Showing posts relating to: The Rounds: Clinical Considerations

Treating Pesky Triglycerides: A Lipid NP's Take

By Guest Contributor Justin Groce MSN,NP-C,CSCS

With cardiovascular disease being the main cause of mortality in the United States it’s no wonder that statins and other lipid-lowering agents have become the victim of both positive and negative attitudes.  Although low-density lipoproteins (LDLs) have become the forefront target of treatment in regards to lipids one must wonder why triglycerides (TGs) take the backseat.

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Cannabis Considerations: Treating Patients Who Use Marijuana

I'm originally from the Washington State, one of our country's more progressive states when it comes to legalizing marijuana. When I visit home now, I see dispensaries scattered along the roadsides. With cannabis use now permissible in an increasing number of states and attention to the drug on the rise, nurse practitioners are more likely than ever to treat patients who are cannabis users. As with any substance, marijuana use brings up a number of clinical considerations. For example, does cannabis interact with prescription drugs?

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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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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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Why Your Patients Quit Taking Their Meds

A pharmacist's insight on patient adherence 

By Guest Author Eric Christianson, PharmD, BCGP, BCPS

Patient adherence is not the sexiest topic on the planet, but you must understand how prevalent this problem is. You can be the smartest clinician on the planet and select the most appropriate medication for your patient every time, but does it really matter if they don’t take it? 

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Can Nurse Practitioners Perform Endoscopy and Colonoscopy?

I recently received a nurse practitioner scope of practice question from a surgical center practice manager. She wanted to know if nurse practitioners and physician assistants can perform endoscopy and colonoscopy. Is this in your scope of practice as an NP or PA?

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Is Dictation or Typing the Most Efficient Documentation Method?

If there's one thing we can agree on as nurse practitioners, it's that time is a commodity. We're constantly pressured by the clock. Completing documentation can fall by the wayside as we move from patient to patient. I have a strict rule for myself - I must complete a patient's chart before I move on to the next visit. But, even so, I still find myself falling behind and scrambling to identify documentation shortcuts. Many of my coworkers dictate rather than type. Is dictating a better bet for charting efficiency?

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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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F.A.Q About Signing Death Certificates as a NP

The first time a death certificate appears on your desk as a nurse practitioner is a nerve wracking moment. Are you allowed to sign death certificates as an NP? If so, what if you are unsure of the cause of death? What's the liability involved with signing a death certificate? Naturally, there's a lot of confusion and concern among nurse practitioners when it comes to signing death certificates so today we're addressing some F.A.Q. to clear up the confusion. 

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What's Up With Tramadol Falling Out of Favor?

Confession: I didn't quite get as far as I wanted to in the opioid blog series this summer. Planning for our epic MMU kickoff got in the way (and it was totally worth it!). But, I'm back on the bandwagon when it comes to talking about this hot topic - in a practical manner. One topic that come up at the kickoff of our residency-like program was Tramadol. I've prescribed Tramadol often for patients in the past as a non-opioid(ish) pain medication option. And, it works (sometimes).

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The Lidocaine Shortage: An End in Sight?

If you're a nurse practitioner who does a lot of procedures or works in the inpatient hospital setting, you're probably aware of the national lidocaine shortage. As an emergency NP, I've been receiving emails about the shortage for awhile now. Just how bad is the shortage and when will it end? I'm not interested in resorting to performing procedures without anesthesia. 

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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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