Showing posts relating to: The Rounds: Clinical Considerations

A Pharmacist's Top Drug Resource Recommendations for NPs & PAs

This week, nurse practitioners in our inaugural Midlevels for the Medically Underserved class sat in on a presentation from pharmacist Dr. Jon Pouliot about medication interactions in the primary care setting. With so many of our patients taking multiple medications, it can be tough as NPs and PAs to keep track of interaction considerations, as well as drug side effects and dosages. So, helpfully, Dr. Pouliot ended the presentation by suggesting a few practical resources nurse practitioners and physician assistants can use for prescribing. 

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The ABCs of Extremity X-Ray Interpretation for NPs

I've previously discussed the ABCDEFGHI's of chest X-ray interpretation, but today wanted to tackle a topic somewhat simpler. Fortunately for nurse practitioners, interpretation of orthopedic extremity X-rays involves fewer steps as there is generally not quite so much anatomy to consider compared with the trunk. While not all NPs interpret their own radiography, it's still essential to have a basic understanding of how the process works. What exactly should you be looking for when you interpret an extremity X-ray?

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Are You Aware of These 10 Drug-Herb Interactions?

By Guest Contributor Leondria Taty, MSN, FNP-C

Within the past 24 hours, you’ve probably consumed an herb and didn’t even know it. Think about it - almonds (Prunus Amygdalus), cinnamon (Cinnamomum verum), ginger (Zingiber officinale), cayenne (Capsicum annuum), grapes/grape seed (Vitis Vinifera), tomatoes (Lycopersicon esculentum), goji (Lycium barbarum), soy (Glycine max), and many others like it all derive from an herbal plant. Studies support the myriad of health benefits that herbs can provide, many of which have little to no side effects. 

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Nurse Practitioners, Are You Complying with This Reporting Law?

By Leondria Taty, MSN, FNP-C

Every state has a reportable disease list, and health care providers including nurse practitioners are required by law to report these diseases. Yes, that’s right by law. That’s because when these diseases are not reported, delayed, or incomplete, new incidences of the disease can occur and spread in your community. Here’s how it works and why it’s important.

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Are Pharmaceutical Companies Targeting Kids?

As nurse practitioners, we're far too familiar with the influence that drug companies have on our patients. Asking for medications by name, patients often come to us knowing exactly what they want. They are influenced by friends, family, or marketing campaigns. While marketing efforts by pharmaceutical companies aren't inherently a bad thing, drugs help billions of people, the tactics of these companies have been called into question. Recently, the issue has taken on new light given it's effect on increasingly younger populations. 

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Are You Following These 4 Practical Prescribing Principles?

Most often, when I read research articles, I find them interesting, but not directly applicable to my practice. Or, the article presents an interesting perspective, however the research is young and not widely tested. Recently, however, a journal article was recommended to me that proved to be practical and directly applicable to my work as a nurse practitioner. The article? Principles of Conservative Prescribing published in the Archives of Internal Medicine

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Beer's List- Medications You Shouldn't Give to Old People

Do you ever get stumped when it comes to prescribing medications for the elderly? Or, maybe you just don't know what you don't know concerning drugs and old people. It seems like some of the most common feedback my colleagues and I working in the emergency department receive from primary care providers relates to prescribing in the elderly population. 

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Clinical Hack: The Ring String Trick

Working in the emergency department, one of my favorite cases to treat is rings stuck on swollen fingers. While it doesn't happen everyday, there's something gratifying about the opportunity to grind through a ring on a finger that is steadily turning bluer and bluer.

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Pharmacogenetics: Have You Heard of This New Way to Prescribe?

Last month I chatted with Emily, a psychiatric nurse practitioner practicing in California. Emily has recently started a new job, and was excited to fill me in on the details of her position. One thing she loves about her new employer, is the integration of technology into the practice. The practice, for example, offers genetic testing to psychiatric patients, helping Emily select the most effective medication for each individual patient. Such testing falls under the realm of pharmacogenetics, the study of how an individual's genome affects his or her response to medications. 

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How to Tell a Patient "I Don't Know"

How do you react when you don't know the answer to a patient's question? Does your face flush? Do you reply with an answer that doesn't directly address the question asked? Do you abruptly end the conversation? Experts say that the words "I don't know" might be some of the hardest to say, even more so than "I love you". Admitting uncertainty or lack of knowledge isn't easy - just ask children and Alzheimer's patients who confabulate rather an utter a simple "I'm not sure". As nurse practitioners, however, we inevitably find ourselves in situations where we don't have the answers. 

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Clinical Hack: Kissing Trick for Nasal Foreign Body Removal

Whenever I notice a toddler has checked into the emergency department waiting room for some sort of foreign body situation, a feeling of dread sends shivers throughout my body. Attempting to remove french fries from the noses of wiggling kids and beads from the ears of screaming infants has never been my forte. Performing procedures on children, especially those involving foreign body removal, just isn't part of my job that I enjoy. Fortunately, there are a few tricks that make removing foreign bodies a bit easier.

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How to Present a Patient to Your Preceptor with Style

Oh the dread! If you're a nurse practitioner student going through a tough round of clinicals, one cause of your education-related anxiety is likely presenting patients to your preceptor. Summing up a patient in a brief on-the-fly presentation is tricky. Although you've written plenty of SOAP notes, nurse practitioner students often struggle with communicating this kind of information verbally. So, how do you neatly package your next patient encounter and deliver the message in a svelte manner? 

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