Pediatric Case Study

Purpose: Discussion class 504 . Pediatric Case Study

Things to remember:

• Discussion post is at least 200 words.
• Answers all questions with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.
• 3 References, try to find resources that are 5 years or less
• No errors with APA format 6thEdition
• See the Discussion Board grading rubric

To Discuss:

• Topic 1: Pediatric Case Study

This Discussion topic is based on a case study on page 108.

Review the facts of the case and discuss how you would find the evidence needed to address the clinical question.

Book:

• Melnyk, B. M., & Fineout-Overholt, E. (2015).  Evidence-based practice in nursing &

healthcare:  A guide to best practice (3rd edition).  Philadelphia, PA: Wolters Kluwer

Health.

Student 1

• When reviewing the case study there are a many key points that are discussed in

regards recovering from a pediatric cardiac surgery and the risk for a cardiac tamponade after

the removal of a pulmonary artery catheter. There are a few pieces of information in this case

study that are critical in determining how one would find the evidence, that is most

appropriate, to determine how a complication, such as a cardiac tamponade, could occur in an

infant only four days after an operative procedure. The key clues include: an infant who is

four days postoperative after a cardiac surgery, abnormal clotting profile, removal of a

pulmonary artery catheter with drainage and ooze, followed by a deterioration in the patient’s

status, which ultimately leads to a diagnosis of a cardiac tamponade (Melnyk & Fineout-

Overholt, 2015). To enhance the likelihood of the most reliable evidence and helpful research,

one would use a PICOT formation, to formulate a research question. The P in PICOT stands

for the population at interest (Melnyk & Fineout-Overholt, 2015). In this case study, the

population the study is aiming toward is an infant four days postoperative (Melnyk & Fineout-

Overholt, 2015). The next searchable topic would be the I, C, and O, which would indicate the

issue at hand, the comparison of that issue, and the affect this event would have on the

outcome; this would include questioning the frequency of removing a pulmonary artery

catheter, or not removing the catheter, and the affects this procedure has on influencing a

cardiac tamponade (Melnyk & Fineout-Overholt, 2015). The next, and final step would be to

determine the T, which delivers a timeline for an event to occur (Melnyk & Fineout-Overholt,

2015). In this case study, the timeline would be four days after surgery, which one would

possibly be able to broaden to a week, to better serve research results. In a study conducted in

• 2012, the authors described the importance of formulating a comprehensive PICOT when

researching a topic at hand (Riva et al.). This study discovered that the more detailed and

specific a PICOT was, the more evidence and research was exposed to better enhance the

topic of understanding (Riva et al., 2012). This study also concluded, the more likely the

researchers used the PICOT formation, the more likely one would develop a more appropriate

and specific research yield (Riva et al., 2012). With all this information, the most suitable

PICOT formulated question, to determine the likelihood of an event similar to this would be:

In an infant who recently had cardiac surgery, what is the frequency of cases regarding the

removal of a pulmonary artery catheter, versus not removing the catheter within a week, have

on the affect of developing a cardiac tamponade within the first week of surgery? This

formation of questions and information would best suit the research topic at hand.

References

• Melnyk, B. M., & Fineout-Overholt, E. (2015).  Evidence-based practice in nursing &

healthcare:  A guide to best practice (3rd edition).  Philadelphia, PA: Wolters Kluwer

Health.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your

research question? An introduction to the PICOT formation for clinicians. Journal of

the Canadian Chiropractic Association, 56(3), 167-171. Retrieved from

http://eds.b.ebscohost.com.lib.kaplan.edu/eds/pdfviewer/pdfviewer?

vid=4&sid=7a00d36e-280b-4d06-9d43-9e7bc0f137e1%40sessionmgr104

Student 2

• In this case study, an infant suffered a complication of cardiac tamponade after removal

of the arterial catheter. As stated in the book, the clinical question that a RN might ask is in

infants who have had cardiac surgery (P), how often does removing pulmonary artery

catheters (I) influence cardiac tamponade (O) within the first week after surgery (T) (Melnyk

• & Fineout-Overholt, 2015)? The best way to find evidence to answer this clinical question

would be getting different studies, and comparing them. The type of study you would

probably want to look for is a case-control study. For example, there was another case study

done that stated the incidence of cardiac tamponade after cardiac surgery is reported as

ranging from 0.04% to 7 (Johnston & McKinley, 2000).  They reviewed the pathophysiology

of cardiac tamponade and the increased risk for pediatric patients was outlined to come up

with their conclusions. Clinical databases from the online library such as EBSCO, CINAHL

Plus, Cochrane Library are just a few databases that can be helpful to look for the

information. By looking up these different databases, and seeing the research conducted, you would be able to answer the clinical question.

References

Johnston, L., & McKinley, D. (2000). Cardiac tamponade after removal of atrial intracardiac

monitoring catheters in a pediatric patient: case report. PubMed, 29 (4):256-61.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence Based Practice in Nursing &

Healthcare. (3rd ed.). Philadelphia: Wolters Kluwer.

• The scenario discusses a pediatric patient with a bleeding disorder with post-operative

complications. To answer the clinical question and determine how rare this complication is in

pediatric patients you must rely on evidenced based research.

According to Melnyk and Fineout-Overholt (2015) the foundation of good searching is well

developed PICOT question. Peer reviewed research is essential for clinicians to answer their

questions (Melnyk & Fineout-Overholt, 2015). You can find a number of peer reviewed

research with online library databases, textbooks, or journals (Melnyk & Fineout-Overholt,

• 2015). Zimmerman (2017) research confirmed the importance of peer reviewed research with

online databases in credibility of evidence based research.

Online databases are going to be the most efficient in finding evidence however you want to

use more than one source to find the answer to your clinical questions according to Melnyk

and Fineout-Overholt (2015). By utilizing scholarly sources, you ensure your sources are up

to date and credible. Google and Google scholar for example are not always the most up to

date reliable sources therefore you should use another source in conjunction with the

information found on their search engines (Melnyk & Fineout-Overholt, 2015). Power and

Siddall (2015) recommend keeping the search simple to avoid information overload. When

searching you should start with key words or the PICOT question then subject headings and if

no results then title searches can be used according Melnyk and Fineout-Overholt (2015).

References:

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence Based Practice in Nursing &

Healthcare. (3rd ed.). Philadelphia: Wolters Kluwer.

Power, A., & Siddall, G. (2015). Ensuring practice is based on the best evidence: Masterclass

on literature searching. British Journal of Midwifery, 23(5), 356-358.

Zimmerman, K. (2017). Essentials of Evidence Based Practice. International Journal Of

Childbirth Education, 32(2), 37-43.

#5 Student’s DQ answer:

The case study is about a four-day old patient who just done with a cardiac surgery

with bleeding disorder noted. After pulling the arterial catheter, the patient showed signs of

distress that required to be back in the operating room to correct the cardiac tamponade. To

address the questions for the situation given, we first have to find evidence knowledge about

cardiac tamponade in infants related to cardiac surgery. We need to know if it’s a common

side effect from the surgery or is this a rare case. Then we can continue to formulate the PICO

model to investigate for further appropriate action. “PICOT represents the patient population,