam
Physician
75(4):501506, 2007.)
Objectives:  Encourage fluid
 After 5 minutes of intake of up to 3000  Fluids help increase
discussion, the mL/day if not moisture in the  The client was
client will be able contraindicated by mouth, which able to identify 4
to identify 4 out the client's medical protects the mucous out of 5
of 5 importances condition membranes from importances of
of oral hygiene damage and helps the oral hygiene
within 3 minutes. healing process. within 3
(Roberts J: minutes.
 After 5 minutes of Developing an oral
discussion the assessment and  The client was
patient will be intervention tool for able to identify 4
able to identify 4 older people: 2, Br J out of 5 foods
out of 5 different Nurs 9(18):2033, and agents that
foods and agents 2000.) can exacerbate
that can  Give the client the oral
exacerbate the frequent sips of  The use of water to condition within
condition within 2 water, and ask client moisten the mouth 2 minutes.
minutes. to rinse the mouth has been shown to be
with water regularly. as effective as many
 After 3 minutes of other agents. (Joanna
demonstration, Briggs Institute:  The client was
the client will be Prevention and able to
able to treatment of oral demonstrate
demonstrate mucositis in cancer proper oral
 Pale to yellowish proper oral patients: best hygiene within 2
appearance of the hygiene within 2 practice information minutes.
sores minutes. sheet)
 Swollen mouth  Monitor the client's
sores  At home, the nutritional and fluid  Dehydration and
client will be able status to determine if malnutrition
to perform it is adequate. predispose clients to  The client was
appropriate impaired oral mucous able to perform
mouth care using membranes. (Evolve, appropriate
soft-bristle Ackley: Nursing mouth care
toothbrush and Diagnosis Handbook, using soft-bristle
non-abrasive 8th Edition) toothbrush and
toothpaste at non-abrasive
least 2x a day.  Determine the client's  Whenever possible, toothpaste at
usual method of oral build on the client's least 2x a day.
 At home, the care and address any existing knowledge
client will be able concerns regarding base and current  The client was
to stop alcohol oral hygiene. practices to develop able to stop
and smoking an individualized plan alcohol and
usage. of care. (Evolve, smoking usage.
Ackley: Nursing
Diagnosis Handbook,
8th Edition)
 If the client does not
have a bleeding  The toothbrush is the
disorder and is able to most important tool
swallow, encourage for oral care. Brushing
the client to brush the the teeth is the most
teeth with a soft effective method for
toothbrush using reducing plaque and
fluoride-containing controlling
toothpaste at least periodontal disease.
twice per day. (American Dental
Association (ADA):
 Cleaning your teeth
and gums, March
2007; Pearson LS,
Hutton JL: A
controlled trial to
compare the ability of
foam swabs and
toothbrushes to
remove dental
plaque, J Adv Nurs
39:5, 2002.)
 Instruct the client to
avoid alcohol-based  Oral irritants can
or hydrogen further damage the
peroxidebased oral mucosa and
commercial products increase the client's
for mouth care and to discomfort. (Evolve,
avoid other irritants Ackley: Nursing
to the oral cavity Diagnosis Handbook,
(e.g., tobacco, spicy 8th Edition)
foods).

 Discourage alcohol or
cigarette use  Alcohol and cigarette
usage can cause
infection and can
aggravate the oral
sores. It can also alter
the healing process. .
(Evolve, Ackley:
Nursing Diagnosis
Handbook, 8th
Dependent: Edition)
 Administer
medications as  To relieve pain an d
prescribed by the to promote faster
physician healing process
(Evolve, Ackley:
Nursing Diagnosis
Handbook, 8th
Edition)