Showing posts relating to: The Rounds: Clinical Considerations

Laceration Repair Round Up: Best Posts for Learning to Suture

Mastering procedures was one of the more difficult parts of life as a new grad nurse practitioner. Procedures take practice. Not to mention, there are additional factors to consider compared with less involved patient interactions. The risk of complications, for example, is much higher with procedures. So, these interventions must be approached with careful consideration. If you could use a brush up on your laceration repair skills, the following blog posts will help. 

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Which States Allow Nurse Practitioners to Prescribe Suboxone?

Nurse practitioners are newly allowed to prescribe buprenorphine (Suboxone) as part of the Comprehensive Addiction and Recovery Act signed into law by former President Obama. While the Act augments nurse practitioners' scope of practice from a federal standpoint, some states are more limiting in the freedoms they allow NPs. In which states can nurse practitioners actually prescribe Suboxone?

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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 Common Charting Inconsistencies and How to Fix Them

Wouldn't it be nice if you could see patients without worrying about documentation? I often lament that box-checking is a soul-sucking part of my job as a nurse practitioner. But, documentation is a must for NPs and has its benefits as part of patient care (i.e. remembering where you left off at a follow-up visit). Protecting ourselves legally is, of course, another reason charting is an essential part of the patient visit. Unfortunately, as nurse practitioners, we're often in a hurry and are prone to some easy-to-remedy documentation errors. Where are your charts falling short?

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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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A Quick Guide to Documenting a Cardiovascular Exam

Do you struggle with documentation as a nurse practitioner? Compiling your physical exam findings into a succinct statement or two isn't always easy. You must use language appropriate to the body system to convey your exam so that your notes make sense to other providers. You must also make sure to cover the components of each system relevant to the patient's presentation. If you're a nurse practitioner who could use a documentation brush up, check out this quick guide to documenting a cardiovascular exam. 

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Six Off-Label Uses of Prescription Medications

Do you write off-label prescriptions for your patients? It’s possible that as a provider, you may be doing so without even knowing it. Although drug companies are prohibited from marketing medications for unapproved uses, off-label prescribing has become a common clinical practice amongst providers and it can be especially beneficial for patients who have exhausted all of the other treatment options.

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5 Prescription Pill Services for Your Patients

Online shopping and delivery services have transformed the way we buy goods and services. From furniture and groceries to live ladybugs and wigs for dogs, consumers can buy nearly anything their hearts desire and have it conveniently delivered right to their doorstep later that day. In similar fashion and with the evolve of telemedicine, now consumers can skip the lines at the pharmacy and have their prescription medications delivered to their homes too. This is certainly welcome news for providers who have trouble getting certain patients to adhere to taking the medications they’re prescribing them.

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Solving the CMP: Basic Lab Interpretation

When I wrapped up my nurse practitioner program, I remember thinking that I could have used more education around lab interpretation. Which abnormals did I need to worry about? When a lab value came back abnormal, what differential diagnoses could be causing the abnormality? I tell participants in MidlevelU's programs that one could get a PhD in lab interpretation - there can be a high degree of complexity in understanding how some of the physiologic systems involved work. So, we master the basics to start, then build on interpretation ability throughout our careers. 

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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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Are You Making I&D Incisions Correctly?

I’m more familiar than I would like to be with I&Ding abscesses. As a nurse practitioner working in the emergency department, it’s pretty much part of my day-to-day. Whether you’re in family practice, ER, urgent care or even some specialties, chances are you do your fair share of office procedures as well. While most nurse practitioners learn these procedures in school, I do find that many haven’t been trained in some of the finer details of performing them correctly. One such point involves I&Ding in a way that maximizes the probability of a favorable cosmetic outcome. Did you know that there’s a correct or suggested orientation by which you should make incisions?

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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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