Most Popular Articles

The therapeutic versatility of antihistamines: A comprehensive review

Shirley, David W.; Sterrett, James; Haga, Neal; More

The Nurse Practitioner. 45(2):8-21, February 2020.

Antihistamines are common and readily available medications for primary care patients and those seeking over-the-counter treatments. This article provides an overview of available antihistamines, their mechanisms of action, safety concerns in specific populations, and their therapeutic uses in several common conditions.

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.

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.

Understanding the most commonly billed diagnoses in primary care: Acute pharyngitis

Rogers, Julia; Eastland, Taryn

The Nurse Practitioner. 46(5):48-54, May 2021.

This is a 12-part series on the most commonly billed diagnoses in primary care. The article discusses the pathophysiologic processes of acute pharyngitis as well as the clinical manifestations and treatments and how they are linked to disease pathogenesis.

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.

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.

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.

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.

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.

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.

Treatment update: Outpatient management of community-acquired pneumonia

Esden, Jana

The Nurse Practitioner. 45(3):16-25, March 2020.

Pneumonia is a leading cause of morbidity and mortality in the US and a primary cause of hospitalization nationwide. A recent guideline update from the American Thoracic Society and Infectious Diseases Society of America provides evidence-based recommendations for managing adults with community-acquired pneumonia in the outpatient setting.

Diagnosis of venous thromboembolism using clinical pretest probability rules, D-dimer assays, and imaging techniques

Thanavaro, Joanne

The Nurse Practitioner. 46(5):15-22, May 2021.

Venous thromboembolism is a significant clinical entity that includes two associated medical disorders: deep vein thrombosis and pulmonary embolism. The goal of this article is to describe the optimal approach to evaluating venous thromboembolism including pretest probability clinical decision rules and appropriate testing to ensure an accurate diagnosis.

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.

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.

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.

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.

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.

Suicide detection and treatment in a nurse-led, interprofessional primary care practice: A 2-year report of quality data

Ketel, Christian; Hedges, Jordan P.; Smith, Jenna P.; More

The Nurse Practitioner. 46(4):33-40, April 2021.

This article analyzes 2 years of quality improvement data after the implementation of a suicidality screening and treatment protocol in a primary care setting. Primary care practices may be viable tools to combat the nation's suicide epidemic.

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.

The role of telemedicine in gynecologic healthcare: A narrative review

Weltin, Ann; Etcher, LuAnn

The Nurse Practitioner. 46(5):24-31, May 2021.

This article offers a comprehensive narrative literature review on telemedicine use in gynecologic healthcare analyzing current telemedicine integration in the field and outlining innovative and best practices. Telemedicine use in contraceptive care, sexually transmitted infections, acute and chronic gynecologic conditions, and education are discussed. NPs are in a unique position to offer these services to patients in need of women's healthcare services. Barriers, facilitators, clinical implications, and future research are addressed.

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.

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.

Diagnosis and treatment for chronic migraine

Moriarty, Maureen; Mallick-Searle, Theresa

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

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

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.

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.

Pharmacogenetic testing: Clinical integration and application for chronic pain management

Fredrikson, Karin M.; Fasolino, Tracy

The Nurse Practitioner. 46(4):12-19, April 2021.

NPs commonly prescribe pharmaceutical therapies such as opiates, antidepressants, and/or other analgesics to improve the health and well-being of patients experiencing chronic pain. This article provides NPs with pharmacogenetic testing knowledge, such as readiness for clinical implementation, considerations for choosing a testing service, and testing costs for chronic pain management.

Loneliness in adults: Evidence-based research and interventions for NPs

Pearson, Tamera

The Nurse Practitioner. 44(9):26-34, September 2019.

Loneliness is a complex psychophysiologic concept, a health risk factor, and a worrisome trend across the globe. This article reviews the latest research on the negative health effects associated with loneliness. Evidence-based NP interventions aimed at improving patients' perceived social connections are also explored.

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.

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.

Identification and management of bipolar disorder

Scrandis, Debra A.

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

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

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.

Understanding the most commonly billed diagnoses in primary care: Gastroesophageal reflux disease

Rogers, Julia; Eastland, Taryn

The Nurse Practitioner. 46(4):50-55, April 2021.

Gastroesophageal reflux disease (GERD) is a chronic, relapsing condition encountered commonly in primary care with an estimated worldwide prevalence of up to 33%. GERD affects all age groups, races, and genders with 25% of the Western population experiencing heart burn at least once a month.

Eosinophilic asthma and the role of monoclonal antibodies

Jarrell, Lynda

The Nurse Practitioner. 46(4):21-27, April 2021.

Eosinophilic asthma presents with continuous airway inflammation resistant to inhaled corticosteroids but responsive to oral glucocorticoids and monoclonal antibodies. Five monoclonal antibodies are used for treatment, with accurate diagnosis and early intervention essential to better outcomes.

Suicide risk assessment in high-risk adolescents

Gray, Barbara P.; Dihigo, Sharolyn K.

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

Hypertension management in patients with chronic kidney disease

Liddell, Toddra S.; Bassett, Robin; Link, Denise K.

The Nurse Practitioner. 44(12):34-40, December 2019.

Managing hypertension, especially when accompanied by chronic kidney disease, is challenging. These different but related conditions are complicated by differing guidelines. NPs can safely prescribe antihypertensive treatments, which reduce hypertension and the risk of associated comorbidities, such as kidney failure, stroke, myocardial infarction, and vascular disease.

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.

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

Dobbins, Elizabeth H.

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

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

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.

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.

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.

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.

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.

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

Phillips, Susanne J.

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

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

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.

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.

An update on gout diagnosis and management for the primary care provider

Mbuyi, Nadine; Hood, Catherine

The Nurse Practitioner. 45(10):16-25, October 2020.

Gout is the most common inflammatory arthritis in the US, affecting 3.9% of the population. Although many effective gout therapies are available for acute flares and chronic management, it is suboptimally treated worldwide, and recurrent gout flares can cause significant pain and irreversible joint damage.

Evidence-based diagnosis and treatment of cervical spine disorders

Metzger, Robert L.

The Nurse Practitioner. 44(8):30-37, August 2019.

Neck pain from cervical spine disorders is the second-leading cause of musculoskeletal disorders. Neck pain can exist alone or with the presence of upper extremity symptoms. This review of evidence-based guidelines assists the provider in identifying and treating various cervical disorders.

Treating pediatric acute-onset neuropsychiatric syndrome

Heavey, Elizabeth; Peterson, Kathleen

The Nurse Practitioner. 44(3):44-49, March 2019.

Pediatric acute-onset neuropsychiatric syndrome (PANS) can be caused by infectious and noninfectious triggers. NPs can help children with PANS recover from their symptoms and prevent future recurrences by appropriately screening, recognizing, and diagnosing the clinical presentation of PANS. PANS treatment includes pharmacologic therapies as well as cognitive behavioral therapy.

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.

Evidence-based treatment of chronic kidney disease

Smith, Cynthia Ann

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

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

Pharmacologic pain management at the end of life

Davies, Pamela Stitzlein

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

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

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.

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.

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.

COVID-19 and telehealth: Applying telehealth and telemedicine in a pandemic

Adelman, Deborah S.; Fant, Catherine; Summer, Georgianne

The Nurse Practitioner. 46(5):34-43, May 2021.

In this second article of a three-part series, we explore how stakeholders can be educated on the use of telehealth technology and telemedicine. We address the need for staff and patient support for the transition to telehealth and offer suggestions to NPs for appropriate presentation and interaction with interdisciplinary teams and patients regarding telehealth.