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Recurrent bacterial vaginosis

Ellington, Kelly; Saccomano, Scott J.

The Nurse Practitioner. 45(10):27-32, October 2020.

Bacterial vaginosis recurrence is common but can lead to recurrent bothersome symptoms associated with infection. This article reviews evidence-based options for practicing providers to improve patient outcomes. Bacterial vaginosis increases the risk of acquiring sexually transmitted infections, including HIV. Adequate treatment is essential to help avoid adverse patient outcomes.

Implications of vitamin D toxicity & deficiency

Waterbury, Susan

The Nurse Practitioner. 43(5):22-30, May 17, 2018.

Vitamin D deficiency is an increasing problem affecting all ages. Patients should be assessed for risk factors as part of preventive health maintenance, and serum 25-hydroxyvitamin D level testing should be done for those at risk.

Postural orthostatic tachycardia syndrome: A conundrum for patients and healthcare providers

Cline, Holly M.; Einhardt, Adam

The Nurse Practitioner. 47(1):12-19, January 2022.

Postural orthostatic tachycardia syndrome is an underdiagnosed disorder of the autonomic nervous system. The median time to achieve correct diagnosis is 2 years and may take more than 10 years for some patients. Symptoms can be devastating to the daily life of patients and can result in long-term disability. Treatment availability is limited due to the need for further studies.

APRN transition to practice: Program development tips

Urbanowicz, Janet

The Nurse Practitioner. 44(12):50-55, December 2019.

Leaving the comfort zone of being an experienced RN for a new career as an inexperienced advanced practice registered nurse (APRN) is one of the greatest difficulties of the APRN transition to practice. To date, very few formal APRN residency or fellowship transition programs exist. Practicing APRNs can advocate for a formal transition program in their organizations.

Low voltage on the 12-lead ECG: A warning sign

Dzikowicz, Dillon J.

The Nurse Practitioner. 45(9):33-40, September 2020.

A 12-lead ECG showing low voltage should be a red flag to providers and can be caused by several serious conditions. A case reported is included that describes how an NP correctly treated a patient with low voltage on an ECG by discerning and managing the underlying causes.

34th Annual APRN Legislative Update: Trends in APRN practice authority during the COVID-19 global pandemic

Phillips, Susanne J.

The Nurse Practitioner. 47(1):21-47, January 2022.

Relaxation of existing regulations in supervision, collaboration, license renewal, and portability due to the continuing COVID-19 pandemic improved practice authority for advanced practice registered nurses (APRNs) in reduced- and restricted practice states. This 34th Annual Legislative Update covers the scope of practice changes, and legislative and regulatory decisions that most impacted APRNs across the US in 2021.

Pain management for patients with chronic kidney disease in the primary care setting

Lowe, Kevin M.; Robinson, Danny R. Jr.

The Nurse Practitioner. 45(1):18-26, January 2020.

Pain is routinely reported in patients with chronic kidney disease. Pain is often multifaceted, making the treatment of this complex patient population even more challenging. Understanding pain types as well as treatment options for these patients with pain is an important skillset for the primary care provider.

SGLT2 inhibitors: What role do they play in heart failure with reduced ejection fraction?

Lenahan, Christy McDonald; Harrington, Deedra; Stueben, Frances

The Nurse Practitioner. 46(7):30-37, July 2021.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors can decrease risk for heart failure in patients with type 2 diabetes and can decrease risk of major cardiovascular events in patients with heart failure (HF) and diabetes. Specific SGLT2 inhibitors can also decrease major cardiovascular events in patients with HF only.

Fibromyalgia: A clinical update

St. John, Amanda W.; Aebischer, Jonathan H.; Friend, Ronald; More

The Nurse Practitioner. 47(4):20-30, April 2022.

Fibromyalgia (FM) is a chronic pain disorder commonly encountered by advanced practice registered nurses in primary and specialty care. Knowing how to recognize FM and its multiple pain and nonpain symptoms facilitates diagnosis. We propose a four-step approach to diagnosis that can reduce costly referrals and treatment delays, and describe evidence-based interventions.

Infertility management in primary care

Thable, Angela; Duff, Elsie; Dika, Cheryl

The Nurse Practitioner. 45(5):48-54, May 2020.

Infertility is a growing issue for couples. Primary care NPs can manage initial treatment as well as address the emotional and financial burdens of patients experiencing infertility. NPs can provide timely access to investigations and treatment, helping patients achieve their goal of pregnancy sooner.

Vesicular hand dermatitis

Sobering, Geraldine; Dika, Cheryl

The Nurse Practitioner. 43(11):33-37, November 2018.

Vesicular hand dermatitis is a type of eczema involving the fingers, hands, and sometimes the feet. It is common in primary care, requiring prompt treatment to prevent chronicity. The cause is often unknown, making the condition challenging to treat. Management consists of avoiding irritants and using emollients and topical corticosteroids.

Noninfectious causes of fever in adults

Steele, Gregory M.; Franco-Paredes, Carlos; Chastain, Daniel B.

The Nurse Practitioner. 43(4):38-44, April 19, 2018.

Fever is a common clinical sign encountered in hospitalized patients and often represents the cardinal sign of infectious processes. However, a number of noninfectious etiologies causing fever should be considered prior to initiating broad-spectrum antibiotic therapy. Reducing unnecessary antibiotic use is crucial in an era of increasing resistance.

Impact of NP follow-up calls on reducing 30-day readmissions in patients with stroke

Hwang, Pauline J.

The Nurse Practitioner. 47(5):39-46, May 2022.

Hospital readmissions are major contributors to increased healthcare costs and lower quality of life. Despite advanced stroke care, patients who have experienced a stroke require ongoing follow-up care to prevent complications and hospital readmissions. We evaluated the impact of NP follow-up calls, providing another level of expertise to promptly identify new symptoms and complications, on readmission rates in patients who have experienced stroke.

Pediatric hypertension: A guideline update

Benenson, Irina; Waldron, Frederick A.; Porter, Sallie

The Nurse Practitioner. 45(5):16-23, May 2020.

The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.

Measles: Moving toward eradication

Feutz, Kristi; Shirey, Deborah

The Nurse Practitioner. 47(5):14-20, May 2022.

Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention.

Caring for military families: Understanding their unique stressors

Owen, Regina; Combs, Teresa

The Nurse Practitioner. 42(5):26-32, May 12, 2017.

Military families are often faced with unique stressors that civilian families do not have to deal with, such as deployment, geographic separation, and frequent relocation. When an NP is providing care for a military family, it is important that these unique stressors are discussed and understood. NPs can employ the Causal Uncertainty Model to encourage effortful cognition and support family attributes to ameliorate the negative effects of the stressors these families may face.

Tetralogy of Fallot: A case study and billing and coding perspective using the 2021 updated fee schedule

Chase, Julia R.; Fliehman, Maci; LeGal, Michael; More

The Nurse Practitioner. 47(5):32-38, May 2022.

The Physician Fee Schedule was updated in 2021 by the Centers for Medicare and Medicaid Services. A case study on Tetralogy of Fallot, the most common cyanotic congenital heart defect, is presented with guidance in billing the office visit to reflect the current guidelines.

Adverse childhood experiences and implementing trauma-informed primary care

Esden, Jana L.

The Nurse Practitioner. 43(12):10-21, December 2018.

Adverse childhood experiences (ACEs) include exposures such as abuse and household dysfunction. These exposures are associated with long-term sequelae and unfavorable health outcomes in adulthood. NPs working in primary care can help to reduce the impact of ACEs in adulthood by identifying individuals with these experiences and implementing trauma-informed care strategies.

Hypertension management options: 2017 guideline

Scordo, Kristine Anne

The Nurse Practitioner. 43(6):33-37, June 11, 2018.

The new hypertension guideline lowers the definition of high BP to 130/80 mm Hg. This means that millions of adults will now be diagnosed with hypertension and that many of those taking antihypertensive drugs are not at goal. The challenge is to communicate the change, the strength of evidence behind the change, and the options available to patients. Healthcare providers must be knowledgeable of the new guideline and ready to meet this challenge.

Bladder cancer: Risk factors, diagnosis, and management

Farling, Kristen Burns

The Nurse Practitioner. 42(3):26-33, March 7, 2017.

Bladder cancer is the most common genitourinary cancer in the United States. Symptoms of bladder cancer mimic those of a urinary tract infection, which can delay timely diagnosis. This article reviews the signs and symptoms of bladder cancer along with management options to safely care for this patient population.

32nd Annual APRN Legislative Update: Improving access to high-quality, safe, and effective healthcare

Phillips, Susanne J.

The Nurse Practitioner. 45(1):28-55, January 2020.

The Annual Legislative Update describes recent legislative and regulatory changes to practice, reimbursement, and prescriptive authority that have the most impact on NPs and other advanced practice registered nurses across the country.

Using telehealth for diabetes self-management in underserved populations

Ju, Hsiao-Hui

The Nurse Practitioner. 45(11):26-33, November 2020.

Diabetes self-management is a complex process and central to well-being of patients with this chronic disorder. A patient-centered telehealth program may potentially meet needs of those in underserved populations to reduce socioeconomic disparities. Achieving this goal requires a focused concentration on health behaviors and practices of individuals in underserved populations.

Acne vulgaris: A review of causes and treatment options

Well, Danielle

The 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.

Mind & body practices in the treatment of adolescent anxiety

Fulweiler, Bernadette; John, Rita Marie

The Nurse Practitioner. 43(8):36-43, August 2018.

Although anxiety is the most common mental health condition among adolescents in the United States, the current standards of practice for treatment are expensive, may be difficult to obtain, and potentially harmful. Even though mind and body practices show great promise in the treatment of adolescent anxiety, the associated financial constraints, lack of education, and structural barriers can hinder the integration of these practices into primary care.

Health disparities in American Indians/Alaska Natives: Implications for nurse practitioners

Carron, Rebecca

The Nurse Practitioner. 45(6):26-32, June 2020.

American Indians/Alaska Natives experience significant health disparities in many areas including metabolic and mental health disorders. NPs have the opportunity to understand the underlying causes of these disparities and provide health interventions that promote wellness.

Asymptomatic GBS bacteriuria during antenatal visits: To treat or not to treat?

Rosenberger, Kelly D.; Seibert, Amy; Hormig, Sara

The Nurse Practitioner. 45(7):18-25, July 2020.

Inconsistencies persist regarding the efficacy of treating asymptomatic group B Streptococcus bacteriuria in pregnant individuals with colony counts below 105 (100,000) CFU/mL. Despite these discrepancies, treatment still occurs. This article examines the role of screening and treatment, evidence-based guidelines, and practice patterns to provide clarification and resolve local practice disparities.

33rd Annual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times

Phillips, Susanne J.

The Nurse Practitioner. 46(1):27-55, January 2021.

In a year unlike any other in recent history, healthcare workers, including advanced practice registered nurses (APRNs), faced challenges and triumphs as the frontline in the battle against COVID-19. This 33rd Annual Legislative Update covers the scope of practice changes and legislative decisions that most impacted APRNs across the US in 2020.

Reversal agents for oral anticoagulants

Griffiths, Carrie L.; Vestal, Mark L.; Livengood, Spencer J.; More

The Nurse Practitioner. 42(11):8-14, November 16, 2017.

For more than half a century, warfarin, a vitamin K antagonist, has been the anticoagulant of choice. However, direct oral anticoagulants are rapidly gaining in popularity, which poses the need for efficacious reversal agents. This review article summarizes the strategies and agents used to reverse oral anticoagulants.

How NPs can help expand telehealth services

Rincon, Teresa A.

The Nurse Practitioner. 44(11):30-35, November 2019.

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.

A review of knee pain in adolescent females

Lipman, Rachel; John, Rita Marie

The Nurse Practitioner. 40(7):28-36, July 15, 2015.

Primary care practitioners are in a position to educate patients and parents of the risk factors that may increase the incidence of knee pain in adolescent females. This article highlights patellofemoral pain syndrome, Sinding-Larsen-Johansson syndrome, Osgood-Schlatter disease, and meniscal tears. This review encourages nurse practitioners to identify potential risk factors for injury.

Primary care management of ulcerative colitis

Davis, Stephanie C.; Robinson, Brittani L.; Vess, Joy; More

The Nurse Practitioner. 43(1):11-19, January 15, 2018.

Ulcerative colitis (UC) is an inflammatory bowel disease marked by mucosal inflammation. UC has an impact on quality of life and places a financial burden on the healthcare system. This article focuses on the impact, presentation, diagnosis and classification, systemic manifestations, complications, management, and treatment associated with UC.

How NPs can eliminate practice barriers to intrauterine device use

Bach, Susan; Heavey, Elizabeth

The Nurse Practitioner. 47(5):22-30, May 2022.

Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.

Menopause: A primary care perspective

Ellington, Kelly; Link, Tamara; Saccomano, Scott J.

The Nurse Practitioner. 47(2):16-23, February 2022.

Menopause signifies permanent cessation of ovarian function and the end of a woman's reproductive potential. Menopausal transition plays a major role in many symptoms common in middle age and may contribute to chronic conditions and disorders of aging. An evidence-based plan of care improves outcomes, enhancing quality of life.

Best practices in benzodiazepine prescribing and management in primary care

Champion, Claire; Kameg, Brayden N.

The Nurse Practitioner. 46(3):30-36, March 2021.

Despite the lack of evidence regarding the long-term effectiveness of benzodiazepines and their potential harmful effects, prescriptions for the drug have significantly increased in the US over the past decade. This article reviews best practices for prescribing benzodiazepines in primary care and explains how providers can best prevent and treat benzodiazepine use disorder and other harmful effects.

Managing insomnia in older adults

Hedges, Christine; Gotelli, John

The Nurse Practitioner. 44(9):16-24, September 2019.

NPs frequently care for patients with complaints of insomnia in the hospital and community settings. Because older adults with insomnia present unique challenges for successful management, NPs should understand the latest assessment and treatment options.

Idiopathic pulmonary fibrosis: A guide for nurse practitioners

Vega-Olivo, Michelle; Criner, Gerard J.

The Nurse Practitioner. 43(5):48-54, May 17, 2018.

Idiopathic pulmonary fibrosis (IPF) is a rare disease characterized by decline in lung function, dyspnea, and cough. The clinical course of IPF is variable and unpredictable. Early referral to specialists is key to ensure timely and accurate diagnosis. Two antifibrotic drugs (nintedanib and pirfenidone) have been approved for the treatment of IPF.

Managing sleep disorders in the elderly

Townsend-Roccichelli, Judith; Sanford, Julie T.; VandeWaa, Elizabeth

The Nurse Practitioner. 35(5):30-37, May 2010.

Sleep disorders and sleeping difficulties are two of the most pervasive and poorly addressed problems of aging. Primary sleep disorders can be associated with significant medical, psychological, and social disturbances.

Red eye emergencies in primary care

Ossorio, Anthony

The 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.

Adult asthma: Diagnosis and treatment

Durham, Catherine O.; Fowler, Terri; Smith, Whitney; More

The Nurse Practitioner. 42(11):16-24, November 16, 2017.

Adult asthma is a prevalent chronic medical condition that is associated with high morbidity, mortality, and cost. Early identification, evidence-based diagnosis, and step-wise management can lead to improvements in patient outcomes, decrease exacerbations, and eliminate respiratory function decline as the patient ages.

Autism spectrum disorder in primary care

Weill, Victoria A.; Zavodny, Stefanie; Souders, Margaret C.

The Nurse Practitioner. 43(2):21-28, February 16, 2018.

Nurse practitioners working in the primary care setting will commonly see children with autism spectrum disorder. It is important for clinicians to be vigilant for subtle developmental signs that can lead to early identification and diagnosis. This article presents information on assessment, screening, the responsibilities of coordinating services, and ways to support families.

HPV, cervical cancer risks, and barriers to care for lesbian women

Waterman, Lindsay; Voss, Joachim

The Nurse Practitioner. 40(1):46-53, January 16, 2015.

The purpose of this article is to identify Pap testing rates among lesbians and reasons for lack of recognition of cervical cancer risks in lesbians. The lesbian community requires better education, and healthcare providers should promote regular Pap smears for all women.

Primary care management of the liver transplant patient

Chaney, Amanda

The Nurse Practitioner. 39(12):26-33, December 13, 2014.

There are over 65,000 people in the United States who have received a liver transplant. In primary care practice, nurse practitioners must be aware of the special considerations for this population.

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