Showing posts relating to: The Rounds: Clinical Considerations

The First Step to Appropriate Pain Management

I have to admit that I kind of hate talking about pain management. Pain is one of those things that your patients can't show you visibly (at least most of the time). It doesn't show up in lab results. Treatment of pain is based on subjective report. So, as a nurse practitioner it can be difficult for me to make decisions about managing pain for my patients. Then, toss into the mix that our nation is facing an opioid crisis, the fact that I've been duped a few times into writing narcotic prescriptions for addicts and I'm not sure what to do next or where to draw the line. 

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New Series! Approaching Pain Management

From pharmacology to putting your foot down

Raise you hand if you struggle with setting boundaries in treating pain for your patients. Pain management is a huge topic these days for nurse practitioners and physician assistants. As one who has personally broken ribs in the past and felt the relief a Lortab provides and as one who suffered from a nasty case of influenza as a child and was comforted by codeine-containing cough syrup, I understand that opioids have a valid place in medicine. But, as a nurse practitioner practicing amidst an opioid crisis, I also feel immense pressure to stray from prescribing these drugs. 

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Which Patients Actually Need Preventative Low Dose Aspirin?

The answer, simplified.

Keeping up with preventative care guidelines can be pretty confusing. It seems like every professional society related to each specialty publishes their own recommendations. From kidney and liver disease prevention to cardiac and osteoporosis screenings, where do you even begin? One particular preventative measure often recommended by nurse practitioners, taking low dose aspirin to prevent cardiovascular disease, is particularly nebulous. 

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Can Essential Oils Interfere With the Prescriptions You're Writing?

When you take a patient’s history, are you asking what essential oils they may be using in addition to any medications they’re taking? Patients are often under the impression that because essential oils are derived from natural, plant-based substances, they’re a safe alternative to traditional pharmaceuticals and pose little to no health risk. As such they may not feel it’s relevant to disclose it to their healthcare provider unless asked. 

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5 Helpful Pocket Orthopedic Guides for Nurse Practitioners

Diagnosing orthopedic symptoms can be tricky. X-rays, for example, don't tell you a lot about tendons and ligaments that are often responsible for joint pain. More advanced testing, like MRI, is costly, and often requires prior authorization from insurance companies leading to a delay in treatment. While there are a number of clinical orthopedic exam maneuvers that indicate the exact type of injury and help lead nurse practitioners to a diagnosis, the specifics of these exam techniques can be difficult to recall on the spot. 

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Now, What Meds Are You Taking Again? Pill Identification Apps

By MidlevelU Intern and BSN in Progress Olivia DeFilippo

Countless times I have peered into my medicine cabinet in search of my allergy medication finding pills that have fallen out of the packaging. "I think that tablet looks like my allergy medicine" I say to myself..."But should I risk it?".

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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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Can Nurse Practitioners Text Patient Care Orders?

Have you ever texted about a patient? In the emergency department where I work, texting can be an easy way to consult with a specialist or send an image of a patient's X-ray, lab results or even chief complaint. But, is this legal? What are the implications of texting about patient care?

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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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Which Flu Patients Need Antiviral Meds?

I didn't originally intend on making it viral syndrome week here on MidlevelU, but given the season it seemed appropriate. After my shift the other day in the emergency department, I felt the need for an influenza brush-up. So, I'm passing on the relevant and lesser known tidbits to other nurse practitioners who could also use a refresher. Yesterday, we looked at influenza testing and its accuracy (see 5 Lesser Known Facts to Help Make a Flu Diagnosis). Today, we'll take the next step in the patient care process and look at treatment. 

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5 Lesser-Known Facts to Help Make a Flu Diagnosis

How accurate is the flu swab? Can I just use clinical intuition? And more...

I'm still crossing my fingers that the last shift I worked in the ER won't leave me sick with the flu. It seems like every other patient I saw tested positive for influenza A. As nurse practitioners this time of year, in many settings we're bombarded by sick patients. While we can't do much for viral syndromes in most cases, there are some general guidelines we must abide by and helpful information to know that impacts diagnosis. 

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What NPs Need to Know About Treating RSV

Cold and flu season if definitely here! In addition to the seasonal flu, respiratory syncytial virus (commonly referred to as RSV) is another prevalent and highly contagious virus that can affect patients of all ages through the fall and spring months. Nurse practitioners can expect to see these patients in their practices this season. In most older children and adults who are generally healthy, RSV causes mild, cold-like symptoms which typically resolve on their own within a few weeks. But for some patients, RSV can be serious and in some cases, life threatening.

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