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.

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.

Deciphering chest pain in women

Briggs, Linda A.

The Nurse Practitioner. 43(4):25-33, April 19, 2018.

The causes of chest pain range from benign sources, such as muscle strain, to life-threatening diagnoses, such as aortic dissection and myocardial infarction. The likelihood and presentations of disorders causing chest pain are different between women and men. This article highlights important features in determining the correct diagnosis.

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.

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.

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.

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.

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.

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.

Polycystic ovary syndrome: Diagnosis and management

Pfieffer, Mary Lauren

The Nurse Practitioner. 44(3):30-35, March 2019.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder. Patients may present with a combination of hyperandrogenism symptoms, menstrual irregularities, metabolic syndrome, infertility, acne, and obesity. PCOS diagnosis is based on three diagnostic guidelines. Treatment options include oral contraceptive pills, antiandrogens, and metformin. NPs can improve diagnosed patients' quality of life through education about this disorder.

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.

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.

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.”

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.

Building skills in organizational and systems changes: A DNP-FNP clinical curriculum

Hoyle, Christine; Johnson, Gail

The Nurse Practitioner. 40(4):14-23, April 13th, 2015.

DNP-prepared nurse practitioner leaders play a pivotal role in quality improvement consistent with the IHI Triple Aim: improving quality of care, health of populations, and reducing cost. A DNP-FNP curriculum is described, designed to build students' leadership competencies for systems change in healthcare settings.

Preeclampsia and future stroke risk in women: What NPs need to know

Davis, Melissa; Sanders, Bethany

The Nurse Practitioner. 44(4):50-54, April 2019.

Preeclampsia is a complication of pregnancy that affects approximately 4% of pregnancies. Preeclampsia is defined as new-onset hypertension after 20 weeks gestation often accompanied by new-onset proteinuria. Women who experience preeclampsia during pregnancy are at an increased risk for hypertension and stroke later in life. Healthcare providers should screen women appropriately to minimize risk.

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.

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.

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.

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.

Improving vaccination rates in older adults: A quality improvement project

Wright, Wendy L.; Bruns, Debra Pettit; Feeney, Adele Susan; More

The Nurse Practitioner. 44(4):40-49, April 2019.

Adults age 65 or older are at increased risk for acute and chronic diseases. Patients in this group who are up to date with all CDC-recommended vaccinations can reduce morbidity and mortality. This article discusses a quality improvement project across four NP-owned primary care clinics in which all clinical staff received an educational intervention focused on best vaccination practices and Medicare billing strategies. This project yielded improved vaccination rates in the older adult patient population over a 3-month period.

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.

The emotional burden of diabetes: A look at diabetes distress

Giese, Karla K.

The Nurse Practitioner. 43(8):23-27, August 2018.

Patients with diabetes are sometimes overwhelmed with the burden of self-care associated with the disease. While it may seem appropriate to diagnose patients experiencing such emotional burdens with depression, the literature over the past 20 years has matured the concept of diabetes distress, which may more accurately describe the phenomenon.

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.

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.

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.

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.

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.

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

Bittle, Polly A.

The Nurse Practitioner. 42(6):31-38, 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.

Recognizing type 1 diabetes mellitus in children & adolescents

Glassford, Melissa A.

The 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.

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.

Evidence-based treatment of chronic kidney disease

Smith, Cynthia Ann

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

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.

The ABCs of RSV

Krause, Christine I.

The Nurse Practitioner. 43(9):20-26, September 2018.

Respiratory syncytial virus (RSV) is a common viral infection affecting many children in the United States. This seasonal virus is the leading cause of hospitalization of infants and neonates. This article reviews the current recommendations for diagnostic testing, treatment options, and prevention of RSV.

Oral squamous cell carcinoma: Focusing on interprofessional collaboration

Janotha, Brenda L.; Tamari, Katrin

The Nurse Practitioner. 42(4):26-30, April 16th, 2017.

Incidence of oral cancer is rising, and often, cases are not discovered until the cancer has metastasized to the lymphatic system. Most oral cancers are squamous cell carcinomas associated with high mortality. This article reviews oral squamous cell carcinoma relevant to primary care practice, focusing on an interprofessional approach to care.

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.

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.

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.

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.

Suicide risk assessment in high-risk adolescents

Gray, Barbara P.; Dihigo, Sharolyn K.

The Nurse Practitioner. 40(9):30-37, September 13th, 2015.

A significant number of adolescents experience depression and other mental health disorders that may put them at risk for suicide. Depression and suicide risk screening can help healthcare providers prevent suicides in this population.

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.

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.

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.

Cognitive Health in Older Adults

Struble, Laura M.; Sullivan, Barbara-Jean

The Nurse Practitioner. 36(4):24-34, April 2011.

NPs should understand both the theoretical and practical issues associated with cognitive aging, including the implications of neurophysiological changes in the brain as well as practical ways of screening for changes that may be problematic or may actually enhance healthy cognitive adaptations.

Advance care planning and anticipatory decision making in patients with Alzheimer disease

Slyer, Jason T.; Archibald, Ella; Moyo, Fernea; More

The Nurse Practitioner. 43(6):23-31, June 11, 2018.

Early advance care planning and anticipatory decision making in the Alzheimer disease (AD) trajectory is a strategy NPs can incorporate to improve managing uncertainty around common decisions. This article explores decisions patients and caregivers face along the AD trajectory and provides resources for patients, caregivers, and NPs.

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.

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.

Speak the language of autism

McCravy, Stephanie; Johnson, Arlene; Wetsel, Margaret A.; More

The Nurse Practitioner. 35(4):26-33, April 2010.

Primary care NPs should be able to recognize the clinical signs of autism, analyze the disorder using diagnostic tools, and provide management and referral options for families with autistic children.

Adult diabetes mellitus: Thinking beyond type 2

Giese, Karla K.

The Nurse Practitioner. 41(5):40-45, May 19th, 2016.

Not all adults presenting with diabetes mellitus have type 2. NPs must become familiar with atypical presentations of type 1 and type 2 diabetes mellitus, as burgeoning diabetes caseloads, coupled with a shortage of endocrinologists, have created a critical need for expert-level diabetes care among NPs. Two case studies illustrate variations of adult-onset diabetes along with discussion and diagnostic clues.

Periodontal disease in children with type 2 diabetes mellitus

Wooton, Angela K.; Melchior, Lynne M.; Coan, Lorinda L.; More

The Nurse Practitioner. 43(2):30-35, February 16, 2018.

Collaborative efforts between health team members can advance early detection of children with elevated blood glucose levels, preventing hyperglycemia and periodontal diseases. Rates of obesity are increasing in children, impacting the prevalence of type 2 diabetes mellitus and periodontal diseases. Collaborative care between nurse practitioners and dental hygienists can detect, prevent, and treat periodontal disease in children.

Managing sexually transmitted infections: Beyond the 2015 guidelines

Johnson-Mallard, Versie; Curry, Kim; Chandler, Rasheeta; More

The Nurse Practitioner. 43(8):28-34, August 2018.

Guidelines for the prevention and management of sexually transmitted infections (STIs) are updated periodically while new science is continuously developed. This article provides recent updates on managing STIs.
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