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Evidence-Based Geriatric Nursing Protocols for Best Practice

6th Edition by Boltz; Capezuti; Zwicker
Verified Chapters 1 - 44 Complete




1

,TABLE OF CONTENTS


I. INCORPORATING EVIDENCE INTO PRACTICE
1. Developing and Evaluating Clinical Practice Guidelines: A Systematic Approach
2. Measuring Performance and Improving Quality
3. Informational Technology: Embedding Geriatric Clinical Practice Guidelines
4. Organizational Approaches to Promote Person-Centered Care
5. Environmental Approaches to Support Aging-Friendly Care


II. ASSESSMENT AND MANAGEMENT PRINCIPLES
6. Age-Related Changes in Health
7. Healthcare Decision-Making
8. Sensory Changes in the Older Adult
9. Assessing Cognitive Function in the Older Adult
10. Assessment of Physical Function in the Older Adult
11. Oral Healthcare in the Older Adult
12. Managing Oral Hydration in the Older Adult
13. Nutrition in the Older Adult
14. Family Caregiving
15. Issues Regarding Sexuality in Older Adults
16. Elder Mistreatment Detection
17. Advance Care Planning


III. CLINICAL INTERVENTIONS
18. Preventing Functional Decline in the Acute Care Setting
19. Late-Life Depression
20. Delirium: Prevention, Early Recognition, and Treatment
21. Dementia: Assessment and Care Strategies
2

,22. Pain Management in the Older Adult
23. Assessing, Managing, and Preventing Falls in Acute Care
24. Reducing Adverse Drug Events in the Older Adult
25. Urinary Incontinence in the Older Adult
26. Prevention of Catheter-Associated Urinary Tract Infection
27. Physical Restraints and Side Rails in Acute and Critical Care Settings
28. Preventing Pressure Injuries and Skin Tears
29. Optimizing Mealtimes for Persons Living With Dementia
30. Disorders of Sleep in the Older Adult
31. The Frail Hospitalized Older Adult
32. HIV Prevention and Care for the Older Adult
33. LGBTQ Perspectives for Older Adult Care


IV. INTERVENTIONS IN SPECIALTY PRACTICE
34. Substance Misuse and Alcohol Use Disorder in the Older Adult
35. Comprehensive Assessment and Management of the Critically Ill Older Adult
36. Fluid Overload: Identifying and Managing Heart Failure Patients at Risk for Hospital Readmission
37. Cancer Assessment and Intervention Strategies in the Older Adult
38. Perioperative Care of the Older Adult
39. General Surgical Care of the Older Adult
40. Care of the Older Adult With Fragility Hip Fracture


V. MODELS OF CARE
41. Acute Care Models
42. Transitional Care
43. Palliative Care Models
44. Care of the Older Adult in the Emergency Department




3

,Chapter 1: Developing and Evaluating Clinical Practice Guidelines: ASystematic Approach

Multiple Choice Test Questions

1. Models of evidence-based practice (EBP) involve which of the following steps when
determining the process of developing protocols? Select all that apply.
*a. Develop an answerable question
b. Compare the evidence to what one feels to be true

*c. Critically appraise the evidence
*d. Locate the best evidence

Rationale: Evidence-based practice (EBP) involves five steps:
1. Develop an answerable question
2. Locate the best evidence
3. Critically appraise the evidence
4. Integrate evidence into practice using clinical expertise with attention to patient’s values and
perspectives; and
5. Evaluate the outcome(s)

Comparing the evidence to what one feels to be true is not a part of evidence-based practice.

2. Which of the following questions are based on the PICO format? Select all that apply.
*a. In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional
physiotherapy in relieving pain?
*b. For obese children, does the use of community recreation activities compared to
educational programs on lifestyle changes reduce the risk of diabetes mellitus?
*c. For deep vein thrombosis, is D-dimer testing or ultrasound more accurate for diagnosis?
d. Do adults who binge drink have higher mortality rates?


Rationale: PICO stands for:
P - Population or patient problemI
- Intervention
C - Comparison group or standard practiceO
- Outcomes

PICO format is used to frame the research question and facilitate literature search. Each research
question is narrowed down to clearly state the population or the patient problem, the intervention
being studied, the comparison group, and the outcome measures. In the question “In patients with
osteoarthritis of the knee, is hydrotherapy more effective than traditional physiotherapy in relieving
pain?”, patients with osteoarthritis form the population, hydrotherapy is the intervention that is being
compared with traditional physiotherapy, and pain relief is the expectedoutcome. In the question “For
obese children, does the use of community recreation activities compared to educational programs on
4

,lifestyle changes reduce the risk of diabetes mellitus?”,
obese children form the study popTuElaStiT
onB,AuN
seKoSf E
coLmLmEuRnity
. COreM
creation services is the intervention, being
compared to educational programs on lifestyle changes, and reducing the risk
of diabetes mellitus is the expected outcome. In the question “For deep vein thrombosis, is D- dimer
testing or ultrasound more accurate for diagnosis?”, deep vein thrombosis is the patient problem, D-
dimer testing is the intervention, being compared to ultrasound for accuracy of diagnosis, that is the
expected outcome. The question “Do adults who binge drink have higher mortality rates?” does not
follow the PICO format. In this question, adults form the population being studied, binge drinking is
the intervention, and higher mortality rate is the outcome beingstudied. However, the comparison
group is not defined and stated in the question.

3. Which of the following statements regarding the AGREE II instrument are true? Select allthat
apply.
*a. The AGREE instrument has 6 quality domains with 23 items divided among these
domains.
*b. Each domain is rated on a 4-point Likert-type scale from “strongly disagree” to “stronglyagree” by
a number of appraisers.
c. The six domain scores are aggregated into a single quality score.
d. The reliability of the AGREE instrument is decreased when each guideline is appraised by morethan
one appraiser.

Rationale: The AGREE II instrument has six quality domains: scope and purpose, stakeholder
involvement, rigor of development, clarity and presentation, application, and editorial independence.
A total of 23 items are divided into these domains. Each domain is rated on a 4- point Likert-type
scale from “strongly disagree” to “strongly agree” by a number of appraisers. Appraisers evaluate how
well the guideline they are assessing meets the criteria of the six qualitydomains. The six domain
scores are independent and should not be aggregated into a single quality score. The reliability of the
AGREE instrument is increased, not decreased, when each guideline is appraised by more than one
appraiser.

4. Four appraisers give the following scores, as shown in the table below, for domain 1 (Scope&
Purpose) in the AGREE II instrument. What will be the scaled domain score?
Item 1 Item 2 Item 3 Item 4
Appraiser 1 5 6 TESTB N
6 KSELL R1.7COM
Appraiser 2 6 6 7 19
Appraiser 3 2 4 3 9
Appraiser 4 3 3 2 8
16 19 18 53
a. 53%
*b. 57%
c. 47%
d. 19%



5

, Rationale:

Maximum possible score = 7 (strongly agree) × 3 (items) × 4 (appraisers) = 84
Minimum possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12

The scaled domain score will be: Obtained

score − Minimum possible score
Maximum possible score −Minimum possible score

53 − 12 × 100 = 41 × 100 = 0.5694 × 100 = 57%
84 − 12 72

5. A 59-year-old patient is diagnosed with acute biliary pancreatitis and noninfected pancreatic
necrosis on contrast enhanced computed tomography scan. The clinician plans to start a course of
prophylactic antibiotics. Which study design is appropriate to evaluate if antibioticsprevent
infection of noninfected pancreatic necrosis and decrease mortality?
a. Case-controlled study
b. Randomized controlled trial
*c. Systematic review and meta-analysis
d. Prospective cohort study

Rationale: Systematic review and meta-analysis of previous randomized control trials to evaluate
use of antibiotics in preventing infection of noninfected pancreatic necrosis and decreasing mortality
will be the appropriate study design in this case. Systematic reviews and meta-analysis constitute the
highest level of evidence (Level I according to the level of evidencehierarchy pyramid).

Case-control studies are observational studies used to identify factors that may contribute to a
medical condition by comparing subjects who have that condition/disease (the “cases”) with subjects
who do not have the condition/disease but are otherwise similar (the “controls’). Case-control
studies require fewer resources but more time; also the evidence obtained is inferior to other types
of study designs (Level IV on the level of evidence hierarchy pyramid). Thus, this will not be an
appropriate study design in this case. A randomized control trial is a study designwith two study
groups: the experimental group, where the intervention being studied is applied;and the control
group, where no intervention is used or a placebo is used instead. A randomizedcontrol trial can be
used in this case toTeB vaAluNaK
teSifEaLnL oTES
tibEiRt.icC
sOprMevent infection of noninfected
pancreatic necrosis and decrease mortality. However, it will be difficult to find matching controls(with
the same stage and severity of disease, and other matching demographic characteristics).
Also, the study will require significant time, as the two study groups will have to be followed upfor a
significant period of time to see results. The evidence obtained from a single randomized control trial
will still be inferior (Level II on the level of evidence hierarchy pyramid) as compared to that from
meta-analysis and systematic review. A prospective cohort study follows over time a group of similar
individuals (cohorts) who differ with respect to certain factors understudy to determine how these
factors affect rates of a certain outcome. Such studies are importantfor research on the etiology of
diseases. In a prospective cohort study, at the time of enrolling subjects and collecting baseline

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