Answer to Question 1
A
In determining the patient's bowel habits, remember normal is unique to each individual. Far too often nurses do not acknowledge an older adult's problems with intestinal elimination as an important consideration in their care. Remember that what appears at the outset to be a trivial complaint may be a significant problem physically and/or psychologically. Apply this knowledge in preparing questions for the patient interview to determine the presence and extent of GI alterations. Although the other questions will help determine if there is a problem, having the patient voice her concern will direct future questions. Determine your patient's usual pattern of bowel elimination. Usual frequency and time of day are important, but also determine if any changes in elimination patterns have occurred. Ask the patient to make suggestions about the reason for any change.
Answer to Question 2
A
Systematic reviews or meta-analyses are state-of-the-science summaries from an individual researcher or panel of experts and are on the highest level of the hierarchy. These research summaries are the perfect answers to PICO(T) questions because the researchers have rigorously summarized all current evidence on the question. A single RCT is not as conclusive as a review of several RCTs on the same question. Opinion of an expert committee is on the lowest level of the hierarchy of evidence. Systematic review is above opinions but is below meta-analysis on the hierarchy of evidence.
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