Monday, May 27, 2019
Bio Medicine Essay
Two Cathy Ann Wilson-Bates Western Governors University EVIDENCE-BASED PRACTICE & APPLIED NURSING investigate EBP 1 Brenda Luther, PhD, RN January 25, 2012 Task Two Introduction What I have learned about working with children in a chronic healthc are set like dialysis is that they are resilient beings with the propensity for rapid changes in their medical condition. Children almost eer surprise me in their unique description of symptoms and pain. Depending on their age, they whitethorn non be able to describe the symptoms they feel or tell me where it hurts.A simple ear ache whitethorn be described as a drum in my ear or may be observed with non verbal cues like tugging on the ear. Acute Otitis Media is seen quite often during the nippy and flu season. Recent clinical guidelines suggest waiting twenty quatern to seventy two hours before beginning antibiotic drug therapy. Parents of children with symptoms of otitis media are accustomed to receiving a prescription for antibioti cs before they leave the medical office. Adults as well are preconditioned for the little white slip of paper from their physician.Waiting twenty four to seventy two hours to evaluate the need for antibiotics will definitely suppress the over-prescription of antibiotics as well as their efficacy. The waiting and watching of several days may seem like an eternity to a parent caring for a softheaded and crying child. Educating parents during routine visits to the physician office about the risks of over-prescribing antibiotics will patron when the physician needs to discuss the possibility of waiting and evaluating before prescribing antibiotics.Providing a list of comfort measures parents can follow may help relieve the fretting they have in caring for a sick child. Any comfort measure taken to reduce crying is facilitatory to the parent of a sick child, but mostly to the child. The following table and paragraphs will share the results of how one group of nurses at an outpatient clinic used clinical evidence to manage this situation. Source sign of Resource Source capture or Type of Research general reading, inappropriate primary research evidence, filtered, or unfiltered evidence summary, evidence-based guideline, or none of these American Academy of Pediatrics and American Academy ofFiltered conquer Evidence-based guideline Family Physicians. Clinical practice guideline diagnosis and management of keen otitis media. Causative pathogens, antibiotic unsusceptibility and Unfiltered Appropriate Evidence-based guideline therapeutic considerations in crafty otitis media. Pediatric Infectious Disease ledger. Ear, nose, and Throat, Current pediatric diagnosis and global Inappropriate None of these treatment. discourse of acute otitis media in an era of Filtered Appropriate Evidence based guideline increasing microbial resistance.Pediatric Infectious Disease Journal Results from interviews with parents who have br ought Unfiltered Appropriate Primary research evidence their children into the clinic for acute otitis media. Subcommittee on Management of Acute Otitis Media. (2004). American Academy of Pediatrics and American Academy of Family Physicians. Clinical Practice Guidelines diagnosis and Manegment of Acute Otitis Media. American Academy of Pediatrics , Vol. 13 No 5 1451-1465. This article is an evidence-based clinical guideline. It is a systematic review making it a filtered mental imagery which is very appropriate for this situation. The article describes the current, (as of 2004) recommendations for the diagnosis and management of Acute Otitis Media (Subcommittee on Management of Acute Otitis Media, 2004). These guidelines show several different ways to treat acute otitis media depending on the symptoms of the child. It states that roughlytimes waiting to give antibiotics is good and well-nightimes waiting to give antibiotics is not good. This article is appropriate and provides clarity on the topic. Block, S. L. (1997).Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. The Pediatric Infectious malady Journal , Volume 16 (4) pp 449-456. This article discusses antibiotic resistance and describes the bacterial pathogens which are responsible for infections do acute otitis media. This article is appropriate. It contains a comparison of studies performed based on the different symbols of bacteria which cause acute otitis media. It stresses the importance of identifying the bacteria causing the infection before giving antibiotics so that number one the bacteria can be eradicated and other bacteria will not become immune (Block, 1997).PE Kelley, N. F. (2006). Ear, nestle and. In M. L. W. W. Hay, Current Pediatric Diagnoisis and Treatment (pp. 459-492). Lang. This textbook source contains general information on the ear, nose and throat. There is much more information here regarding basic anatomy and physio logy as well as characteristics of the ear nose and throat. The information regarding otitis media is basic and not an appropriate source of research in this situation for three reasons. Number one, the information is very basic, number two, it does not give any up to date information on how to treat this type of infection, and number three there is too much non-relevant information.McCracken, G. H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. The Pediatric Infectious Disease Journal , Volume 17(6) pp576-579. This article is a review of the known etiologies that may cause acute otitis media. The article gives up to date information on therapeutic approaches when selecting an appropriate antibiotic therapy. We dont practice cookie cutter medicine. The aforementioned(prenominal) prescription is not always right for all patients or all communities where some bacterias may be more prevalent than others (McCracken, 1998). This is appropriate info rmation for this group of people or community. media, P. o. (n. d. ).Interviews. (C. nurses, Interviewer) This set of interviews is simply raw data. General information can however provide great insight as to what is happening out in the community. For example, this information might shed light on the fact that if the parents are willing to hold off on antibiotics for example, would they be more likely to follow up and come back into the clinic when asked? The reaction of parents is capable upon other several basic factors like finances, a belief system and possibly the ability to obtain transportation. Knowing how the community is going to respond to their election may have a great effect on the decisions they make.When evaluating the findings of these sources cumulatively, one must(prenominal) first determine the causative pathogens infecting patients in this given community with acute otitis media. After pathogen determination we can determine which antibiotics may be most use ful in eradicating the given bacteria. Careful selection of antibiotic therapy will reduce the propensity for antibiotic resistance. Watchful waiting may be a good thing from the perspective of increasing microbial resistance however we must always evaluate patients on their individual needs or on a patient by patient case. One size doesnt always fit all. Patient education is the key to keeping the public informed of current practice.Physicians and Nurses need to be consistent in the lesson plan shared with patients and tolerate true to our scope of practice. Communication is essential between the physician, nurse and other multidisciplinary team members in order to provide the best care. There are legion(predicate) considerations in assessing if patients are able to withstand the waiting and evaluation period. Low income families are one example of how the waiting and watching method might not work. Parents may have to take time off work to come to clinic with a sick child. They might struggle finding money for the additional slip by trip to the clinic and may risk losing their job if they take more time off work.Many low income families may have already waited before pursuance help thus creating their own watchful waiting period. They also may not be able to afford antibiotics and as a result may not give the full dose if symptoms have subsided. The perception is that they will save the medication for the next time symptoms arise. Confidentiality might be an fare in smaller communities. People tend to be concerned about neighbors and co-workers and some may not care to share their experience with others. This may be an issue for parents who dont share custody as in the case of divorce. It is a greater issue when parents or partners dont share the same fundamental values, especially those related to healthcare. ConclusionWatchful waiting like the nurses in this clinic are looking at may be useful for some of the patients, but not all. Again, a one size f its all philosophy is not always appropriate in healthcare. Tools like algorithms may be helpful in determining the appropriateness for watching and waiting versus immediate action as determined by physical findings and social circumstances like paternal adherence for follow up and ability to afford treatment. Whatever course you choose, watchful waiting or immediate antibiotics the best practice remains a plan of care based on the individual needs of our patients. References Block, S. L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media.The Pediatric Infectious disease Journal , Volume 16 (4) pp 449-456. McCracken, G. H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. The Pediatric Infectious Disease Journal , Volume 17(6) pp576-579. media, P. o. (n. d. ). Interviews. (C. nurses, Interviewer) PE Kelley, N. F. (2006). Ear, Nose and. In M. L. W. W. Hay, Current Pediatric Diagnoisis and Treatme nt (pp. 459-492). Lang. Subcommittee on Management of Acute Otitis Media. (2004). American Academy of Pediatrics and American Academy of Family Physicians. Clinical Practice Guidelines Diagnosis and Manegment of Acute Otitis Media. American Academy of Pediatrics , Vol. 113 No 5 1451-1465.