Showing posts relating to: The Rounds: Clinical Considerations

CT Scans: When Do You Need Contrast?

Working in the emergency department as a nurse practitioner, I order CT scans in my evaluation of patients every day. When I was newer to my role, I had a lot of questions about diagnostic imaging, when it was indicated, and what test to order. One of these questions that came up frequently related to CT scans was "Do I need contrast?". If you're a nurse practitioner who struggles with the same question, check out the following guide to contrast and CT scans. 

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X-Ray vs. CT vs. MRI: What's the Difference?

When a child comes in to the clinic after a fall with pain in an extremity, as a nurse practitioner you know what to do. You order an X-ray of the affected area, right? Sometimes, however, selecting the appropriate diagnostic test isn't so simple. Ultimately, test selection depends on the condition(s) you are looking for or trying to rule out as determined by the patient's history and physical exam. If you're not quite sure what to order and when, here are some general differences between common diagnostic imaging tools which may help you make a decision. 

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Top 10 Posts for Taking Your Clinical Game to the Next Level

Whether you're a nurse practitioner student or a savvy, experienced NP, there's always room to improve when it comes to clinical knowledge and skills. Over the course of the year, we've written several posts to help up your clinical game. From quick hacks to what to do when you screw up, here are your top 10 favorite clinical posts from 2016 to welcome the New Year. 

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How Well Do You Know Your Injectable Anesthetics?

A significant part of my job as a nurse practitioner in the emergency department is performing procedures. At any given time during my shift, you're likely to find me gathering supplies for an I&D, placing a few sutures to close a laceration, reducing a dislocation, or removing a pesky foreign body from the bottom of a patient's foot. Needless to say, I use a lot of injectable anesthetics. 

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The 411 on Documenting a HEENT Exam

If you're a nurse practitioner student or new grad NP, documenting a patient encounter can be a bit of a struggle. You need to present your patient in a manner such that other providers can glance at the chart and pick up where you left off. You must also provide sufficient documentation so that you can justify your decision making should questions about the care you provided arise. Completing charts in a time efficient manner is no easy task, particularly early in your nurse practitioner career. 

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Why NPs Need to Antibiogramit!

Part of MidlevelU's residency-like program for NPs, which we fondly refer to as MMU, consists of weekly education sessions for newly minted nurse practitioners. I have the distinct pleasure of sitting in on these sessions, and learning from our weekly speakers. Although with eight years of experience, I am now comfortable in my practice, there's always more to learn. This past week, while listening to our speaker, I got a more in depth glance at the concept of an antibiogram and became convinced that implementing this tool into my practice would be a valuable move to make. 

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How Accurate are Rapid Flu Tests?

Relying on the rapid influenza test may not be your best bet

For some, the holiday season brings the joy of cooler temperatures, peppermint mochas and kindling fires. But for nurse practitioners, the time of year also means the loom and doom of the dreaded influenza season.

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Documenting a Back and Neck Exam Made Simple

Whether you're a seasoned nurse practitioner or a new grad, there's always room for improvement when it comes to documentation skills. Over the past few months here at MidlevelU, we've been looking at documentation basics for the various body systems. Accurately recording the findings of your physical exam is essential for the continued care of your patient and to protect yourself legally as a healthcare provider. What do you need to know when it comes to documenting exam findings of the back and neck?

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Foreign Body Freakout! How to Remove an Insect from the Ear

Have you ever treated a patient presenting with a case of insect-in-the-ear? Understandably, the situation is quite distressing for the patient. Spiders, cockroaches, and other creepy-crawlies entering the ear canal, particularly during sleep, occurs more commonly than you might think. While this isn't a problem I treat on a daily basis as a nurse practitioner in the emergency department, it happens from time to time. What is the best approach for removing an insect from the ear?

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Charting Hacks for Nurse Practitioners

Sometimes charting makes me want to scream. When I work in the fast track area of the emergency department diagnosing ear infections, suturing lacerations and treating minor injuries, I quickly become frustrated with documentation. It seems that charting the patient interaction takes longer than the visit itself. Not to mention, documenting what seems like the same visit over and over again makes me certifiably crazy. 

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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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Auscultate It! Super Quick Lung Sounds Tutorial

It's interesting how much you can learn with a review of the most basic skills. As nurse practitioners, many of us have been listening to lung sounds for years. But, when a reader asked me to post a refresher on auscultation, even as an experienced NP I came away with a few new interesting tidbits of information. So, whether you're new to the nurse practitioner profession, or you're a seasoned NP with years of experience, check out this super quick refresher on lung sounds. 

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