Care of Adults With Down Syndrome: The Nurse Practitioner Perspective

Down syndrome is a chromosomal disorder that is commonly diagnosed in childhood. The most referenced care guidelines need updating and focus on children. As a result of advancements in health care, life expectancies for people with Down syndrome have reached middle to late adulthood, leaving providers unprepared for the management of common comorbidities in adults with Down syndrome. To promote quality of life in this population, this overview of emerging recommendations and evidence-based literature through a systems-based approach may help nurse practitioners foster high-quality and cost-effective services in providing care for adults with Down syndrome.     

Multiple Myeloma: The Role of the Primary Care Nurse Practitioner

Multiple myeloma is a hematologic disease characterized by an excessive number of abnormal plasma cells that infiltrate the bone marrow and overproduction of monoclonal immunoglobulins. It is the third most prevalent hematologic disease and makes up just over 15% of all hematologic malignancies. Patients may present with 1 or more nonspecific symptoms of hypercalcemia, renal insufficiency, anemia, or new-onset bone pain. Early recognition, referral, and monitoring may improve the quality of life and extend the survival of patients.     

The Family Practitioner and the Extended Care Facility

Extended care institutions can benefit from the advice and help of a broadly experienced physician who can help clarify the type of patient they should accept and the kind of program they should provide. He can improve staff awareness, attitudes and interest in the special problems of patients with long term or terminal disease. The family practitioner has the breadth of knowledge necessary for this role, and short courses should be set up to provide information on specific questions.     

Overview of Diabetic Foot Care for the Nurse Practitioner

Foot and ankle complications of diabetes result in significant morbidity, mortality, and health care expenditure. Diabetes may result in foot deformity, neuropathy, and peripheral artery disease with risk of callus, foot ulcer, infection, and subsequent amputation. Appropriate patient education, medical management, and use of therapeutic footwear can prevent many diabetic foot complications. Nurse practitioners are key members of foot care teams in both primary and specialty care. The nurse practitioner managing a patient’s diabetes is an appropriate provider to certify the need for diabetic shoes and should be authorized to do so to provide quality care without unnecessary delay.