Np Notes: Nurse Practitioner's Clinical Pocket Guide (Davis's Notes)

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NP

Notes Nurse Practitioner’s Clinical Pocket Guide

Ruth McCaffrey, DNP, ARNP, FNP-BC, GNP-BC Ellis Quinn Youngkin, PhD, RNC, WHCNP, ARNP Purchase additional copies of this book at your health science bookstore or directly from F. A. Davis by shopping online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN) A Davis’s Notes Book

F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2010 by F. A. Davis Company All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in China by Imago Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne DaCunha, RN, MSN Director of Content Development: Darlene D. Pedersen Senior Developmental Editor: William Welsh Project Editor: Kim DePaul Cover Design: Carolyn O’Brien Consultants: Kathleen Anderson, MS, RNP-C; Susan Berg, MSN, FNP-BC; Noreen Chikotas, DEd, CRNP; Jane Flanagan, PhD, ANP-BC; Lea R. Hall, RN, MSN, FNP-BC; Andra Hanlon, PhD, ARNP, CPNP; Jennifer Knopp-Sihota, NP, MN; Nancy Kramer, EdD, CPNP, CNE, ARNP; Lori Martin-Plank, PhD, MSPH, MSN, FNP-BC, GNP-BC; Linda Gay Morris, ARNP; Diane Nuñez, DNP, RN, ANP-BC; Patricia Nymark, NP, MN ; Arlene Pericak, RN, FNP-c, MS; Zelda Peters, MSN, FNP-C; Maureen Ryan, RN, MSN, EdD (c), FNP-BC; Susan M. Seglie, RN, MSN, CNS, FNP-BC, CDE; Lynn Wimett, APRN-C, EdD; Ken Wysocki, MS, FNP-C As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-2167-1/10 0 + $.25.

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SCREENING

ASSESS

LABS

DIFF DX

BILLING/ CODING

MEDS

CAM

TOOLS

Look for our other Davis’s Notes titles Available Now!

Derm Notes: Dermatology Clinical Pocket Guide ISBN: 978-0-8036-1495-6 ECG Notes: Interpretation and Management Guide, 2nd Edition ISBN: 978-0-8036-2142-8 LabNotes: Guide to Lab and Diagnostic Tests, 2nd edition ISBN: 978-0-8036-2138-1 MedNotes: Pocket Drug Guide, 3rd edition ISBN: 978-0-8036-2139-8 Pocket Anatomy and Physiology ISBN: 978-0-8036-1824-4 Pocket Psych Drugs ISBN: 978-0-8036-2201-2 Provider’s Coding Notes: Billing & Coding Pocket Guide ISBN: 978-0-8036-1745-2 PsychNotes: Clinical Pocket Guide, 2nd Edition ISBN: 978-0-8036-1853-4

For a complete list of Davis’s Notes and other titles for health care providers, visit www.fadavis.com.

1

Screening Tests General health Full checkup, including weight and height Heart health Blood pressure test Cholesterol test

Diabetes Blood sugar test Prostate health Digital rectal exam (DRE) Prostate-specific antigen (PSA) blood test

Health Assessment Tools

Adult Men’s Health Screening Guidelines

Yearly

At least every 2 years

Yearly

Ages 65 and Older

Yearly

At least every 2 years

Every 3 years Every year if hyperlipidemia present Every 3 years

Ages 50–64

Every 5 years

At least every 2 years

Every 3 years Every year if hyperlipidemia present Every 3 years

Yearly Yearly

Ages 40–49

At least every 2 years

Every 3 years Every year if hyperlipidemia present Start at age 45, then every 3 years

Yearly Yearly

Ages 18–39

Start at age 20

Yearly Yearly

Continued

SCREENING

SCREENING

Ages 18–39

Ages 40–49

Monthly selfMonthly selfexam; part of a exam; part of a general checkup general checkup If risk factors exist, If risk factors exist, both partners both partners should get testshould get ed for STDs, tested for STDs, including HIV, including HIV, before having before having sexual intersexual intercourse course

Every 5 years (if not having a colonoscopy)

Yearly

Monthly selfexam; part of a general checkup If risk factors exist, both partners should get tested for STDs, including HIV, before having sexual intercourse

Ages 50–64

Every 5 years (if not having a colonoscopy)

Yearly

Monthly selfexam; part of a general checkup If risk factors exist, both partners should get tested for STDs, including HIV, before having sexual intercourse

Ages 65 and Older

Adult Men’s Health Screening Guidelines—cont’d Screening Tests Reproductive health Testicular exam Chlamydia test Sexually transmitted disease (STD) tests

Colorectal health Fecal occult blood test Flexible sigmoidoscopy (with fecal occult blood test is preferred)

Continued

2

3

Ages 18–39

Ages 40–49

Every 3 years

Every 2–4 years

Ages 50–64 Every 5–10 years (if not having a colonoscopy or sigmoidoscopy) Every 10 years Every 5–10 years with each screening (sigmoidoscopy, colonoscopy, or DCBE)

Every 3 years

Every 1–2 years

Ages 65 and Older Every 5–10 years (if not having a colonoscopy or sigmoidoscopy) Every 10 years Every 5–10 years with each screening (sigmoidoscopy, colonoscopy, or DCBE)

Adult Men’s Health Screening Guidelines—cont’d Screening Tests Double contrast barium enema (DCBE) Colonoscopy Rectal exam

Eye and ear health Eye exam

Hearing test

If you have any Every 2–4 years vision problems; at least one exam from ages 20–29 and at least two exams from ages 30–39 Starting at Every 10 years age 18, then every 10 years

Continued

SCREENING

BASICS SCREENING

Monthly mole self-exam; by a provider every year

One to two times every year Discuss with your provider or nurse

Monthly mole self-exam; by a provider every year

Ages 65 and Older

Monthly mole self-exam; by a provider every year

One to two times every year Discuss with your provider or nurse

Every 10 years

Ages 50–64

Monthly mole self-exam; by a provider every 3 years, starting at age 20

One to two times every year Discuss with your provider or nurse

Yearly if risk factors exist Every 6–8 years if risk factors warrant Every 10 years

Ages 40–49

One to two times every year Discuss with your provider or nurse

Yearly if risk factors exist Every 6–8 years if risk factors warrant Every 10 years

Yearly if risk factors exist One time only

Yearly if risk factors exist Every 6–8 years if risk factors warrant Every 10 years

Ages 18–39

Adult Men’s Health Screening Guidelines—cont’d Screening Tests Skin health Mole exam

Oral health Dental exam Mental health screening Immunizations Influenza vaccine Pneumococcal vaccine Tetanus-diphtheria booster vaccine Meningococcal vaccine

Discuss with your provider if attending college

4

5

Screening Tests General health Full checkup, including weight and height Thyroid stimulating hormone test (TSH) Heart health Blood pressure test Cholesterol test Bone health Bone mineral density test Diabetes Blood glucose test Breast health Mammogram (x-ray of breast)

Adult Women’s Health Screening Guidelines

At least every 2 years Every 3 years

Every 5 years

Yearly

Bone mineral density test every 2 years

At least every 2 years Every 3 years

Every 5 years

Yearly

Ages 65 and Older

Bone mineral density test at menopause

Every 3 years

Ages 50–64

Yearly

Every 3 years

Every 1–2 years

Ages 40–49

Every 5 years

Every 1–2 years

Ages 18–39

At least every At least every 2 years 2 years Every 3 years Starting at age 20, every 3 years

Yearly

Start at age 45, then every 3 years

Discuss need for Discuss need for adequate calcium adequate calcium

Start at age 35, then every 5 years

Every 1–2 years

Continued

SCREENING

SCREENING

Ages 18–39

Ages 40–49

Every 1–3 years Yearly until age 25 if sexually active If new or multiOlder than age ple partners 25, if new or multiple partners Both partners Both partners should get should get tested tested for STDs, for STDs, includincluding HIV, ing HIV, before before having having sexual sexual interintercourse course As needed As needed

Every 1–3 years

Ages 50–64

Ages 65 and Older

If new or multiple partners

Both partners should get tested for STDs, including HIV, before having sexual intercourse As needed

As needed

Both partners should get tested for STDs, including HIV, before having sexual intercourse

Every 1–3 years sexually active, pelvic exam yearly If new or multiple partners

Adult Women’s Health Screening Guidelines—cont’d Screening Tests Reproductive health Pap test and pelvic exam Chlamydia test

Sexually transmitted disease tests

Mental health screening

Continued

6

7

Ages 18–39

Ages 40–49

Yearly

Every 5 years (if not having a colonoscopy)

Yearly

Ages 65 and Older

Every 5 years (if not having a colonoscopy)

Every 5–10 years (if not having a colonoscopy or sigmoidoscopy) Every 10 years Every 5–10 years with each screening (sigmoidoscopy, colonoscopy, or DCBE)

Ages 50–64

Adult Women’s Health Screening Guidelines—cont’d Screening Tests Colorectal health Fecal occult blood test Flexible sigmoidoscopy (with fecal occult blood test is preferred) Double contrast barium enema

Colonoscopy Rectal exam

Every 5–10 years (if not having a colonoscopy or sigmoidoscopy) Every 10 years Every 5–10 years with each screening (sigmoidoscopy, colonoscopy, or DCBE)

Continued

SCREENING

SCREENING

Every 10 years

Every 2–4 years

Ages 40–49

Monthly mole self-exam and at yearly visit

Every 3 years

Every 2–4 years

Ages 50–64

One to two times every year

Monthly mole self-exam and at yearly visit

Every 3 years

Every 1–2 years

Ages 65 and Older

Monthly mole self-exam and at yearly visit

One to two times every year

Ages 18–39

Monthly mole self-exam and at yearly visit

One to two times every year

One exam from ages 20–29, and at least two exams from ages 30–39 Starting at age 18, then every 10 years

One to two times every year

Adult Women’s Health Screening Guidelines—cont’d Screening Tests Eye and ear health Eye exam

Hearing test

Skin health Mole exam

Oral health Dental exam

Continued

8

9

Recommended before attending college

Up to age 26

If risk factors are present If risk factors are present Every 10 years

Ages 18–39

If risk factors are present If risk factors are present Every 10 years

Ages 40–49

Yearly

Ages 65 and Older

Yearly

Starting at age 60, one time only

One time only

Every 10 years

Starting at age 60, one time only

If risk factors are present Every 10 years

Ages 50–64

Adult Women’s Health Screening Guidelines—cont’d Screening Tests Immunizations Influenza vaccine Pneumococcal vaccine Tetanus-diphtheria booster vaccine Human papillomavirus vaccine (HPV) Meningococcal vaccine Herpes zoster vaccine (to prevent shingles)

SCREENING

SCREENING

Once every 5 years Once every 12 months Once every 24 months Once every 12 months Once every 48 months Once every 48 months is used instead of sigmoidoscopy or colonoscopy Once every 12 months Once every 12 months Yearly Once Three shots in recommended sequence Yearly Once every 12 months 8 face-to-face visits in a 12-month period

How Often Medicare Covers Within the first 6 months of enrollment

Medicare Preventative Services (Covered Under Medicare Part B) Test “Welcome to Medicare” physical exam (includes vision screening and EKG) Cholesterol screening Mammogram Pap test Fecal occult blood test Sigmoidoscopy Barium enema DRE for prostate screening PSA Flu shot Pneumonia shot Hepatitis B vaccination Fasting glucose test Glaucoma study Smoking cessation

10

11 Adult Treatment Panel (ATP) III Guidelines for Cholesterol Management Step 1: Determine Lipoprotein Levels Obtain complete lipoprotein profile after 9- to 12-hour fast.

ATP III Classification of LDL Cholesterol (mg/dL) ■ ■ ■ ■ ■