Running head: EVIDENCE BASED PRACTICE EXERCISE

Evidence Based Practice Exercise Emily W. Kosmicki Ferris State University

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Nursing Problem According to the Center for Disease Control (CDC), the leading cause of death in 2009 in the United States was heart disease with stroke as the fourth leading cause of death (Kochanek, et al, 2011). A study by Ridker, Cushman, Meir, Tracy, and Hennekens looks at the correlation between elevated CRP and the risk of a myocardial infarction and thromboembolic stroke while also comparing elevated CRP levels and the risk of developing PVD (1998). With advances in medical technology (such as the one in this study) the millions of people that are affected by myocardial infarction, strokes, and peripheral vascular disease could significantly decrease once elevated CRP levels are detected. Nurses can help individuals with these elevated levels change their modifiable risk factors to diminish the effects of these diseases. Methods of Study This study used a double-blind, randomized, placebo controlled method. As defined by Nieswiadomy, a random sampling involves the selection of a sample from a population. Double blind studies are when neither the researcher nor the research participants know which participants are in the experiment and which are in the control group (2012). The study measured baseline blood levels of 144 men that had developed symptoms of PAD and an equal number of men without symptoms of PAD in similar age and have a current smoking habit. Participants were randomly assigned to one of four treatments: 325 mg. of aspirin on alternate days, 50 mg. of B-carotene on alternate days, both, or neither (Ridker et al, 2008). Results of Study The results of the study found that median levels of CRP were significantly higher at baseline among study participants who had developed PVD than those who had not developed symptoms. The data suggests that the baseline levels of CRP can predict a risk of future PVD

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which can ultimately result in a myocardial infarction and stroke. Although there was not any significant evidence of interaction between the random aspirin assignment and CRP among study participants, the Physician Health Study (PHS) found that aspirin was found to reduce the risk of peripheral artery revascularization (Ridker et al,2008). Although aspirin consumption by participants in this study did not have a direct correlation with CRP levels, nurses can still educate their patients on the importance of taking aspirin (as prescribed by physician) if they are at risk for a MI or stroke. Limitations of Study There are several factors that limit the overall outcomes of the study. The first being in that the population studied was only men. It is unknown that if elevated CRP levels have the same possible outcomes of increased risk of a myocardial infraction, stroke, and PVD in women. To deem that elevated CRP levels are indicative of stroke, the same study should be conducted with a group of women with the same qualifications. A second limitation would be that group used for the this study were apparently healthy men that participated in a Physicians Health Study that were seeking care for developing symptoms of PAD. With this being said, there may be greater numbers of men with these symptoms that are not seeking care that would contribute to the results of this study. Other Populations The participants in this study were 144 apparently healthy men that had access to health care by participating in the Physicians Health Study. Participants were required to complete self-reports as well as have blood work drawn on a regular basis. A population that lives in a more rural setting may not have access to health-care on a regular basis or live in a medically underserved area. The aspect of the study that requires completion of self-reports

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would discriminate against those that may be illiterate and unable to complete the reading/writing portion of the study. A population that does not have access to a pharmacy or funds to provide the medication required for specific control groups may also pose as an issue for this study. Plan of Care There are several nursing diagnosis that develops a plan of care correlating health and preventing well-being. Mobsys Guide to Nursing Diagnosis (2011) discuss several nursing diagnosis and interventions that would be relevant to the participants of the study. The first diagnosis; activity intolerance r/t imbalance between peripheral oxygen supply and demand. A desired outcome would be to verbalize an understanding of the need to gradually increase activity based on testing, tolerance, and symptom. Nursing interventions could include: assessing the client daily for appropriateness of activity and monitor and record the clients ability to tolerate activity while monitoring vitals. The second diagnosis; risk for injury with risk factors, tissue hypoxia, altered mobility, and altered sensation. A desired outcome for the client would be to remain free of injuries. Nursing interventions could include: educating the client and family on how to recognize safety issues and validating the clients feelings and concerns relating to risks (study in this case).The third diagnosis; readiness for enhanced self health management, self-care and treatment of disease. A desired outcome would be for the client would be to demonstrate continued commitment to integration of therapeutic regimen into daily living routines. Nursing interventions could include: reviewing factors that contribute to the likelihood of health promotion and health protection and provide knowledge as needed related to the

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pathophysiology of the disease or illness, prescribed medication, and activity tolerance (Ladwig, 2011). Relevance to Nursing Practice Without preventative measures or changes, these diseases (heart disease and stroke) will continue to be the leading causes of mortality in the United States. Nurses play a vital role in education in health promotion. When individuals have elevated CRD levels, nurses can help educate on how to change modifiable risk factors such as exercising, eating a healthy/balanced diet, and smoking cessation.

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References ochane iaquan urphy inin o ung 11 eaths final

data for 2009. National Vital Statistics Reports , 60(3), 1. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf Ladwig, G., & Ackley, B. (2011). Mosbys guide to nursing diagnosis. (3rd ed.). Maryland Heights, MS: Mosby Elsevier. Nieswiadomy, R. M. (2012). Foundations of nursing research. Upper Saddle River, NJ: Pearson Education, Inc. Ridke, P. M., Cushman, M., Stampf, M. J., Tracy, R. P., & Hennekens, C. H. (1998). Plasma concentration of c-reactive protein and risk of developing peripheral vascular disease. Circulation: Journal of American Heart Disease, 97, 425-428. doi: doi: 10.1161/01.CIR.97.5.42

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