Most Popular Articles

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.

31st Annual APRN Legislative Update: Improving state practice authority and access to care

Phillips, Susanne J.

The Nurse Practitioner. 44(1):27-55, January 2019.

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.

Addressing transgender patients' barriers to access care

Rowe, Denise; Ng, Yeow Chye; O'Keefe, Louise C.

The Nurse Practitioner. 44(6):30-38, June 2019.

The transgender population faces several barriers to accessing quality medical care in the US healthcare system. This article examines the challenges that prevent this marginalized group from obtaining high-quality healthcare services and discusses how NP advocacy can help create a welcoming environment for transgender patients.

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.

Cardiac stress testing review for the primary care provider

Daniels, Karen J.

The Nurse Practitioner. 44(6):48-55, June 2019.

Various modes of cardiac stress testing are conducted in outpatient practices today. This article presents information on the current methods of testing to help primary care providers gain confidence in test selection, the testing process, and interpreting results.

Evaluation and current treatments for urinary incontinence

Hooper, Gwendolyn L.

The Nurse Practitioner. 44(6):21-28, June 2019.

Although aging and urinary incontinence are often associated, urinary incontinence is not a normal part of aging. As the population ages, the challenge of urinary incontinence will place a greater demand on the healthcare system. NPs can effectively direct treatments to mitigate the symptoms of urinary incontinence, improving patient quality of life.

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.

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.

30th Annual APRN Legislative Update: Improving access to healthcare one state at a time

Phillips, Susanne J.

The Nurse Practitioner. 43(1):27-54, January 15, 2018.

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

NP student encounters with obesity bias in clinical practice

Hauff, Caitlyn; Fruh, Sharon M.; Graves, Rebecca J.; More

The Nurse Practitioner. 44(6):41-46, June 2019.

This study explores NP students' encounters with obesity stigma and bias in their clinical environment as well as recommendations to decrease obesity stigma and bias. Results indicate a need for continued education on the topic of weight management within NP curricula.

Diagnosis and treatment for chronic migraine

Moriarty, Maureen; Mallick-Searle, Theresa

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

Approaches to male hypogonadism in primary care

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

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

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.

Elevating diagnostic skills with logical reasoning

Gilliam, Stephen

The Nurse Practitioner. 44(5):51-55, May 2019.

NPs can use the abductive, deductive, and inductive forms of reasoning to adopt a rational and consistent approach to transforming effective data into accurate diagnoses. A case example is used throughout the article to illustrate how these classic logical reasoning skills may be combined with knowledge and experience to address issues of diagnostic accuracy and decrease diagnostic errors.

Allergic rhinitis: Diagnosis through management

Krouse, Helene J.; Krouse, John H.

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

Assessing for and managing chronic insomnia in primary care settings

Cadet, Myriam; Tucker, Lorna; Allen, Deborah H.; More

The Nurse Practitioner. 44(7):27-35, July 2019.

Chronic insomnia is the most common sleep disorder. Improper or delayed diagnosis can lead to serious health problems. Early accurate assessment is essential to guide and provide safe treatment. This article reviews assessment and management of insomnia in the primary care setting.

The Million Hearts initiative: Guidelines and best practices

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

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

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.

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

Phillips, Susanne J.

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

Managing dyslipidemia for CVD prevention: A review of recent clinical practice guidelines

Ciffone, Nicole A.; Copple, Tina

The Nurse Practitioner. 44(1):8-16, January 2019.

The American Association of Clinical Endocrinology and the American College of Endocrinology Clinical Practice Guideline is a comprehensive, practical tool that can be used to diagnose and manage dyslipidemia, a major risk for the development and progression of atherosclerotic cardiovascular disease. Effective therapies are available to improve lipid profiles and reduce cardiovascular events.

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.

Acute compartment syndrome: An orthopedic emergency

Harding, Margaret Meyer

The Nurse Practitioner. 44(4):23-28, April 2019.

Acute compartment syndrome (ACS) is a true orthopedic emergency. NPs in all settings should be able to recognize ACS to ensure swift surgical intervention is not delayed. This article highlights a systematic approach to exam and diagnosis.

Pharmacologic pain management at the end of life

Davies, Pamela Stitzlein

The Nurse Practitioner. 41(5):26-37, May 19th, 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.”

Drug updates and approvals: 2018 in review

Mospan, Cortney; Mospan, Geoffrey; Byland, Emily; More

The Nurse Practitioner. 43(12):23-32, December 2018.

In 2018, the FDA approved several new drugs for use in primary care. This article highlights the following new drugs: bictegravir, emtricitabine, and tenofovir alafenamide (Biktarvy); doxylamine succinate and pyridoxine hydrochloride (Bonjesta); erenumab-aooe (Aimovig); lofexidine hydrochloride (Lucemyra); tezacaftor and ivacaftor (Symdeko); and tildrakizumab-asmn (Ilumya).

An NP's guide to diagnosing and treating alpha-1 antitrypsin deficiency

Newell, Judith A.; Donahue, Christine; Hogarth, D. Kyle

The Nurse Practitioner. 44(4):13-21, April 2019.

As NPs play an increasingly vital role in primary care, they must be well versed in a variety of conditions. Alpha-1 antitrypsin (AAT) deficiency is a respiratory disease with a particularly low awareness in both the nursing profession and the wider medical community. This article provides an overview of AAT deficiency and includes guidance for diagnosing the disease.

ADHD: From childhood to young adulthood

Wesemann, Daniel; Van Cleve, Susan N.

The Nurse Practitioner. 43(3):8-15, March 12, 2018.

Attention-deficit hyperactivity disorder (ADHD) affects approximately 11% of children between the ages of 4 and 17 years. This article discusses performing a comprehensive assessment for ADHD, the use of validated tools to make an accurate diagnosis, physical exam findings that may be suggestive of certain conditions, and ADHD treatment options.

HIV and aging: A primer for NPs

Kwong, Jeffrey; Reyes, Darcel; Murphy, Nancy; More

The Nurse Practitioner. 44(5):32-41, May 2019.

Estimates indicate 70% of all individuals with HIV will be age 50 or older by 2030. Chronic conditions, including cardiovascular disease, diabetes mellitus, kidney disease, malignancies, neurocognitive disorders, and osteopenia or osteoporosis, occur more frequently in patients with HIV and have become the leading cause of morbidity in this population. NPs play an integral role in helping this population age healthfully.

Acne vulgaris: A review of causes and treatment options

Well, Danielle

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

Diagnosis and Management of Primary Aldosteronism

Thanavaro, Joanne L.

The Nurse Practitioner. 36(4):12-22, April 2011.

Primary aldosteronism is characterized by excessive production of aldosterone, which leads to hypernatremia, hypertension (HTN), hypokalemia, and alkalosis. The three crucial diagnostic steps are case detection, case confirmation, and subtype classification. Marked improvement or cure of HTN is achieved with appropriate treatment.

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.

Long-acting reversible contraceptives: Addressing adolescents' barriers to use

Turner, Jennifer H.

The Nurse Practitioner. 44(5):23-30, May 2019.

NPs caring for adolescent females have an opportunity to reduce US teen pregnancy rates through unbiased counseling on contraception options, including highly effective long-acting reversible methods. Intrauterine devices and subdermal implants are safe, effective contraception options for adolescents, but their rates of use remain low among this patient population. This article discusses current adolescent contraceptive practices, barriers to access, and current recommendations for long-acting reversible contraceptive use.

Pediatric metabolic syndrome

Felix, Abigail; John, Rita Marie

The Nurse Practitioner. 44(7):18-25, July 2019.

Although the prevalence of obesity and its related complications are increasing among pediatric patients, appropriate management can prevent chronic disease. This article will present an overview of metabolic syndrome, pediatric metabolic syndrome guidelines, pathophysiology, associated risk factors, and clinical practice implications.

Cannabis for posttraumatic stress disorder: A neurobiological approach to treatment

Krumm, Bryan A.

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

Dental avulsions: Review and recommendations

Hicks, Rodney W.; Green, Roger; Van Wicklin, Sharon A.

The Nurse Practitioner. 41(6):58-62, June 19th, 2016.

Tooth avulsion injuries are common. This article reviews the causes of tooth avulsion and provides management guidelines. Recommendations for NP education and practice are reviewed.

Tremors: Learning to stop the shakes

Struble, Laura M.

The Nurse Practitioner. 35(6):18-25, June 2010.

A tremor is a common, abnormal, involuntary movement of muscles that may be noted during a routine physical examination. Identifying the type of tremor is necessary to determine underlying neurological disorders. This article offers a practical approach to assessment and diagnosis of the most common tremors seen in practice.

Use of GLP-1 receptor agonists in patients with T2DM and chronic kidney disease

Aldrich, Sarah; Ashjian, Emily

The Nurse Practitioner. 44(3):20-28, March 2019.

Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in the US. An increasing number of glucagon-like peptide-1 receptor agonists are available for diabetes management. Differences between medications in this class, as well as limited data on patients with CKD, underscore the importance of a patient-centered approach to care.

Diabetic autonomic neuropathy resulting in sexual dysfunction

Wooton, Angela K.; Melchior, Lynne M.

The Nurse Practitioner. 43(11):39-45, November 2018.

Although diabetic autonomic neuropathy (DAN), a complication associated with diabetes, is increasing in prevalence, it is often overlooked. Knowledge regarding the development and progression of this complication is limited. NPs are in a key position to prevent complications of DAN, including sexual dysfunction, in this vulnerable population.

Identifying malnutrition: From acute care to discharge and beyond

Tyler, Renay D.; Guenter, Peggi

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

Adolescent use of electronic nicotine delivery systems

Vincent, Debra; Potts, Jeanne; Durbin, Jessica; More

The Nurse Practitioner. 43(3):17-21, March 12, 2018.

Use of electronic nicotine delivery systems is flourishing among adolescents. The long-term effects have not been fully determined; however, literature suggests there is potential for significant harm. Providers must be aware of usage trends, device safety, and product knowledge. Adolescents should be evaluated through routine screening, and cessation counseling should be initiated.

Hypertriglyceridemia: A review of the evidence

Elkins, Casey; Friedrich, Debra

The Nurse Practitioner. 43(10):22-29, October 2018.

Elevated triglycerides are independently associated with increased atherosclerotic cardiovascular disease risk. Hypertriglyceridemia is often a polygenic condition that can be affected by numerous interventions. Primary care NPs are well positioned to appropriately evaluate and manage hypertriglyceridemia, improving overall health outcomes.

HPV awareness and vaccination rates in college-aged male athletes

McCutcheon, Tonna; Schaar, Gina; Herline, Alan; More

The Nurse Practitioner. 42(11):27-34, November 16, 2017.

College-aged males are at high risk for human papillomavirus (HPV); however, vaccination rates remain low, suggesting minimal HPV knowledge. Therefore, an educational intervention was developed and implemented to determine if an increase in HPV knowledge, perceived HPV risk, intention and perceived self-efficacy to obtain the vaccine, and vaccination rates were observed.

A new look at abnormal uterine bleeding

Twiss, Janice J.

The Nurse Practitioner. 38(12):22-30, December 10th, 2013.

This article presents new universal terminology, classifications, and definitions recommended by the International Federation of Gynecology and Obstetrics and supported by the American College of Obstetricians and Gynecologists to describe abnormal uterine bleeding abnormalities in reproductive women. Identification and management of anovulatory and ovulatory uterine bleeding are explored.

Non-fasting versus fasting cholesterol measurement

Dyce, Evan

The Nurse Practitioner. 43(2):16-20, February 16, 2018.

Fasting for cholesterol measurement has long been the accepted convention. Recent research expounded in clinical guidelines indicates that nonfasting cholesterol measurements predict outcomes at least as well as fasting cholesterol measurements. In most—but not all—clinical scenarios, fasting is not necessary. This article provides clinical recommendations based on the literature.

Managing the airway in acute care patients

Meissen, Heather; Johnson, Laura

The Nurse Practitioner. 43(7):23-29, July 2018.

Understanding how to assess, secure, and manage an airway can save a patient's life in an emergent situation. The NP must assess patients in respiratory distress quickly and in an organized manner to implement life-saving treatment and stabilize the patient before further decline occurs. This article will briefly describe the basics of airway management.

EHR quality indicator tracking: A process improvement pilot project to meet MACRA requirements

Savas, Andrea; Smith, Eben; Hay, Brittany

The Nurse Practitioner. 44(4):30-39, April 2019.

This article outlines an information technology process improvement pilot project undertaken at a large primary care practice in western Florida to support readiness for Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 using new EHR quality indicator tracking features.

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

Dobbins, Elizabeth H.

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

Hidradenitis suppurativa: A Clinician's Tool for Early Diagnosis and Treatment

Beshara, Monica A.

The Nurse Practitioner. 35(5):24-28, May 2010.

Dermatology complaints are among the most common reasons people seek advice from their NP. Because some conditions, such as hidradenitis suppurativa, are seldom seen, NPs must have reliable tools to correctly identify the disease and initiate appropriate treatment quickly.

Improving dermatological screening in primary care

Wheatley, Brittany

The Nurse Practitioner. 43(4):19-24, April 19, 2018.

Skin cancer is treatable and curable; therefore, primary care providers should perform skin assessments for detection of skin cancer. Due to conflicting guidelines and time constraints, most providers do not conduct adequate skin inspections. This project aimed to improve skin inspection, documentation, and skin cancer detection through increased patient gowning.