Assessment of childhood allergy for the primary care practitioner

PURPOSE: To update the primary care practitioner on the assessment of common childhood allergic illnesses. DATA SOURCES: Relevant scientific literature and published clinical practice guidelines. CONCLUSIONS: Atopic children often develop symptoms that occur in a predictable progression from atopic dermatitis to gastrointestinal disturbances, chronic serous otitis media, rhinitis, and asthma. Evaluation of allergic symptoms should be based on their chronicity, family history of atopy, and knowledge of how the information will change patient management. Both skin and blood testing are accurate and useful tools in establishing a diagnosis of allergic disease. Management includes avoidance/environmental control, medications, and, when necessary, referral to specialists. IMPLICATIONS FOR PRACTICE: As the incidence of allergic disease increases, the human and monetary costs associated with allergies place a major burden on our healthcare system. Early identification of allergies and appropriate intervention are important to prevent progression to more significant disease. The use of objective diagnostic testing aids in implementing appropriate evidence-based medical management.     

Nurse practitioner management of hospital-affiliated primary care centers.

Escalating health care costs have forced hospitals to develop alternative sources of revenue. Hospital-affiliated primary care centers that provide comprehensive health services to patients may also supplement hospital revenues with referrals for admission and/or special services. With their documented history of effectiveness, nurse practitioners are well-qualified to manage these primary care centers. This article provides guidelines to help nurse practitioners establish and manage a hospital-affiliated primary care center. Identification of clinical-services and staffing needs, and determination of office, administrative and facility requirements are also discussed.     

Clinical considerations and practical recommendations for the primary care practitioner in the management of anemia of chronic kidney disease

Anemia is prevalent in patients with chronic kidney disease (CKD) and is a risk factor for poor disease outcome. Anemia acts as a risk multiplier, significantly increasing the risk of death in anemic versus nonanemic CKD patients with similar comorbidities. Erythropoiesis-stimulating agents (ESA) are a mainstay for the treatment of anemia in renal patients on dialysis, but recent data suggests that earlier treatment of anemia in CKD may delay the onset of end-stage renal disease (ESRD) and decrease mortality. Nonetheless, anemia of CKD is under-recognized and undertreated during the period before initiation of dialysis, when anemia correction may have the greatest impact on disease outcome. This report describes anemia in CKD and its association with diabetes, cardiovascular disease, and poor disease outcome, and offers suggestions for the recognition and treatment of anemia of CKD in the primary care setting.     

Role of the nurse practitioner in diabetes and pregnancy management.

Preexisting maternal diabetes and gestational diabetes (GDM) create challenges for health care providers to avoid complications for both mother and infant. Poor control of preexisting diabetes during the first trimester of pregnancy predisposes the infant to major congenital anomalies. Infants born to mothers with GDM are at increased risk for macrosomia as well as other perinatal morbidity and mortality. This article discusses the role of the NP in diagnosing, managing, and treating pregnant women with preexisting and gestational diabetes.     

Assessment and management of pediatric constipation in primary care

Assessment and management of pediatric constipation is a challenging problem frequently faced by primary care practitioners. The purpose of this article is to offer a review of the literature including the definition of pediatric constipation and the presentation, etiology, and management of this common childhood disorder. Education and anticipatory guidance with children and their families should be included in the treatment regimen to prevent recurrences and promote health maintenance.     

Assessment and management of the developmentally delayed infant in primary care

Developmental delay is common, and early identification is important. This article discusses the nurse practitioner's role in the assessment and management of the developmentally delayed infant. Assessment procedures and tools are described. Current controversies regarding early assessment and intervention are discussed. Research on early intervention programs for both the environmentally deprived and the biologically impaired infant is reviewed, and guidelines for the evaluation of these programs are given. Management issues and the nurse practitioner's role in the ongoing care of these infants are discussed.     

Cardiovascular disease prevention in women: the role of the nurse practitioner in primary care

Cardiovascular disease (CVD) is the most prevalent health problem in the United States. By following the American Heart Association 2007 update guidelines, nurse practitioners in primary care settings are in a prime position to provide CVD risk assessment and prevention strategies to women across the lifespan. This article describes each recommendation in the guidelines and the role of the nurse practitioner in primary care in implementing the recommendations in clinical practice.     

The primary care nurse practitioner: advocate for self care

PURPOSE: To critically analyze the role of the primary care nurse practitioner (NP) as advocate in promoting health through self care. DATA SOURCES: Selected philosophical and theoretical texts and articles, scientific literature, professional standards, and ethical arguments. CONCLUSIONS: Philosophical reasoning and nursing theory must be used to validate and direct human practice. If self-care and well-being are desirable as an end and are defined as a movement toward self-determination, then the philosophical goal of the NP must be the protection and promotion of self care and autonomy through client advocacy. IMPLICATIONS FOR PRACTICE: The role of the NP must be defined by its philosophy of care rather than by its function. The influence of philosophical reasoning, nursing, and critical social theory impact the ability of the NP to promote self-care through advocacy. Understanding the lived experience is an essential component of advocacy.     

Wolff-Parkinson-White syndrome: essentials for the primary care nurse practitioner

PURPOSE: To provide nurse practitioners with a basic understanding of the pathophysiology, clinical characteristics, diagnostic methods, and management of Wolff-Parkinson-White (WPW) syndrome. DATA SOURCES: Selected research and clinical articles. CONCLUSIONS: WPW syndrome is the most common form of ventricular preexcitation. The ventricular myocardium is activated earlier than expected by an accessory conduction pathway that allows a direct electrical connection between the atria and ventricles. Although many patients remain asymptomatic throughout their lives, approximately half of the patients with WPW syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Symptoms include palpitations, dizziness, syncope, and dyspnea. Diagnosis is usually made by electrocardiogram findings, but further testing may be warranted to confirm the diagnosis. IMPLICATIONS FOR PRACTICE: A thorough patient history and physical examination can aid the practitioner in identifying patients who may have WPW syndrome. With appropriate referral, treatment, and patient education, patients with WPW syndrome can expect to have a normal life expectancy and good quality of life.     

Nurses in primary care and the nurse practitioner role in Thailand

Thailand supports a system of universal health care coverage and promotes a system of primary care. Effective and efficient primary health care can improve health through increasing access and thereby reducing inequities. Nurses are key providers of primary care services, particularly in remote areas and play an important role in improving the health and well-being of the Thai community.     

GPs' perceptions of the nurse practitioner role in primary care

The role of nurse practitioner (NP) is increasingly integrated into the primary healthcare team, yet there remains some confusion among general practitioners about what the role entails. Following on from previous work (Carr et al, 2001), this study indicates that the majority of GPs surveyed were supportive of the integration of the NP role in primary care, both to help reduce the GPs' workload and more importantly to give the patient a choice of who to consult. However, there was some difference in opinion as to what tasks were most appropriately linked to the NP role. This may be due to the GPs' lack of knowledge and experience of the role. There were also some reservations about the financial cost of training and employing NPs. If the health needs of the population are to be met and high quality, seamless care provided, the NP could provide a solution.     

Childhood asthma: considerations for primary care practice and chronic disease management in the village of care

Childhood asthma is at historically high levels, with significant morbidity and mortality. Despite more than two decades of improved understanding of childhood asthma care and the evolution of beneficial medications, widespread control remains poor, leading to suboptimal patient outcomes and quality of life. This lack of control results in excessive emergency department use, hospitalizations, and inappropriate and/or unnecessary costs to the health care system. Advanced practice models that incorporate community-based approaches and services for childhood asthma are needed. Innovative, community-included methods of care to address the burden of childhood asthma may provide examples for care of other chronic diseases.     

Diagnosing occupational lung disease a practical guide to the occupational pulmonary history for the primary care practitioner

A well-executed occupational pulmonary history should be part of the evaluation of workers presenting with respiratory illnesses or symptoms. In this article, we review the scope of occupational lung disease and detail the essential elements of the occupational pulmonary history. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Exercise and pregnancy in primary care

An increasing number of women exercise throughout pregnancy. New evidence illustrates that moderate intensity exercise in healthy pregnant women, with certain considerations, does not increase adverse pregnancy risks. Exercise during pregnancy may actually decrease pregnancy-associated discomforts and improve maternal fitness and well-being. By following the American College of Obstetricians and Gynecologists recommendations, clinicians can confidently prescribe exercise to women during preconception, pregnancy, and the postpartum period.