Showing posts relating to: The Rounds: Clinical Considerations

Documenting a Neuro Exam, Decoded

A neuro exam is one of the more complex body systems to master when it comes to assessment and documentation. Testing the cranial nerves, for example, takes practice. Omitting a small part of the process can mean missing a potentially serious diagnosis. Given the importance of the neurological exam, today as part of our documentation series, we're going to look at exactly how to record your exam findings. 

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The Essentials of Documenting an Extremity Exam

Today, we're continuing our series on documentation with the extremities. From orthopedic injuries, to infection, and symptoms of systemic illness, there's a wide range of findings you may note on an exam of the upper and/or lower extremities. Documenting these findings appropriately is important not only to the continuity of care for your patient, but also to protect yourself legally as a provider and justify your treatment plan. So, how do you document an extremity exam?

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The Skinny on Documenting an Abdominal Exam

If you're a newer nurse practitioner, chances are you may find documentation a challenge, especially if you don't have an electronic medical records system prompting the input of your physical exam findings. Documentation is key to continuity of care for your patients, as well as to protecting yourself should questions arise about the patient encounter. Given the importance of this foundational skill, we're going to spend some time covering how to document a physical exam, system-by-system (in no particular order) over the next few weeks here on MidlevelU. 

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5 Fantastic Resources for Women's Health Nurse Practitioners

If you're a women's health nurse practitioner, or an NP that sees patients for issues related to reproductive health, you're in luck. There are a number of online resources out there to make your job easier. Whether you're looking to keep up with the latest treatment guidelines, or stash a few quality handouts for your patients, there's a website to help. Here are a few of our favorites. 

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The Rules for Treating Partners of Patients with STDs

As a nurse practitioner working in the emergency department, I've become accustomed to treating patients for sexually transmitted infections. In fact, I do so nearly every shift I work. While having these sometimes awkward conversations with patients has become much easier, the waters surrounding treatment for the partners of these patients remains murky. Is it allowable to prescribe antibiotics for the partner of a patient I have never laid eyes on? What are the legal implications of doing so?

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4 Key Questions to Help Your Patients Make Lifestyle Changes

Last week at the Midlevels for the Medically Underserved kickoff, a speaker discussed the concept of motivational interviewing. In my eight years as a nurse practitioner, I had never been introduced to the topic. I wasn't quite sure what to expect. Midway through her discussion, I had an 'Aha!' moment that will make a significant difference in the way I interact with my patients. Here's what happened. 

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Orthopedic Decision-Making Made Easy for the Ankle and Knee

Earlier this week, I discussed the concept of clinical prediction rules. Essentially, these rules are tools nurse practitioners can use to simplify and increase the accuracy of clinical decision making. If you've ever used Wells Criteria to rule out a DVT for example, you've used a clinical prediction rule. I frequently take advantage of such algorithms in my own nurse practitioner practice as they lend an added level of confidence to my course of diagnosis and treatment. So, today, let's talk about a few of these guidelines as they relate to orthopedics.

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What is a Rust Ring and How Do You Remove It?

Have I mentioned before that I hate treating ophthalmology problems? Well, that and testicular diagnoses. In each case, the patient only has two of the particular body part and the stakes are, needless to say, high when it comes to getting the right diagnosis. Diagnosing and treating eye related problems doesn't give me quite the amount of anxiety it once did now that I am more seasoned in my practice. So, I do enjoy treating the occasional ocular foreign body- as long as I can successfully remove it, that is. 

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The Nurse Practitioner's Guide to Zika in the U.S.

Now that the Zika virus has reared its ugly head here in the United States with cases of local transmission reported in Florida, nurse practitioners must be even more aware of how to treat patients with possible exposure to the virus. This is especially important for NPs caring for pregnant women, and women of childbearing age, as the virus can have devastating effects in pregnancy. What are the latest guidelines in patient care now that Zika transmission has occurred on U.S. soil?

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The 411 on Nurse Practitioner Prescribing

Prescribing is a core component of life as a nurse practitioner. While we advocate for lifestyle change and encourage alternate therapies, sometimes medication is the answer for our patients. Prescribing as a nurse practitioner can be a complex matter. Laws related to NPs and prescribing vary state to state. Some require a collaborative agreement with a physician, while others allow for independence. Even in states where nurse practitioners enjoy a greater scope of practice, state and federal guidelines still apply. What do nurse practitioners need to know when it comes to prescribing?

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Summer Medicine: Evaluation & Treatment of Snakebites

Hailing from the Pacific Northwest, where snakes are common, but not a health hazard, I rarely think about the possibility of snakebite emergencies. Now, living in Tennessee, things are different. There are a number of venomous snakes indigenous to the United States. Summertime, when outdoor activities, like wading in creeks and working in fields is common, snakes do pose a potentially serious danger. The other day while I was working in the emergency department, a patient arrived with the first serious snakebite we have seen this summer, prompting me to brush up on my envenomation know-how. 

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5 Online Trauma CME Resources for Nurse Practitioners

The hospital where I work has recently upped it's trauma level status. So, it has come to my attention, there is now a trauma-related continuing education requirement for nurse practitioners working in the emergency department. My continuing education hours necessary for certification have already been completed, so, in the interest of maximizing my budget, I prefer to meet this new trauma requirement at low or no cost. Fortunately, I was able to identify a few budget-friendly trauma CME resources available to nurse practitioners online. 

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