Showing posts relating to: The Rounds: Clinical Considerations

Can Nurse Practitioners Perform Endoscopy and Colonoscopy?

I recently received a nurse practitioner scope of practice question from a surgical center practice manager. She wanted to know if nurse practitioners and physician assistants can perform endoscopy and colonoscopy. Is this in your scope of practice as an NP or PA?

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How Can NPs Learn LARC Insertion?

As a nurse practitioner, training to provide more services and procedures gives your career a major boost. Not only do these abilities serve your patients well, they also make you a more marketable provider and provide value in the workplace. In my own nurse practitioner career, I have enjoyed furthering my clinical and procedural skills as this also keeps me relevant, challenged and up to date with the latest in evidence-based practice. 

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What are PECARN Rules? Hint: They Don't Involve Nuts

Deciding when to order a CT scan in the case of a head injury can be a frustrating process. Yes, the likelihood of a serious finding is often low, but do you really want to be wrong when it comes to a head injury? Absolutely not- the stakes are too high. In kids, the CT decision becomes an even riskier process. Ordering a CT scan unnecessarily increases risk of radiation-related malignancy later in life. Enter the PECARN rules. 

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Clinical Pearls for Otic Foreign Body Removal

When I began working in the emergency department, I was surprised the first time I encountered a patient presenting with a case of insect-in-the-ear. Really? It just crawled in there?! Then, the scenario played itself out over and over again. Whether it's an exploring insect, a bead, or a pea that makes its way into a patient's ear canal, as a nurse practitioner you may find yourself removing otic foreign bodies from time to time. While the procedure is usually quite simple, if done improperly serious complications can result. 

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4 Written Resources for Lab Interpretation

Our last post talked apps for lab interpretation. While apps are convenient and take up only virtual storage space, we totally side with nurse practitioners who prefer more tangible clinical resources. If you're a book-loving NP, there are a number of helpful references out there to guide you in ordering and interpreting lab studies. Which pack the most punch in the clinical setting?

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The Rules for Delivering Bad News to Patients

I've talked to some colleagues recently who've been a little down about their roles as nurse practitioners. Working in family practice, they have found themselves in the position of delivering bad or upsetting news to their patients. Cancer diagnoses were fortunately made rather than missed, but letting a patient know they've got a serious, life-altering illness or condition is tough, not to mention, this is not something most of us as NPs learn to do in school. 

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3 Things You'll Learn at 'What's Up with Primary Care Emergencies?!'

It's almost mid-November and with the upcoming Thanksgiving holiday, I also get the feeling that the year is winding down. Once Thanksgiving week comes, the holiday season takes over and it's all I can do to squeeze in work, shopping, social engagements and all that comes with Christmas time. But, before holiday madness and distractions take over, I plan to get a few productive works weeks in and do some planning to get myself organized in preparation for 2018. 

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What's the Primary Care NP's Role in Managing CKD Patients?

Some of the nurse practitioners participating in Midlevels for the Medically Underserved recently let me know that they see a lot of patients with chronic kidney disease (CKD). Whether these patients are presenting for management of CKD itself or another issue, management and treatment of patients with such chronic comorbidities can be complex. Prescribing, for example, reaches a new level of complexity as the NP must decide which medications and at what doses and intervals are appropriate for the CKD patient. 

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Do Redheads Really Require More Lidocaine?

So, is it fact or fiction? Are redheads really more resistant to anesthetic compared to the rest of the population? In a recent suturing and office procedures training session I attended, the speaker mentioned that redheads may require a greater amount of subcutaneous lidocaine for these procedures than other patients. Curious as to the veracity of this claim, I decided to do a little research. 

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How Accurate are Rapid Strep Tests?

With an estimated seven million Americans seeking medical treatment for sore throats annually, it’s a safe bet that as a nurse practitioner you will treat your fair share of patients with swollen glands and tonsils. Sore throats are often the first sign of an impending illness; but sudden and severe sore throats combined with fever are the telltale sign of a more serious, yet common illness known as Group A Streptococcus or strep pharyngitis. With just one in ten cases of pharyngitis caused by strep, how do you make an accurate diagnosis?

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7 Questions to Ask about Your State Prescription Drug Monitoring Program

Do you look patients up on your state's controlled substance monitoring database before writing prescriptions for these medications? I've long been aware of this resource available to nurse practitioners and other prescribers, however I recently learned that there's a lot more to using these databases than most providers are aware of. Did you know that it may be illegal for you to print out the results of an inquiry into the system? Or, for example, that you may be legally obligated to look a patient up in your state's database before writing certain prescriptions?

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3 Apps to Help Your Patients With Medication Management

Even though I have been a nurse practitioner for a number of years, I don't think I ever fully appreciated how difficult it can be for patients to manage a medication regimen until recently. Given that a few individuals close to myself have found themselves in similar situations, prescribed numerous meds, the problem now seems closer to home. Some drugs must be taken with food, and others without. Medications may be prescribed one, two, three, or even four times a day making taking each pill at the appropriate time nearly impossible. In yet other cases, drugs must be refrigerated, which makes taking them on the go a challenge. 

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