The Family Nurse Practitioner E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Case Studies in Nursing
• Sprache: Englisch

Seitenzahl: 1006

Veröffentlichungsjahr: 2020

Beschreibung

The Family Nurse Practitioner provides essential guidance and information for understanding how to diagnose and manage typical (and some atypical) patient cases. With contributions from noted experts on the topic, this new edition contains updated cases to reflect today's patient-centered approach, and includes the most recent advances in patient care. From neonatal to geriatric, all the cases demonstrate real-life scenarios and present appropriate solutions on a case-by-case basis to reflect the nuance required in practice. The revised edition emphasizes pharmacological management, with a new section on mental health care and additional cases on chronic conditions. Greater consideration is given to race, gender, ethnicity and their impact on management options. * Contains more than 70 case studies * Offers new cases on pelvic pain, substance abuse, food allergies, celiac disease, child abuse, pre-conception planning, and dermatology * Includes discussion questions to help develop understanding Written for students and academics of nursing and nurse practitioners, The Family Nurse Practitioner is the ideal text for developing and expanding one's knowledge and comprehension of the diagnosis and management of patient care.

Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Contributors

EDITOR

CONTRIBUTORS

Preface

Acknowledgments

Introduction

Abbreviations and Acronyms

Section 1: The Neonate

Case 1.1: Cardiovascular Screening Exam

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 1.2: Pulmonary Screening Exam

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 1.3: Skin Screening Exam

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 1.4: Oxygenation

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 1.5: Nutrition and Weight

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 2: The Infant

Case 2.1: Nutrition and Weight

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.2: Breastfeeding

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.3: Growth and Development

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.4: Heart Murmur

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.5: Cough

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.6: Diarrhea

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 2.7: Fall from Height

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 3: The Toddler/Preschool Child

Case 3.1: Earache

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 3.2: Bedwetting

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 3.3: Burn

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 3.4: Toothache

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 3.5: Abdominal Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 3.6: Lesion on Penis

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 4: The School‐Aged Child

Case 4.1: Rash without Fever

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.2: Rash with Fever

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.3: Red Eye

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.4: Sore Throat

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.5: Disruptive Behavior

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.6: Cough and Difficulty Breathing

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.7: Left Arm Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.8: Nightmares

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.9: Gastrointestinal Complaint

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.10: Food Allergies

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 4.11: Obesity

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 5: The Adolescent

Case 5.1: Drug Use

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.2: Weight Loss

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.3: Menstrual Cramps

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.4: Missed Periods

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.5: Birth Control Decision‐Making

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.6: Vaginal Discharge

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.7: Sexual Identity

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 5.8: Knee Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 6: Women’s Health

Case 6.1: Preconception Planning

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.2: Bleeding in the First Trimester of Pregnancy

SUBJECTIVE

OBJECTIVE

CRITIAL THINKING

Case 6.3: Night Sweats

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.4: Pelvic Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.5: Vaginal Itching

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.6: Redness and Swelling in the Breast

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.7: Sexual Assault

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.8: Abdominal Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.9: Urinary Frequency

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.10: Headache

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.11: Fatigue and Joint Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.12: Muscle Tenderness

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 6.13: Insomnia

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 7: Men’s Health

Case 7.1: Fatigue

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 7.2: Testicular Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 7.3: Prostate Changes

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 8: General Adult Health

Case 8.1: Substance Use Disorder (SUD)

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.2: Foot Ulcer

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.3: Abdominal Pain and Weight Gain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.4: Burning Leg Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.5: Difficulty Breathing

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.6: Burning Epigastric Pain after Meals

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.7: Chest Pain and Dyspnea without Radiation

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.8: Chest Pain with Radiation

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.9: Persistent Cough and Joint Tenderness

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.10: Morning Headache

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.11: Facial Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.12: Fatigue, Confusion, and Weight Loss

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.13: Hand Numbness

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.14: Chronic Diarrhea

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.15: Intractable Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 8.16: Wrist Pain and Swelling

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 9: Mental Health

Case 9.1: Sad Mood

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 9.2: More Than Depression

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 9.3: Postpartum Depression

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 9.4: Anxiety

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 9.5: Trauma

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Section 10: The Older Adult

Case 10.1: Forgetfulness

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.2: Behavior Change

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.3: Tremors

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.4: Weight Gain and Fatigue

SUBJECTIVE

OBJECTIVE

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.5: Visual Changes

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.6: Back Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.7: Acute Joint Pain

SUBJECTIVE

OBJECTIVE

CRITIAL THINKING

Case 10.8: Itching and Soreness

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.9: Knee Pain

SUBJECTIVE

OBJECTIVE

CRITICAL THINKING

Case 10.10: Hyperthermia and Mental Status Changes in the Elderly

OBJECTIVE

CRITICAL THINKING

Section 11: Resolutions

Case 1.1 Cardiovascular Screening Exam

RESOLUTION

REFERENCES AND RESOURCES

Case 1.2 Pulmonary Screening Exam

RESOLUTION

REFERENCES AND RESOURCES

Case 1.3 Skin Screening Exam

RESOLUTION

REFERENCES AND RESOURCES

Case 1.4 Oxygenation

RESOLUTION

REFERENCES AND RESOURCES

Case 1.5 Nutrition and Weight

RESOLUTION

REFERENCES AND RESOURCES

Case 2.1 Nutrition and Weight

RESOLUTION

REFERENCES AND RESOURCES

Case 2.2 Breastfeeding

RESOLUTION

REFERENCES AND RESOURCES

Case 2.3 Growth and Development

RESOLUTION

REFERENCES AND RESOURCES

Case 2.4 Heart Murmur

RESOLUTION

REFERENCES AND RESOURCES

Case 2.5 Cough

RESOLUTION

REFERENCES AND RESOURCES

Case 2.6 Diarrhea

RESOLUTION

REFERENCES AND RESOURCES

Case 2.7 Fall from Height

RESOLUTION

REFERENCES AND RESOURCES

Case 3.1 Earache

RESOLUTION

REFERENCES AND RESOURCES

Case 3.2 Bedwetting

RESOLUTION

REFERENCES AND RESOURCES

Case 3.3 Burn

RESOLUTION

REFERENCES AND RESOURCES

Case 3.4 Toothache

RESOLUTION

REFERENCES AND RESOURCES

Case 3.5 Abdominal Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 3.6 Lesion on Penis

RESOLUTION

REFERENCES AND RESOURCES

Case 4.1 Rash without Fever

RESOLUTION

REFERENCES AND RESOURCES

Case 4.2 Rash with Fever

RESOLUTION

REFERENCES AND RESOURCES

Case 4.3 Red Eye

RESOLUTION

REFERENCES AND RESOURCES

Case 4.4 Sore Throat

RESOLUTION

REFERENCES AND RESOURCES

Case 4.5 Disruptive Behavior

RESOLUTION

REFERENCES AND RESOURCES

Case 4.6 Cough and Difficulty Breathing

RESOLUTION

REFERENCES AND RESOURCES

Case 4.7 Left Arm Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 4.8 Nightmares

RESOLUTION

REFERENCES AND RESOURCES

Case 4.9 Gastrointestinal Complaint

RESOLUTION

REFERENCES AND RESOURCES

Case 4.10 Food Allergies

RESOLUTION

REFERENCES AND RESOURCES

Case 4.11 Obesity

RESOLUTION

REFERENCES AND RESOURCES

Case 5.1 Drug Use

RESOLUTION

REFERENCES AND RESOURCES

Case 5.2 Weight Loss

RESOLUTION

REFERENCES AND RESOURCES

Case 5.3 Menstrual Cramps

RESOLUTION

REFERENCES AND RESOURCES

Case 5.4 Missed Periods

RESOLUTION

REFERENCES AND RESOURCES

Case 5.5 Birth Control Decision‐Making

RESOLUTION

REFERENCES

Case 5.6 Vaginal Discharge

RESOLUTION

REFERENCES AND RESOURCES

Case 5.7 Sexual Identity

RESOLUTION

REFERENCES AND RESOURCES

Case 5.8 Knee Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 6.1 Preconception Planning

RESOLUTION

REFERENCES AND RESOURCES

Case 6.2 Bleeding in the First Trimester of Pregnancy

RESOLUTION

REFERENCES AND RESOURCES

Case 6.3 Night Sweats

RESOLUTION

REFERENCES AND RESOURCES

Case 6.4 Pelvic Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 6.5 Vaginal Itching

RESOLUTION

REFERENCES AND RESOURCES

Case 6.6 Redness and Swelling in the Breast

RESOLUTION

REFERENCES AND RESOURCES

Case 6.7 Sexual Assault

RESOLUTION

REFERENCES AND RESOURCES

Case 6.8 Abdominal Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 6.9 Urinary Frequency

RESOLUTION

REFERENCES AND RESOURCES

Case 6.10 Headaches

RESOLUTION

REFERENCE AND RESOURCE

Case 6.11 Fatigue and Joint Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 6.12 Muscle Tenderness

RESOLUTION

REFERENCE AND RESOURCE

Case 6.13 Insomnia

RESOLUTION

REFERENCES AND RESOURCES

Case 7.1 Fatigue

RESOLUTION

REFERENCES AND RESOURCES

Case 7.2 Testicular Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 7.3 Prostate Changes

RESOLUTION

REFERENCES AND RESOURCES

Case 8.1 Substance Use Disorder (SUD)

RESOLUTION

REFERENCES AND RESOURCES

Case 8.2 Foot Ulcer

RESOLUTION

REFERENCES AND RESOURCES

Case 8.3 Abdominal Pain and Weight Gain

RESOLUTION

REFERENCES AND RESOURCES

Case 8.4 Burning Leg Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 8.5 Difficulty Breathing

RESOLUTION

REFERENCES AND RESOURCES

Case 8.6 Epigastric Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 8.7 Chest Pain and Dyspnea without Radiation

RESOLUTION

REFERENCES AND RESOURCES

Case 8.8 Chest Pain with Radiation

RESOLUTION

REFERENCES AND RESOURCES

Case 8.9 Persistent Cough and Joint Tenderness

RESOLUTION

REFERENCES AND RESOURCES

Case 8.10 Morning Headache

RESOLUTION

REFERENCES AND RESOURCES

Case 8.11 Facial Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 8.12 Fatigue, Confusion, and Weight Loss

RESOLUTION

REFERENCES AND RESOURCES

Case 8.13 Hand Numbness

RESOLUTION

REFERENCES AND RESOURCES

Case 8.14 Chronic Diarrhea

RESOLUTION

REFERENCES AND RESOURCES

Case 8.15 Intractable Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 8.16 Wrist Pain and Swelling

RESOLUTION

REFERENCES AND RESOURCES

Case 9.1 Sad Mood

RESOLUTION

REFERENCES AND RESOURCES

Case 9.2 More Than Depression

RESOLUTION

REFERENCES AND RESOURCES

Case 9.3 Postpartum Depression

RESOLUTION

REFERENCES AND RESOURCES

Case 9.4 Anxiety

RESOLUTION

REFERENCES AND RESOURCES

Case 9.5 Trauma

RESOLUTION

REFERENCES AND RESOURCES

Case 10.1 Forgetfulness

RESOLUTION

REFERENCES

Case 10.2 Behavior Change

RESOLUTION

REFERENCES AND RESOURCES

Case 10.3 Tremors

RESOLUTION

REFERENCES AND RESOURCES

Case 10.4 Weight Gain and Fatigue

RESOLUTION

REFERENCES AND RESOURCES

Case 10.5 Visual Changes

RESOLUTION

REFERENCES AND RESOURCES

Case 10.6 Back Pain

RESOLUTION

REFERENCES

Case 10.7 Acute Joint Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 10.8 Itching and Soreness

RESOLUTION

REFERENCES AND RESOURCES

Case 10.9 Knee Pain

RESOLUTION

REFERENCES AND RESOURCES

Case 10.10 Hyperthermia and Mental Status Changes in the Elderly

RESOLUTION

REFERENCES AND RESOURCES

Index

End User License Agreement

List of Tables

c11-3

Table 3.3.1. Rule of Nines Burn Chart.

Table 3.3.2. Lund and Browder Burn Chart (Part 1).

Table 3.3.3. Lund and Browder Burn Chart (Part 2).

c11-4

Table 4.9.1. Classification of Symptoms.

Table 4.10.1. Symptoms of Anaphylaxis.

Table 4.10.2. Allergy Symptoms.

c11-5

Table 5.4.1. Nonsteroidal Anti‐Inflammatory Drugs Used in the Treatment of Pr...

c11-6

Table 6.3.1. Symptoms Associated with the Menopause Transition.

Table 6.3.2. Prescription Options

*

for Managing Vasomotor Symptoms Associ...

Table 6.5.1. Wet Mount Findings.

Table 6.5.2. Differential Diagnosis.

Table 6.13.1. Comparison of Hypo‐ and Hyperthyroidism.

c11-8

Table 8.6.1. Medications Used to Treat GERD.

Table 8.11.1. Plan of Treatment.

Table 8.13.1. Diagnostic Testing.

c11-10

Table 10.2.1. Potential Contributors to Antonio’s Delirium.

Table 10.6.1. Prescription Agents for Osteoporosis Management.

Table 10.7.1. Differential Diagnoses.

List of Illustrations

C8-7

Figure 8.7.1 Zachary’s ECG.

c11-4

Figure 4.9.1. Child/Adolescent with Symptoms Suggestive of Celiac Disease.

c11-8

Figure 8.8.1. Oliver’s ECG.

Guide

Cover Page

Title Page

Copyright

Contributors

Preface

Abbreviations and Acronyms

Introduction

Abbreviations and Acronyms

Table of Contents

Begin Reading

Index

WILEY END USER LICENSE AGREEMENT

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The Family Nurse Practitioner

Clinical Case Studies

SECOND EDITION

Edited by

Leslie Neal‐Boylan, PhD, APRN, CRRN, FAAN, FARN

Mansfield Kaseman Health Clinic

Rockville, MD, USA

This edition first published 2021© 2021 John Wiley & Sons Ltd

Edition HistoryJohn Wiley & Sons, Inc. (1e, 2011)

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Library of Congress Cataloging‐in‐Publication Data

Names: Neal‐Boylan, Leslie, editor.Title: The family nurse practitioner : clinical case studies / [edited by] Leslie Neal‐Boylan.Other titles: Clinical case studies for the family nurse practitioner. | Case studies in nursing.Description: Second edition. | Hoboken, NJ : Wiley‐Blackwell, 2021. | Series: Case studies in nursing | Preceded by Clinical case studies for the family nurse practitioner / [edited by] Leslie Neal‐Boylan. 2011. | Includes bibliographical references and index.Identifiers: LCCN 2020026509 (print) | LCCN 2020026510 (ebook) | ISBN 9781119603191 (paperback) | ISBN 9781119603214 (adobe pdf) | ISBN 9781119603221 (epub)Subjects: MESH: Family Nurse Practitioners | Family Nursing | Primary Care Nursing | Case ReportsClassification: LCC RT82.8 (print) | LCC RT82.8 (ebook) | NLM WY 128 | DDC 610.7306/92–dc23LC record available at https://lccn.loc.gov/2020026509LC ebook record available at https://lccn.loc.gov/2020026510

Cover Design: WileyCover Image: © Arthur Tilley/Getty Images

Contributors

EDITOR

Leslie Neal‐Boylan, PhD, APRN, CRRN, FAAN, FARNMansfield Kaseman Health ClinicRockville, MD, USA

CONTRIBUTORS

Ivy M. Alexander, PhD, APRN, ANP‐BC, FAANP, FAANProfessor and Director, Adult‐Gerontology Primary Care TrackCoordinator, Clinical ScholarshipSchool of NursingUniversity of ConnecticutStorrs, CT, USA

Nancy Cantey Banasiak, DNP, PPCNP‐BC, APRNAssociate ProfessorYale University School of NursingNew Haven, CT, USA

Vera Borkowski, MSN, APRN, FNP‐CFamily Nurse PractitionerChild and Family Agency of Southeastern CTNew London, CT, USA

Suellen Breakey, PhD, RNAssociate ProfessorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USAAmy Bruno, PhD, RN, ANP‐BCTerm LecturerSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USAAdult Nurse PractitionerGalileo HealthNew York, NY, USA

Jessica Chan, MSN, APRN, PPCNP‐BCCoordinator of Medical ServicesChild and Family Agency of Southeastern CTNew London, CT, USA

Karen M. Flaherty, MSN, MEd, APRN‐BC, CBCNInstructor, Academic Support CounselorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Betsy Gaffney, MSN, APRN, FNP‐BCFamily Nurse PractitionerChild and Family Agency of Southeastern CTNew London, CT, USA

Anna Goddard, PhD, APRN, CPNP‐PCAssistant ProfessorCollege of NursingSacred Heart UniversityFairfield, CT, USAPediatric Nurse PractitionerChild and Family Agency of Southeastern CTNew London, CT, USA

Clara Gona, PhD, FNP‐BC, RNAssistant ProfessorsSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Allison Grady, MSN, APNPClinical InstructorCollege of NursingUniversity of Wisconsin–MilwaukeeMilwaukee, WI, USAPediatric Nurse PractitionerMedical College of Wisconsin/Children’s Wisconsin ClinicsMilwaukee, WI, USA

Millie Hepburn, PhD, RN, SCRN, ACNS‐BCAssistant ProfessorQuinnipiac UniversityHamden, CT, USA

Rebecca Hill, DNP, RN, FNP‐C, CNEAssistant ProfessorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USAFamily Nurse PractitionerFamily Doctors, LLCSwampscott, MA, USA

Erin Janicek, LCSWSenior Director of Clinical ServicesChild and Family Agency of Southeastern CTNew London, CT, USA

Sara Ann Jakub, MA, SYC, LPCDirector of Clinical Services for School‐Based Health CentersDirector of Quality AssuranceChild and Family Agency of Southeastern CTNew London, CT, USA

Annette Jakubisin‐Konicki, PhD, ANP‐BC, FNP‐BC, FAANPAssociate ProfessorDirector, Family Nurse Practitioner Primary Care TrackSchool of NursingUniversity of ConnecticutStorrs, CT, USA

Erin Janicek, LCSWSenior Director of Clinical ServicesChild and Family Agency of Southeastern CTNew London, CT, USA

Susan M. Jussaume, MSN, APRN, FNP‐BC, AHN‐BCInstructor and Family Nurse PractitionerSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Andrew Konesky, MSN, APRNPediatric Nurse PractitionerChild and Family Agency of Southeastern CTNew London, CT, USA

Jason R. Lucey, DNP, FNP‐BCAssistant ProfessorFamily Track Co‐CoordinatorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Antonia C. Makosky, DNP, MPH, ANP‐BC, ANPAssistant ProfessorAdult‐Gerontology Primary Care Track Co‐CoordinatorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Mikki Meadows‐Oliver, PhD, RN, FAANAssociate ProfessorSchool of NursingQuinnipiac UniversityHamden, CT, USA

Sheila L. Molony, PhD, APRN, GNP‐BC, FGSA, FAANProfessor of NursingQuinnipiac UniversityHamden, CT, USA

Patrice K. Nicholas, DNSc, DHL (Hon), MPH, MS, RN, NP‐C, FAANDistinguished Teaching Professor and DirectorCenter for Climate Change, Climate Justice, and HealthSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Meredith Scannell, PhD, MSN, MPH, CNM, CEN, SANE‐AClinical Research Nurse and Emergency NurseBrigham and Women’s HospitalBoston, MA, USA

Sara Smoller, RN, MSN, ANP‐BCAssistant ProfessorSchool of NursingMGH Institute of Health ProfessionsBoston, MAAdult Nurse PractitionerFamily Doctors, LLCSwampscott, MA, USA

Sheila Swales, MS, RN, PMHNP‐BCInstructorSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Nancy M. Terres, PhD, RNAssociate Professor of NursingSchool of NursingMGH Institute of Health ProfessionsBoston, MA, USA

Preface

The purpose of this book is to help clinicians and students better understand how to diagnose and manage typical (and some atypical) patient cases. While the focus is on the nurse practitioner role, this book will be useful to other patient care providers, such as physicians and physician’s assistants. The contributing authors have worked hard to update cases from the first edition of this book to better reflect patient‐centered language and advances in care. We have developed several new cases, such as one on climate change, to assist clinicians with scenarios that were not as predominant as they are today.

We have presented a variety of patients in these cases with regard to age, gender identity, socioeconomic status, family status, and other considerations. However, please don’t hesitate to alter these demographics to tailor the cases for your specific needs.

The contributing authors in this book are all subject matter experts. They have written these cases from real life. Consequently, the cases do not result in cookie‐cutter solutions. Critical thinking questions encourage the reader to think carefully about the case as presented and about potential resolutions to the case given variations that occur in real life. These cases should be used to jump‐start conversations among students, faculty, and clinicians regarding possible treatment options depending on the individual patient. All cases include the most current research and guidelines for treatment.

The cases are presented chronologically from pediatric to adolescent to adult and older adult. Cases in women’s health and men’s health have their own separate chapters. Mental health cases are now in a separate chapter.

For this second edition we moved the case resolutions to the end of the book. The best use of the book is to read and analyze the case, alter the demographics of the patient to view the case from multiple perspectives, and then review and discuss the resolutions. Keep in mind that there is typically more than one way to treat a patient and patients should always be diagnosed and treated on an individual basis, so there is often more than one possible resolution to a case. We have only included one resolution per case in this book.

Acknowledgments

I am so grateful to the readers of the first edition of this book. Thank you for using it. I hope you will find this second edition even more helpful. Many thanks to the contributing authors of this second edition. Several rejoined me from the first edition and others are new to this edition. All were easy to work with and are consummate professionals and excellent clinicians.

Thanks to all the patients and colleagues who’ve taught me so much throughout the years. Clinical practice and nursing education are my great passions and I’m grateful for all I learn every day.

Finally, thank you to Edward and Natalie Rotkoff, Kevin Boylan, Paul Neal, Corinne Neal, Andrew Neal, and Bonnie Brown.

Introduction

By Leslie Neal‐Boylan, PhD, APRN, CRRN, FAAN, FARN

Family practice is not simply the practice of caring for individuals across the lifespan. Contrary to the perceptions of many students who enter the world of family practice, it is not simply to care for people “from womb to tomb.” Practice that is guided by that philosophy risks missing so much, not only regarding the individual patient’s own health but the family dynamics and the tangible and intangible aspects of the family that impact the individual patient. If the “family” aspect of family practice is ignored or neglected, then the clinician is simply caring for individuals as any clinician would and cannot really style themselves as a family practice clinician regardless of title or certification.

To practice as a family practice clinician, it is important to have a basic understanding first about what is meant by “family” and then how the family is integrated into the plan of care and ultimately often becomes the “patient.” In previous work about home health clinicians, this author found that home health clinicians care for the “patient entity,” which is defined as all those who impact or potentially impact the patient’s health. In family practice, the clinician also cares for and, at the very least, considers the patient entity when developing and pursuing a plan of care for an individual who seeks health care.

The meaning of “family” has undergone significant societal change. Consequently, it is important that the clinician not make assumptions about who is “family” and who is not. It is important to ask the patient who they consider their family. As I write this, society, both nationally and globally, is undergoing the crisis brought on by the coronavirus. Aside from the medical implications, the virus is already having an impact on how people interact with each other. We are required to practice “social distancing,” which requires us to maintain our relationships, whether personal or professional, in other ways besides close proximity or touching. Neighbors are calling to check in on the elderly, especially those who don’t have family nearby, and older adults are checking on the young parents in their neighborhoods who are working from home while trying to manage children who are unable to attend school due to the pandemic. What is the definition of family during a crisis like this? How will we keep each other from becoming socially isolated?

Crises like these imply a new definition of family. Technology allows us to keep in contact despite the prohibition on being physically within six feet of another human being. A crisis like this reminds us how vulnerable we are as human beings, not only to disease but to loneliness and despair. Knowing that others care about us takes on even greater significance. We are reminded that “family,” however we define it, is crucial to our survival.

As clinicians, we are just as vulnerable but have the advantage of a vast store of medical knowledge. As laypersons disseminate misconceptions about how to prevent and treat the virus, nurse practitioners and our health professions colleagues are stepping up to make sure the public has accurate health care information.

Our care of individuals and families does not just take place in the clinic or health care setting. It occurs via every encounter we have with the people in our communities and across cyberspace. The coronavirus crisis illustrates that while we have better means of communication than in years past, we are also vulnerable to more misinformation.

The cases in this book were chosen in an attempt to illustrate mostly typical (and some atypical) cases that occur in family practice. Remembering the impact “family” has on our physical and mental health and that the patient is part of a subsystem within the larger family system can help the reader see that the patient’s illness or condition not only impacts the patient but potentially has a ripple effect on many others both within and outside of the family system.

Abbreviations and Acronyms

AAA:

Abdominal aortic aneurysm

AACE:

American Association of Clinical Endocrinologists

AAP:

American Academy of Pediatrics

ABG:

Arterial blood gas

ABI:

Ankle brachial index

ACC:

American College of Cardiology

ACIP:

Advisory Committee on Immunization Practices

ACL:

Anterior cruciate ligament

ACS:

Acute coronary syndrome

ADHD:

Attention‐deficit hyperactive disorder

ad lib:

At liberty or whenever the patient wants to do something

AGS:

American Geriatrics Society

AHA:

American Heart Association

AMI:

Acute myocardial infarction or heart attack

ANA:

Anti‐nuclear antibody

AP:

Anterior‐posterior

APA:

American Psychiatric Association

Apgar:

The score given to newborns at 1 minute and 5 minutes after birth. The newborn is scored on activity (muscle tone), pulse, grimace (reflex irritability), appearance (skin color), and respirations.

AS:

Active surveillance

BD:

Blastomycoses dermatitidis

BDI:

Beck Depression Inventory

BMI:

Body mass index

BMP:

Basic metabolic panel

BP:

Blood pressure

BS:

Bowel sounds

BUN:

Blood urea nitrogen

CAD:

Coronary artery disease

CAM:

Complementary and alternative medicine

or

Confusion Assessment Method

CBC:

Complete blood count, with or without diff (differential)

CBT:

Cognitive behavioral therapy

CCB:

Calcium channel blocker

CCRC:

Continuing care retirement community

CKD:

Chronic kidney disease

CLI:

Critical limb ischemia

CLIA:

Clinical Laboratory Improvement Amendment

CMP:

Complete metabolic panel

CMT:

Cervical motion tenderness

COC:

Combined oral contraceptive pill

COPD:

Chronic obstructive pulmonary disease

COWS:

Clinical Opiate Withdrawal Scale

CRP:

C‐reactive protein

C‐SSRS:

Columbia–Suicide Severity Rating Scale

CT:

Computed tomography

CTA:

Clear to auscultation

CVA:

Cerebrovascular accident

CXR:

Chest X‐ray

D&C:

Dilatation and curettage

DASH:

Dietary Approaches to Stop Hypertension

DDVAP:

Desmopressin acetate vasopressin

DEA:

Drug Enforcement Agency

DFA:

Direct fluorescent antibody (testing)

DMARD:

Disease‐modifying antirheumatic drug

DMPA:

Depo‐Provera

DoD:

Department of Defense

DOE:

Dyspnea on exertion

DRE:

Digital rectal examination

DVT/PE:

Deep vein thrombosis/pulmonary embolism

DXA:

Dual‐energy absorptiometry

EBV:

Epstein‐Barr virus

ECG:

Electrocardiogram

ED:

Emergency department

EEG:

Electroencephalogram

ELISA:

Enzyme‐linked immunosorbent assay

EM:

Erythema migrans

EMA:

Endomysial antibody

EMDR:

Eye movement desensitization and reprocessing

ENT:

Ear, nose, and throat

EOB:

Explanation of benefits

EOM:

Extraocular movement

EPT:

Expedited partner therapy

ESPGN:

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

ESR:

Erythrocyte sedimentation rate

ETOH:

Alcohol (drinking kind)

FBG:

Fasting blood glucose

FBS:

Fasting blood sugar

FIT:

Fecal immunochemical test

FM:

Fibromyalgia

FROM:

Full range of motion

FTT:

Failure to thrive

GABHS:

Group A beta‐hemolytic streptococci

GAD:

Glutamic acid decarboxylase

GC/CHL:

Gonorrhea/chlamydia

GCA:

Giant cell arteritis

GCS:

Glasgow Coma Scale

GDMT:

Guideline‐directed medical therapy

GDS:

Geriatric Depression Scale

GERD:

Gastroesophageal reflux disease

GFR:

Glomerular filtration rate

GI:

Gastrointestinal

GINA:

Global Initiative for Asthma

HA1c:

Hemoglobin A1c

HCV:

Hepatitis C virus

HPV:

Human papilloma virus

HR:

Heart rate

HRI:

Heat‐related illness

HSDD:

Hypoactive sexual desire disorder

HSM:

Hepatosplenomegaly

HSV:

Herpes simplex virus

HT:

Hormone therapy

HTN:

Hypertension

HZO:

Herpes zoster opthalmica

IBD:

Inflammatory bowel disease

IBS:

Irritable bowel syndrome

IgA:

Immunoglobulin A

IgE:

Immunoglobulin E

ITP:

Idiopathic thrombocytopenic purpura

IUC:

Intrauterine contraception

IUD:

Intrauterine device

KOH:

Potassium hydroxide

KUB:

Kidneys, ureters, and bladder

LARC:

Long‐acting reversible contraceptives

LDH:

Lactic acid dehydrogenase

LEAP:

Learning Early About Peanut

LFT:

Liver function test

LLSB:

Left lower sternal border

LMP:

Last menstrual period

LNMP:

Last normal menstrual period

LR:

Light reflex

LRI:

Lower respiratory infections

LROM:

Limited range of motion

MCI:

Mild cognitive impairment

MCP:

Metacarpal phalangeal (joint)

MCV:

Mean corpuscular volume

MDD:

Major depressive disorder

MDI:

Metered dose inhaler

MGF:

Maternal grandfather

MGM:

Maternal grandmother

MI:

Myocardial infarction

or

motivational interviewing

MMSE:

Mini‐Mental State Examination

MoCA:

Montreal Cognitive Assessment

MRI:

Magnetic resonance imaging

MRSA:

Methicillin‐resistant

Staphylococcus aureus

MSSA:

Methicillin‐susceptible

Staphylococcus aureus

MSU:

Monosodium urate

MTP:

Metatarsophalangeal (joint)

MVI:

Multiple vitamin

NAAT:

Nucleic acid amplification test

NAD:

No apparent distress

NAPNAP:

National Association of Pediatric Nurse Practitioners

NARES:

Nonallergic rhinitis with eosinophilia syndrome

NIAAA:

National Institute of Alcohol Abuse and Alcoholism

NICU:

Neonatal intensive care unit

NIDA:

National Institute on Drug Abuse

NKDA:

No known drug allergies

NKFA:

No known food allergies

NOF:

National Osteoporosis Foundation

NP:

Nurse practitioner

NPH:

Normal pressure hydrocephalus

NSAID:

Nonsteroidal anti‐inflammatory drug

NSTEMI:

Non‐ST elevation myocardial infarction

NSVD:

Normal spontaneous vaginal delivery

NT/ND:

Nontender/nondistended

OA:

Osteoarthritis

O2 sat:

Oxygen saturation

OCP:

Oral contraceptive pill

ODD:

Oppositional defiant disorder

OGTT:

Oral glucose tolerance test

OP:

Osteoporosis

OSA:

Obstructive sleep apnea

OTC:

Over‐the‐counter (medication)

OUD:

Opioid use disorder

PAD:

Peripheral artery disease

PCOS:

Polycystic ovarian syndrome

PCR:

Polymerase chain reaction

PDA:

Patent ductus arteriosus

PE:

Pulmonary embolism

PEG:

Polyethylene glycol

PEP:

Post‐exposure prophylaxis

PERRLA:

Pupils equal, round, reactive to light and accommodation

PGF:

Paternal grandfather

PGM:

Paternal grandmother

PH/G:

Pubic hair/gonads

PHN:

Postherpetic neuralgia

PHQ:

Patient Health Questionnaire

PID:

Pelvic inflammatory disease

PIP:

Proximal interphalangeal (joint)

PLP:

Phantom limb pain

PMDD:

Premenstrual dysphoric disorder

PMR:

Polymyalgia rheumatica

PMS:

Premenstrual syndrome

PNE:

Primary nocturnal enuresis

PPD:

Postpartum depression

PPI:

Proton pump inhibitor

PRN:

As needed

PSI:

Pneumonia Severity Index

PTSD:

Post‐traumatic stress disorder

PVD:

Peripheral vascular disease

QD:

Once daily

RAI:

Radionucleotide uptake scan with iodine

RED‐S:

Relative energy deficiency in sports

REM:

Rapid eye movement

RICE:

Rest, ice, compression, and elevation

ROS:

Review of systems

RR:

Respiratory rate

RRR:

Regular rate and rhythm

RSV:

Respiratory syncytial virus

RUQ:

Right upper quadrant

SAFE‐T:

Suicide Assessment Five‐Step Evaluation and Triage

SAMHSA:

Substance Abuse and Mental Health Services Administration

SANE:

Sexual assault nurse examiner

SART:

Sexual assault response team

SBHC:

School‐based health center

SBIRT:

Screening, Brief Intervention, and Referral for Treatment

SEM:

Systolic ejection murmur

SERM:

Selective estrogen receptor modulator

SGA:

Small for gestational age

SIB:

Self‐injurious behavior

SJS:

Stevens‐Johnson Syndrome

SLE:

Systemic lupus erythematosus

SM:

Stroke mimic

SNRI:

Serotonin norepinephrine reuptake inhibitor

SSP:

Syringe services program

SSRI:

Selective serotonin reuptake inhibitor

STI:

Sexually transmitted infection

SUD:

Substance use disorder

SWS:

Slow‐wave sleep

TANF:

Temporary Assistance for Needy Families

TBI:

Traumatic brain injury

or

toe brachial index

TBSA:

Total body surface area

TCA:

Tricyclic antidepressant

TEN:

Toxic epidermal necrosis

TENS:

Transcutaneous electrical nerve stimulation

TM:

Tympanic membrane

TPO:

Antithydroperoxidase antibody

TRAb:

Thyrotropin receptor antibody

TRUS:

Transrectal ultrasound

TSH:

Thyroid‐stimulating hormone

tTG:

Tissue transglutaminase

TTN:

Transient tachypnea of the newborn

TTP:

Tenderness to palpation

ULT:

Urate‐lowering therapy

URI:

Upper respiratory infection

USPSTF:

U.S. Preventive Services Task Force

UTI:

Urinary tract infection

VA:

Veterans Administration

VCF:

Vertebral compression fracture

VCUG:

Voiding cystourethrography

VDRL:

Venereal disease research laboratory

VZV:

Varicella zoster virus

WBC:

White blood cell

WHI:

Women’s Health Initiative

WIC:

Women, Infants, and Children Supplemental Nutrition Program

Section 1The Neonate

Case 1.1

Cardiovascular Screening Exam

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 1.2

Pulmonary Screening Exam

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 1.3

Skin Screening Exam

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 1.4

Oxygenation

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 1.5

Nutrition and Weight

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Section 2The Infant

Case 2.1

Nutrition and Weight

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.2

Breastfeeding

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.3

Growth and Development

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.4

Heart Murmur

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.5

Cough

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.6

Diarrhea

By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 2.7

Fall from Height