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An update on type 2 diabetes management in primary care

Waddell, Jeffrey

Nurse Practitioner . 42(8):20-29, August 17, 2017.

Diabetes mellitus is a chronic disease impacting glucose metabolism. Type 2 diabetes mellitus (T2DM) stems from the inability of the body to utilize endogenous insulin properly. Approximately 90% to 95% of newly diagnosed cases of diabetes are T2DM. This article focuses on the initial treatment of T2DM based on the 2017 American Association of Clinical Endocrinologists and the American College of Endocrinology clinical practice guidelines. The 2017 update includes changes and additions regarding psychosocial management, physical activity, surgery, and hypoglycemia.

New oral antiplatelet medications

Jeffords, Travis

Nurse Practitioner . 42(8):32-39, August 17, 2017.

New and more potent oral antiplatelet agents have shown better clinical outcomes over the last few years. This article discusses four of the newest FDA-approved oral antiplatelet agents and simplifies the latest research and guidelines to provide a better understanding of the current oral antiplatelet therapy available, indications and contraindications, genetic considerations in relation to resistance, and major drug interactions.

Approaches to male hypogonadism in primary care

Lawrence, Kristi L.; Stewart, Felicia; Larson, Brandi M.

Nurse Practitioner . 42(2):32-37, February 12, 2017.

Evidence suggests that providers are not adhering to current testosterone replacement therapy guidelines when treating male hypogonadism. Understanding diagnosis and management is further complicated by conflicting recommendations among available guidelines. NPs must select and follow the best guideline recommendations available to optimally treat this condition.

Pharmacologic pain management at the end of life

Davies, Pamela Stitzlein

Nurse Practitioner . 41(5):26-37, May 19, 2016.

Escalating pain is common in the final weeks of life, requiring skilled management to assist patients with a life-limiting illness. Using a cancer model, pharmacologic approaches to treat pain in the final weeks of life are reviewed. The purpose is to improve care of the dying and contribute toward the goal of a “good death.”

Performing pediatric eye exams in primary care

Martin, Elaine F.

Nurse Practitioner . 42(8):41-47, August 17, 2017.

Early vision care is critical for all children. If undetected, eye disorders such as amblyopia and strabismus may result in permanent vision loss. Vision exams should include a careful history and physical including fix and follow, red reflex, and cover/uncover testing. Photo screening and visual acuity exams should be administered whenever possible.

Acne vulgaris: A review of causes and treatment options

Well, Danielle

Nurse Practitioner . 38(10):22-31, October 10, 2013.

Acne vulgaris is a disorder of the sebaceous follicle. The cause is multifactorial, and both adolescents and adults can be affected. Acne is associated with a significant financial burden and considerable psychological distress. Treatment options are reviewed in this article, including over-the-counter medications, prescription medications, and in-office procedures.

Identifying malnutrition: From acute care to discharge and beyond

Tyler, Renay D.; Guenter, Peggi

Nurse Practitioner . 42(4):18-24, April 16, 2017.

Nutrition assessment and intervention significantly contribute to the well-being of patients. NPs should advocate that patients be appropriately evaluated and implement recommendations as part of a comprehensive care plan to avoid malnutrition in patients while they are in the hospital and when they return home.

The Million Hearts initiative: Guidelines and best practices

Melnyk, Bernadette Mazurek; Orsolini, Liana; Gawlik, Kate; More

Nurse Practitioner . 41(2):46-53, February 18, 2016.

Million Hearts® is a national initiative to improve the nation's cardiovascular health through evidence-based practices and prevention. This article reviews the ABCS of Million Hearts with an emphasis on nurse practitioner-led care models. Recommendations for clinical practice, education, research, and health policy are highlighted.

Cannabis for posttraumatic stress disorder: A neurobiological approach to treatment

Krumm, Bryan A.

Nurse Practitioner . 41(1):50-54, January 16, 2016.

The endocannabinoid system is intricately involved in regulation of the neurobiological processes that underlie the symptomatology of posttraumatic stress disorder (PTSD). This article discusses the neurobiological underpinnings of PTSD and the use of cannabis for treating PTSD in the New Mexico Medical Cannabis Program.

Diagnosis and treatment for chronic migraine

Moriarty, Maureen; Mallick-Searle, Theresa

Nurse Practitioner . 41(6):18-32, June 19, 2016.

Migraine is a debilitating headache disorder that is underdiagnosed and undertreated worldwide, partially attributable to misdiagnosis and expectations of poor treatment outcomes. This article provides a review of chronic migraine, with special emphasis on the role of NPs.

Evaluation of a new genetic family history screening questionnaire for identifying Lynch syndrome

Harrison, Dawn S.; Handley, Marilyn

Nurse Practitioner . 42(8):48-51, August 17, 2017.

Family history is essential when screening for hereditary cancer syndromes. This article explores whether a detailed genetic family history questionnaire is more effective in identifying at-risk individuals for Lynch syndrome than a basic family health questionnaire.

Medical marijuana: Legal and regulatory considerations

Kaplan, Louise

Nurse Practitioner . 40(10):46-54, October 16, 2015.

Nearly half of the United States have legalized medical marijuana. Advanced practice registered nurses (APRNs) in six of these states can authorize patients for medical marijuana use. Knowledge of legal and regulatory aspects of medical marijuana laws will protect an APRN's license and the public.

Recognizing type 1 diabetes mellitus in children & adolescents

Glassford, Melissa A.

Nurse Practitioner . 42(6):16-22, June 16, 2017.

The common chief complaint of abdominal pain, nausea, and vomiting should prompt a broad differential diagnosis list. When a 17-year-old previously healthy male presented to a primary care clinic with these symptoms, it provoked a detailed workup and found a startling diagnosis of type 1 diabetes mellitus (T1DM). This article provides an overview of recognizing T1DM in children and adolescents with a thorough diagnostic evaluation.

28th Annual APRN Legislative Update: Advancements continue for APRN practice

Phillips, Susanne J.

Nurse Practitioner . 41(1):21-48, January 16, 2016.

This year's review and annual advanced practice registered nurse legislative update heralds significant state legislative accomplishments in the areas of APRN practice authority, reimbursement, and prescriptive authority.

The rising incidence of nonalcoholic fatty liver disease

Wisocky, Jessica; Paul, Sonali

Nurse Practitioner . 42(7):14-20, July 15, 2017.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the United States and will soon be the leading indication for liver transplantation. NAFLD can lead to cirrhosis of the liver and is usually asymptomatic. Prompt referral to a hepatologist may halt the morbidity and mortality associated with NAFLD.

The use of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes & chronic kidney disease

Bittle, Polly A.

Nurse Practitioner . 42(6):31-37, June 16, 2017.

There is a need for treatment options in patients with type 2 diabetes mellitus and kidney disease to achieve glucose targets without risk of hypoglycemia. This article describes management options for these patients using glucose lowering therapies, in particular dipeptidyl peptidase-4 inhibitors.

Hepatitis C infection: Updates on treatment guidelines

Pozza, Renee; Hill, Catherine; Hefner, Anna Marie; More

Nurse Practitioner . 42(5):14-23, May 12, 2017.

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. Due to the asymptomatic nature of the infection, many acute cases of HCV infection are left undiagnosed, so screening individuals at risk is an important public health priority. New medications offer sustained virologic response rates of over 95%, fewer adverse reactions, and shorter durations of therapy. This article reviews the new treatment guidelines for the evaluation and management of patients with HCV infection.

Managing herpes zoster in older adults: Prescribing considerations

Beuscher, Linda; Reeves, Geri; Harrell, Debbie

Nurse Practitioner . 42(6):24-29, June 16, 2017.

NPs must be aware of special prescribing considerations for medication safety when managing the care of older adults with herpes zoster. Age-related physiologic changes of the body impact the pharmacokinetics and pharmacodynamics of antiviral and pain medications and can lead to potential adverse events.

The transition of care from hospital to home for patients with hypertension

Franklin, Mary M.; McCoy, Mary Anne

Nurse Practitioner . 42(2):12-18, February 12, 2017.

Approximately 50% to 75% of hospital patients have hypertension. This article describes the transition of care from the hospital to home for patients with hypertension and discusses practice implications for NPs.

Evidence-based treatment of chronic kidney disease

Smith, Cynthia Ann

Nurse Practitioner . 41(11):42-48, November 19, 2016.

To aid in diagnosis and treatment, Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease provides an evidence-based approach. This article reviews the major recommendations of this guideline.

Sodium-glucose cotransporter-2 inhibitors: Expanding oral treatment options for type 2 diabetes mellitus

Ashjian, Emily; Tingen, Jeffrey

Nurse Practitioner . 42(4):8-15, April 16, 2017.

Glycemic control among patients with type 2 diabetes mellitus is important to prevent future complications, including microvascular and macrovascular disease. A novel class of medications, sodium-glucose cotransporter-2 inhibitors, presents an additional oral treatment option.

Genetic counseling for hereditary cancer: A primer for NPs

McReynolds, Kate; Lewis, Sara

Nurse Practitioner . 42(7):22-28, July 15, 2017.

Many patients have concerns regarding their family's cancer history and may be appropriate for referral to genetic counseling. This article examines indications for referral for genetic counseling for hereditary cancer, the process of genetic counseling and testing, and ways for NPs to collaborate with genetics providers.

Treating co-occurring chronic low back pain & generalized anxiety disorder

Janzen, Kristina; Peters-Watral, Brenda

Nurse Practitioner . 41(1):12-18, January 16, 2016.

The complex, bidirectional correlation between chronic low back pain (CLBP) and generalized anxiety disorder (GAD), common ailments in primary care, can increase the risk of inadequate treatment. This article reviews the relationship between CLBP and GAD and provides optimal management strategies for NPs caring for individuals with this dyad.

Hormonal contraception and headaches: What are the prescriber's options?

Hellier, Susan

Nurse Practitioner . 38(12):32-37, December 10, 2013.

This article reviews evidence-based hormonal contraception prescribing options in the primary care setting for reproductive age women who experience headaches. To prescribe hormonal contraception safely, the nurse practitioner must be able to differentiate between common primary headache phenotypes, such as the migraine and the tension-type headache.

An update on gout for primary care providers

Harding, Mariann

Nurse Practitioner . 41(4):14-21, April 17, 2016.

This article discusses the current beliefs regarding the pathogenesis of gout and reviews the 2012 guidelines from the American College of Rheumatology regarding diagnostic testing, optimal treatments, and lifestyle modifications. Implementing these guidelines will help clinicians resolve acute episodes and manage gout, improving outcomes and quality of life.

Red eye emergencies in primary care

Ossorio, Anthony

Nurse Practitioner . 40(12):46-53, December 12, 2015.

Severe red eye conditions can be the result of intraocular inflammation, corneal insults or inflammation, and acute glaucoma. These pathologies require the knowledge and assessment tools of an ophthalmologist. NPs should maintain a high level of suspicion during the history and physical exam and ask key questions that can lead to the correct diagnosis and management of these ocular pathologies. This article will discuss red eye emergencies that the NP should promptly recognize and refer to ophthalmology.

Allergic rhinitis: Diagnosis through management

Krouse, Helene J.; Krouse, John H.

Nurse Practitioner . 39(4):20-28, April 13, 2014.

Allegic rhinitis (AR) is an immune hypersensitivity response of the nasal mucosa affecting children and adults. Patients with a genetic predisposition become sensitized to certain allergens over time with repeated exposures. This article discusses AR from diagnosis through treatment.

Type 1 diabetes & cardiovascular disease

Kreider, Kathryn Evans; Padilla, Blanca I.

Nurse Practitioner . 41(10):18-25, October 20, 2016.

Individuals with type 1 diabetes mellitus (T1DM) have a high risk of developing cardiovascular disease (CVD), but some risk factors can be mediated by lifestyle modification and medication. NPs should understand evidence-based management approaches to counsel patients with T1DM about appropriate self-management interventions to reduce the likelihood of CVD.

Constipation in children: Diagnosis, treatment, and prevention

Ferrara, Lucille R.; Saccomano, Scott J.

Nurse Practitioner . 42(7):30-34, July 15, 2017.

Deviation from normal bowel function in the pediatric population is often a cause for concern for parents and caregivers, prompting numerous visits to a primary care provider. Constipation is a common and challenging issue in children that can have an adverse impact on their psychosocial and emotional well-being as well as quality of life. This article provides practical strategies for diagnosing, treating, and preventing constipation in children.

Pediatric portal hypertension: A review for primary care

Vogel, Clarissa Barbon

Nurse Practitioner . 42(5):35-42, May 12, 2017.

Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. This article reviews the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests available, and treatment and management options.

Improving end-of-life care: Recommendations from the IOM

Dobbins, Elizabeth H.

Nurse Practitioner . 41(9):26-34, September 22, 2016.

A 2014 consensus report by the Institute of Medicine offers recommendations for healthcare providers to decrease unwanted care and improve the quality of life at the end of life. This article discusses the recommendations of interest to advanced practice registered nurses and applies them to a common patient and family experience.

Identification and management of bipolar disorder

Scrandis, Debra A.

Nurse Practitioner . 39(10):30-37, October 15, 2014.

Bipolar disorder is a complex and chronic mental illness. Individuals with this disorder usually have medical comorbidities needing management in primary care. This article focuses on bipolar identification and medication management concerns for primary care nurse providers.

Prevention of Alzheimer disease: The roles of nutrition and primary care

Bane, Tabitha J.; Cole, Connie

Nurse Practitioner . 40(5):30-35, May 15, 2015.

Risk factors for developing Alzheimer disease include hypercholesterolemia, hypertension, obesity, and diabetes. Due to a lack of effective treatments for Alzheimer disease, nutrition and primary prevention become important.

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