What is a clinical pearl in nursing
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I was inspired to write this series to serve as a guide for student and new nurse practitioners. I remember being faced with so many things to consider during the last year of my family nurse practitioner program and my first year after graduation, and wishing I had someone to guide me through that transitional time.
It is my hope that this article can provide navigation for student and new NPs. When I was a new NP, I had a patient that had a shellfish allergy in addition to environmental allergy and bee sting allergy, and was allergic to penicillin and erythromycin.
In the process, I found out something else that was interesting, that I was previously unaware of. First, an allergic reaction to sulfa medications does not mean that shellfish also need to be avoided since there is no sulfa in shellfish. Clinical Pearl 2: Acetaminophen vs.
I had given him an antibiotic and also wanted to recommend something for his sinus headache and facial discomfort; however, he was already taking daily aspirin as a preventative measure. It was my understanding that ibuprofen would be contraindicated in a patient with concurrent use of aspirin; therefore, I recommended acetaminophen for him since it is not a non-steroidal anti-inflammatory drug NSAID , does not have the platelet effects that aspirin has, nor does it have a drug interaction with aspirin.
However, I also saw many patients for cholesterol screenings who, while taking their health histories, found out they were taking daily aspirin as a preventative measure and ibuprofen for arthritis concurrently. As a result, I felt I needed to research this further. According to the U. An alternative remedy that may be considered for BV is boric acid capsules used intravaginally.
Boric acid is a powder and natural antiseptic that helps to acidify the vagina and restore normal vaginal flora. Supplies can be purchased over-the-counter OTC in some pharmacies, while others require a prescription. I had not previously heard of a form of psoriasis associated with strep throat, so I looked it up and found the following. According to MedlinePlus, 5 one type of psoriasis called guttate psoriasis is associated with strep throat.
It is a relatively uncommon form of psoriasis, usually seen in patients younger then 30yo my patient was 25yo , and is a condition which often develops suddenly, usually after an infection, most notably strep throat.
Guttate psoriasis is not contagious, seems to be inherited, and may become a chronic or lifelong condition. Nature Made CholestOff Cholesterol Fighter Caplets with Reducol proprietary blend of natural plant sterols and stanols is a dietary supplement containing phytosterols which can help to lower LDL cholesterol by reducing the absorption of dietary cholesterol into the bloodstream. This was the only medication she reported taking and her cholesterol readings, performed using CardioCheck, were all within normal limits.
According to Lee, 8 red yeast rice is rice that has been fermented by red yeast and has been used by the Chinese for many centuries as a food preservative, food coloring responsible for the red color of Peking duck , spice, and an ingredient in rice wine.
It continues to be a staple in China, Japan, and Asian communities in the U. Recently, red yeast rice has been developed by Chinese and American scientists as a product to lower blood lipids including cholesterol and triglycerides. Clinical Pearl 6: Birth Control, Antibiotics, and Condoms I was taught in my NP training to advise patients on birth control who are prescribed an antibiotic, to use a back-up method such as a condom while taking the antibiotic.
I wondered if that varied based on the birth control method being used and type of antibiotic prescribed, and did some research on this with a colleague of mine who is a pharmacist.
According to Gold Standard, 9 anti-infectives which disrupt the normal gastrointestinal flora, including amoxicillin, ampicillin, chloramphenicol, clindamycin, lincomycin, neomycin, nitrofurantoin, penicillin V, sulfonamides, and tetracyclines, may potentially decrease the effectiveness of estrogen-containing oral contraceptives, and antituberculosis drugs such as rifampin, were agents that have been clearly associated with oral contraceptive failure and pregnancy.
It only takes a moment to provide such education to our patients and that small amount of time can prevent the serious impact of an unwanted pregnancy and its potential complications. In addition, even computers are not error proof. For these reasons, it is important to know which OTCs are best when addressing pain relief in such patients, i. This is just one example of why it is important to not become too dependent and reliant on computers, and why it is important to pass along information and suggestions to other colleagues when potential snags are encountered, in an effort to counteract them and ultimately improve patient safety.
Clinical Pearl 8: Poison Ivy in the Winter One winter, following a warming trend in mid-March, I treated a patient with rhus dermatitis poison ivy. The patient stated she was playing Frisbee golf over the weekend with friends near a wooded area, when the Frisbee disc landed in the forest. Later that day, she started itching and noticed a rash on her face, ears, and arms. She took a shower and using a washcloth, rubbed vigorously all over her skin.
The next day, the itching worsened and she noticed that the rash had spread to a different area on her arms and stomach. She had tried using OTC anti-itch creams and ointments which helped temporarily, but she stated she was still itching and uncomfortable even several days later.
These plants are common in the spring and summer. Although poison ivy rash is usually a summer complaint, cases may occur in winter when people are cleaning their yards and burning wood with urushiol on it or when cutting poison ivy vines to make wreaths. All parts of the plant contain urushiol which causes the allergic response, so even contact with the leafless vines in the winter can cause a reaction.
When urushiol gets on the skin, it begins to penetrate in minutes. A reaction usually occurs within a few hours to several days after exposure. There is severe itching, redness and swelling, followed by blisters. The rash is often arranged in streaks or lines where the person brushed up against the plant.
In a few days, the blisters become crusted and can take 10 days or longer to heal. Poison plant dermatitis can affect any part of the body. In general, the rash does not spread by touching it unless you have urushiol on your hands, although it may seem to when it breaks out in new areas. This may happen because urushiol absorbs more slowly into skin that is thicker such as forearms, legs and trunk; from repeated exposure to a contaminated object; or if urushiol is trapped under fingernails.
It is applied to the skin before risk of exposure, at least 15 min. Clinical Pearl 9: Creative Investigation with Otitis Externa OE I had a patient who presented for ear pain and who upon investigation of risk factors i. He later asked me if using an iPod could be a risk factor for OE.
Goguen 17 supports this noting that wearing devices that occlude the ear canals can increase the risk of OE if worn frequently by injuring the skin.
I decided to research this further to gain more knowledge into who to recommend which analgesic to. Clinical Pearl Alternative Treatment for Chronic, Recurrent Sinusitis I had a patient who was a firefighter that dealt with recurrent sinus infections. I recommended he use a SinuCleanse Neti Pot since I was concerned that his occupational exposures to smoke, dust, and other airborne irritants were a predisposing or risk factor for his recurrent sinus infections.
I had another patient who traveled regularly to an area overseas with poor sanitation and pollution who stated that every time she traveled there, she returned with a sinus infection. I recommended she use a SinuCleanse Neti Pot as I was concerned environmental exposures were a risk factor for her sinus infections. It may mean the difference as to whether or not the patient would need an antibiotic for a bacterial sinus infection.
Clinical Pearl Acetaminophen vs. Ibuprofen for Greater Antipyretic Activity It was my understanding that, although both are analgesics, acetaminophen is more antipyretic and ibuprofen is more anti-inflammatory. As a new NP, I decided to research this.
According to earlier information published by Wahba, 24 in children, acetaminophen produced a greater initial body temperature reduction 0.
Additional information published on the University of Michigan Department of Pediatrics website, indicates that ibuprofen is more effective at achieving temperature normalization than acetaminophen, though both effectively lower temperatures greater than 1. I verified with my patient that he is not monitored by a specialist for his condition, that he is not on any medications for his condition, and that he does not have any restrictions.
The main importance of making the diagnosis is to rule out other potentially more serious causes of jaundice such as hepatitis. In closing, I hope that upon reading this guide, it will be as helpful and interesting to you, as it was to me in writing it. Good luck in your practices and may you never stop learning! References 1. Kagan S. Allergy to sulfa drugs. Allergy and Asthma Newsletter. More D. Glucosamine and shellfish allergy. Department of Food and Drug Administration. Information for healthcare professionals: Concomitant use of ibuprofen and aspirin.
Centers for Disease Control and Prevention. Nature Made CholestOff. Maki KC, et al. Lipid-altering effects of a dietary supplement tablet containing free plant sterols and stanols in men and women with primary hypercholesterolaemia: A randomized, placebo-controlled crossover trial.
International Journal of Food Sciences and Nutrition , ;63 4. Lee D. Red yeast rice and cholesterol. Gold Standard. Drug interaction report for healthcare professionals. Retrieved by pharmacist from local CVS pharmacy. Skidmore-Roth L. Louis, MO: Elsevier Mosby. Walgreens pharmacy. Do antibiotics reduce the effectiveness of birth control pills? Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient.
Life after bariatric surgery. American Academy of Dermatology. Poison ivy. Outsmarting poison ivy and other poisonous plants. Ivy X. Goguen LA. Patient information: External otitis Including swimmers ear; Beyond the basics. American Academy of Allergy, Asthma, and Immunology.
Medications may trigger asthma symptoms.
– Clinical “Pearls” that will Prepare Nursing Students for Real-World Practice – KeithRN
Dec 28, · SOME PEARLS OF WISDOM: 20 THINGS EVERY NEW NURSE & NURSING STUDENT SHOULD KNOW Insulin generally lowers potassium. Albuterol treatments, . Mar 29, · Clinical pearls that you don’t learn during medical training. Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!”. . Jan 01, · Clinical Pearls. Am J Crit Care () 29 (1): 7. Many evidence-based practice (EBP) protocols are used in the care of critical care patients; however, the speed of .
Clinical pearl | definition of clinical pearl by Medical dictionary – Most Popular
I have encouraged my company to purchase it for all the nurses! I would give it more than 5 stars if I could!! An excellent tool. I use this time and time again, especially when I am training family group homes. Your email address will not be published. IntellectAbility Product Shop. Click here to purchase on Amazon. Out of stock. Weight Rated 5 out of 5. Add a review Cancel reply Your email address will not be published. Our panelists from the UAB Arts in Medicine group will discuss how they encourage healing by engaging patients in creative arts such as music therapy, poetry, visual arts, and more.
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