Outpatient Initiation of Insulin: A Nurse Practitioner Protocol

Noninsulin dependent diabetes (type II diabetes) is a chronic disease characterized by hyperglycemia. Clients can generally be controlled by diet and exercise or a combination of diet, exercise, and oral hypoglycemic agents. When this therapy is not effective in controlling the hyperglycemia, the health care provider must choose to initiate insulin therapy. Outpatient initiation of insulin is an alternative to hospitalization in the type II diabetic client. Clinical guidelines for the initiation of insulin on an outpatient basis and management of the diabetic client are presented.     

Pelvic Inflammatory Disease: Clinical Overview

Acute pelvic inflammatory disease (PID) adversely affects the health of 1 million American women annually. The best understood etiologic organisms are Chlamydia trachomatis and Netsseria gonorrhea; however, information regarding the contributions of facultative and causative anaerobes continues to emerge. Chronic PID presents a diagnostic and management challenge to health care providers. Because of morbidity and sequelae the importance of early detection of, and intervention for, upper tract pelvic infections cannot be overemphasized. Nursing interventions in PID prevention, early assessment, accurate diagnosis, and thorough treatment can have a positive impact on women's health.     

An examination of preconception health teaching by nurse practitioners

Fifteen nurse practitioners in a Midwestern urban area in the United States of America volunteered to participated in a study which sought to determine what preconception self-care practices are taught to female clients at risk for pregnancy as a part of routine health maintenance. Subjects' teaching responses were compared to an investigator-developed model for preconception counselling. The subjects listened to an audiotape of a stimulus client-nurse practitioner interview. Their responses were audiotaped and categorized into the following categories: nutrition, vitamins, preconception weight, menstrual cycle review, alcohol, smoking, drug use, exercise, environment hazards, dental care, immunizations, and 'other'. Frequency counts of the teaching responses and a X2 analysis comparing teaching responses to expected teaching based on the PREPARED model (X2 = 78.01, P = 0.001) demonstrated a lack of teaching overall. The conclusion was reached that obstetrical care has not expanded into preconception counselling.     

Provision of Health Care in a Frontier Setting: An Alaskan Perspective

The Community Health Aide Program is the Indian Health Service's answer to to the provision of care to 45,000 Alaska Native people living in remote areas of the state. Community health aides are local people who live and work in their villages. They offer health services from emergency to preventative care with the help of their referral physician, who may be up to 1,300 miles away. Nurse practitioners play an important role in the training and supervision of community health aides. This article gives an overview of the program, its successes and problems, with implications as a health care delivery model for care in other underserved areas of the United States.