Relevant Evaluation Criteria Scenario/Model Outcome
Information Gathering
1. Gather essential information about the patient’s symptoms, including:
a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient inquires about information found on the Internet recommending supplementation with various vitamins to prevent cancer and aging. He states he currently takes Centrum Silver plus extra vitamin C to prevent colds and gingko biloba for his memory.
b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) N/A
c. description of the patient’s efforts to relieve the symptoms N/A
2. Gather essential patient history information:
a. patient’s identity Bruce Trappers
b. patient’s age, sex, height, and weight 79-year-old male, 6 ft 1 in, 190 lb
c. patient’s occupation Retired professor of agriculture
d. patient’s dietary habits Eats only two meals daily to help maintain weight: typically cereal and fruit or 3-4 eggs, starch, and fruit for breakfast: balanced meals for dinner with salad, protein, starch, vegetable, and a glass of wine
e. patient’s sleep habits N/A
f. concurrent medical conditions, prescription and nonprescription medications, and dietary supplements Patient has a history of hyperlipidemia with family history of myocardial infarction in his brother. Every morning he takes 325 mg aspirin, atorvastatin 10 mg, 2 omega-3 fish oil capsules, 1 Centrum Silver multivitamin, 500 mg vitamin C, and 120 mg of gingko biloba.
g. allergies Sulfa
h. history of other adverse reactions to medications N/A
Assessment and Triage
3. Differentiate the patient’s signs/symptoms and correctly identify the patient’s primary problem(s). Taking multiple supplements can increase the risk of exceeding the UL for various nutrients. There is no evidence to suggest that this practice is beneficial, and evidence is mounting that supplementation of certain nutrients can potentially be harmful.
4. Identify exclusions for self-treatment. None
5. Formulate a comprehensive list of therapeutic alternatives for the primary problem to determine if triage to a medical practitioner is required, and share this information with the patient. Options include:

(1) Assess the client’s perceived need for the nutrient supplements.
(2) Evaluate dietary intake from food groups, encouraging at least 5 servings of produce daily, 3 servings of low-fat dairy products, 2 servings of protein, and 6 servings of whole-grain food sources daily.
(3) Discuss which nutrients may need supplementation, on the basis of the patient’s patterns of dietary intake. Evaluate Centrum Silver for adequacy, while avoiding intakes above the UL.
(4) Discuss the lack of data and potential harm associated with megadoses of vitamin.
(5) Take no action.
Plan
6. Select an optimal therapeutic alternative to address the patient’s problem, taking into account patient preferences. Encourage a well-balanced diet, emphasizing that studies repeatedly demonstrate that good nutrition is associated with multiple health benefits, including a lower risk of some cancers and other age-related diseases. Evaluate the Centrum Silver multi-vitamin with the client, comparing the level of supplementation of each nutrient compared with the dietary reference intake. Point out that the product contains gingko biloba and vitamin C; therefore, additional supplementation of these substances is not necessary.
7. Describe the recommended therapeutic approach to the patient. See step 6.
8. Explain to the patient the rationale for selecting the recommended therapeutic approach from the considered therapeutic alternatives. See step 6.
Patient Education
9. When recommending self-care with non-prescription medications and/or nondrug therapy, convey accurate information to the patient:
a. appropriate dose and frequency of administration Consider one U.S. Pharmacopeia-approved multivitamin daily that contains no more than 100% of dietary reference intake for nutrients.
b. maximum number of days the therapy should be employed N/A
c. product administration procedures You may take your multivitamin with your current medications in the morning. However, check with your pharmacist on coadministration of any newly prescribed medications.
10. Solicit follow-up questions from patient. What about antioxidant vitamins?
11. Answer patient’s questions. Data from well-designed trials do not support antioxidant supplementation for the prevention or treatment of cancer. In fact, some trials have suggested potential harm is associated with supplementation of vitamins A, E, and C, selenium, and other nutrients in relation to cancer risk. Therefore, dosing of these nutrients above the dietary reference intake cannot be recommended at this time.