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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.

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.

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.

Recommended screenings for chlamydia and gonorrhea: A Canadian guidelines review

O'Byrne, Patrick

The Nurse Practitioner. 44(2):35-41, February 2019.

Chlamydia and gonorrhea are the most commonly diagnosed bacterial sexually transmitted infections (STIs), and both are increasing in incidence. Because these STIs are often asymptomatic and found at extragenital sites, such as the pharynx and rectum, it is important that clinicians know when and how to screen for them.

Early diagnosis and treatment of familial hypercholesterolemia

Elkins, J. Casey; Fruh, Sharon

The Nurse Practitioner. 44(2):18-24, February 2019.

If undiagnosed and untreated, familial hypercholesterolemia can lead to serious cardiac complications, such as premature atherosclerotic cardiovascular disease. NPs should be familiar with the clinical presentation of this inherited metabolic disease to diagnose patients as early as possible and promptly begin treatment that may include lifestyle changes, statin therapy, and/or nonstatin therapy.

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.

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.

Antimicrobial prescribing in older adults

Brandburg, Gloria L.

The Nurse Practitioner. 44(2):42-48, February 2019.

Determining the appropriate use and selection of antimicrobials in older adults can be challenging. Age-related physiologic changes, multiple comorbidities, and polypharmacy can make prescribing antimicrobials complicated and the effectiveness of therapy unpredictable.

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.

  • Doctor of Nursing Practice

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.

Combating insulin resistance with the paleo diet

Olivieri, Chrystyne

The Nurse Practitioner. 44(2):49-55, February 2019.

As primary care providers, NPs can help inform patients, particularly those with prediabetes and T2DM, about healthy lifestyle choices and provide them with resources to achieve weight loss success. This article explores the potential benefits of replacing low-calorie diets with the paleo diet.

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.

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.

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.

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.

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.

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.

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.”

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.

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.

A practitioner's guide to necrotizing fasciitis

Harrington, Deedra H.; Lenahan, Christy M.; Sanders, Rachelle M.

The Nurse Practitioner. 40(4):48-54, April 13th, 2015.

Necrotizing fasciitis (NF) is a severe bacterial infection that attacks subcutaneous fat tissues, superficial fascia, and muscle. NF is a rare condition with a mortality that demands nurse practitioners to be adept at identifying signs and symptoms to prompt a quick diagnosis and treatment.

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.

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.

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.

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.

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.

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).

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.

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.

Bladder cancer: Risk factors, diagnosis, and management

Farling, Kristen Burns

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

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.

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.

26th Annual Legislative Update: Progress for APRN authority to practice

Phillips, Susanne J.

The Nurse Practitioner. 39(1):29-52, January 11th, 2014.

The Annual Legislative Update describes the legislative issues that have the most impact on nurse practitioners and other advanced practice nurses across the country.

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.

Family history of substance use disorder and chronic pain management

Pestka, Elizabeth L.; Evans, Michele

The Nurse Practitioner. 43(6):43-48, June 11, 2018.

The use of family history of substance use disorder information as part of a comprehensive assessment of chronic pain can provide important data for treatment. This case example illustrates assessment, patient education, and brief motivational interviewing with referral to appropriate resources.

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.

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.

Prediabetes: Early identification and management

Rariden, Christina

The Nurse Practitioner. 43(12):35-40, December 2018.

Prediabetes continues to be a national and worldwide health concern, affecting 84 million adults in the US. Early identification and intervention have been successful in delaying and/or preventing the progression to type 2 diabetes mellitus (T2DM). Nonpharmacologic treatment of prediabetes is paramount, although pharmacologic treatment is appropriate in high-risk patients. In an attempt to curb the increasing prevalence of T2DM, recognizing the importance of identifying and managing prediabetes should remain in the national healthcare forefront.

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.

Evidence-based updates to the 2016 Surviving Sepsis Guidelines and clinical implications

Lehman, Karen D.

The Nurse Practitioner. 44(2):26-33, February 2019.

Despite numerous advances in understanding the pathophysiology of sepsis and its treatment, sepsis morbidity and mortality remain high. The 2016 Surviving Sepsis Campaign guidelines incorporated the latest research to formulate new sepsis diagnoses and updated treatment recommendations. This article reviews how to manage patients with sepsis and provides insight into the 2016 guidelines, updates, and suggestions.

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.

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.

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.

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.

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.

Evaluation of common breast complaints in primary care

Smania, Mary Alison

The Nurse Practitioner. 42(10):8-15, October 18, 2017.

Discovery of a breast mass, nipple discharge, or breast pain is a common, anxiety-producing occurrence for many women. Although most irregularities are benign, every woman presenting with a breast complaint should be evaluated to exclude or establish a diagnosis of cancer. The patient visit to the provider for a breast complaint can also present an opportunity for the NP to address and update any needed breast screenings.

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.

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.

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.

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.
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