Clinical excellence for nurse practitioners : the international journal of NPACE
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Clin Excell Nurse Pract · Mar 2001
ReviewCreating order out of chaos: models of GNP practice with hospitalized older adults.
It has been well documented that hospitalization of an older adult can trigger a cascade of events that negatively affect quality of life long after hospitalization. Three models of care directed by hospital-based geriatric nurse practitioners (GNPs) are described. The GNPs' roles include primary care provider, consultant, educator, researcher, and/or administrator. ⋯ In a third model, the GNP coordinated care of hospitalized nursing home residents in a "scatter bed" program. Working synergistically with a case management program, the length of stay for this group of patients decreased from a median of 12 days to 9 days in the first year to 6.8 days in the third year. All three models showed that the GNP facilitate change, improve resource utilization, and create innovative strategies to optimize care for hospitalized elders.
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Diabetic peripheral neuropathy (DPN) is a common complication of both type I and II diabetes mellitus. Although the exact cause remains unknown, peripheral neuropathy can cause significant health concerns and decrease the quality of life for those with this condition. Diagnosis of DPN can be made when signs and/or symptoms of peripheral nerve dysfunction are present. ⋯ Strict glycemic control and daily foot care are of utmost importance in the management and prevention of DPN. Pharmacologic therapies for pain control include tricylic antidepressants, anticonvulsants, analgesics, and capsaicin. DPN remains a frequent and serious complication of diabetes mellitus, and left unmanaged, may lead to debilitating consequences of foot ulcers and amputations.
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Stroke is indicated by an abrupt manifestation of neurologic deficits secondary to an ischemic or hemorrhagic insult to a region of the brain. Stroke is ranked as the third leading cause of death in the United States, affects more than 730,000 individuals per year, and accounts for 160,000 deaths annually. Approximately $40 billion is spent annually for health care treating stroke victims. This case report shows that despite the use of antithrombotic and/or antiplatelet aggregating drugs, the key to stroke management is primary prevention.
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Clin Excell Nurse Pract · Nov 1999
ReviewAmyotrophic lateral sclerosis: a team approach to primary care.
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease that causes degeneration of motor neurons and results in death. The most frequent presenting symptom of patients with ALS is muscle weakness. The role of the nurse practitioner (NP) in the diagnosis and management of ALS is multifaceted. ⋯ The role of the NP is important in providing symptomatic relief for the patient, and essential in providing education and psychosocial support for the patient and family caregivers. This article reviews the pathophysiology, assessment, management, and recent advances in research related to ALS. The challenging role of the NP in improving the quality of life of patients with ALS and their families is discussed.
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Clin Excell Nurse Pract · Nov 1999
ReviewThe use of bupropion hydrochloride for smoking cessation therapy.
All healthcare providers have an obligation to promote smoking cessation to their patients who smoke. While patients are advised to stop smoking, the use of specific smoking cessation strategies is rarely addressed by primary care providers. This article discusses smoking cessation for two specifically vulnerable groups: women and African-Americans. ⋯ Relapses in smoking cessation are due to nicotine craving and the attempt to alleviate symptoms of nicotine withdrawal. Bupropion hydrochloride, an oral antidepressant, is believed to work by elimination of nicotine cravings and to decrease the physiologic and psychologic symptoms associated with nicotine withdrawal. Patients who have not been successful in smoking cessation may benefit from bupropion hydrochloride therapy in conjunction with counseling and behavior modification.