Fitzgerald Health Education Associates (FHEA) is committed to the success of nurse practitioners; we publish practical information for practicing NPs and NP students, which includes NP interviews, NP certification Q&A;, avoiding malpractice, and news.
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Click to View Previous Issues... Clinical Update Evaluating and Treating Vitamin D Deficiency Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC VITAMIN D has long been rec- ognized as essential for the ef- ficient absorption and utiliza- tion of dietary calcium as well a s for bone and muscle health. 1 I ntestinal calcium absorption is s ignificantly enhanced by the presence of adequate vitamin D and is conversely reduced in deficiency of this important micronutrient. 1 During the past 15 years, research has highlighted multiple nonskeletal chronic diseases associ- ated with vitamin D deficiency, 2,3 including certain cancers, 4 cardiovascular diseases, 5,6 autoimmune diseases, 7,8 metabolic disorders, 9 and infectious dis- e ases. 10 A s an inhibitor of abnormal cellular growth, vitamin D is needed to h elp with cell differentiation and thereby minimize abnormal cell proliferation; this abnormality is a key step in cancer development. 1,4 A stimulator of insulin secretion in response to increased blood glucose, vitamin D plays a role in the maintenance of normoglycemia by possibly minimizing the risk of developing type 2 diabetes mellitus. 9 Because vitamin D receptors are expressed by most cells of the immune system, vitamin D plays an important role as an immuno - modu lator. 11 When vitamin D is available in physiologic amounts, this micronu- t rient acts to decrease renin production, therefore contributing to blood pres- sure control. 12 Sources of Vitamin D A combination of dietary intake of foods rich in vitamin D in addition to regular p eriods of skin exposure to the sun should provide the body with an adequate Inside C linical Update ................. 1 Malpractice .................... 10 Review Courses ............. 15 Certification Q&A............; 16 Contraceptive Pearl ....... 19 News Briefs ..................... 22 2015 Live Courses NP Essentials Skills and Workshop (4- or 2-day courses) Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) NP Certification Exam Review Course Tracks F amily, Adult-Gerontology, and Adult Primary Care A cute Care, Adult- G erontology Acute Care P ediatric Primary Care P sychiatric-Mental H ealth Women's Health Click or see page 15 Look for bold orange text for clickable web links. F itzgerald Health Education Associates fhea.com C ommitted to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 2, February 2015 Clinical Update M easles: Making a Comeback Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC OU TBREAKS of vaccine-preventable diseases including measles (rubeola) are occurring with increasing frequency in the United States. In fact, the 644 measles cases reported in 27 states during 2014 is the highest number of cases reported since 2000, when the Centers for Disease Control and Preven- tion (CDC) declared measles eliminated in the United States. Elimination of a disease means that there has been no endemic disease transmission for at least 12 months. Although measles is no longer endemic in the United States, o utbreaks still occur each year. The ongoing multi-state measles outbreak linked to two Disney theme parks in California, which began in December 2014, shows that measles remains a threat in the Unites States despite exten- sive vaccination efforts. 1 As the incidence of measles rises, all healthcare providers must ensure they can recognize the disease and know the appropri- a te steps to manage it. How Outbreaks Occur Outbreaks of measles occur in the United States when measles is imported by u nvaccinated travelers (U.S. residents traveling abroad and foreign visitors) w ho acquire the infection while in other countries where the disease is en- demic or where an outbreak is occurring. Measles continues to circulate in many parts of the world, with an estimated 20 million cases occurring world- wide each year. 2 Once imported into this country, measles can spread readily i n communities with low measles/mumps/rubella (MMR) vaccination rates. Measles is one of the most contagious viral diseases known, with secondary attack rates >90% in susceptible household and institutional contacts. Most people who get measles are unvaccinated or incompletely vaccinated. For ex- ample, of the 118 measles cases reported over a 19-week period in 2011, 89% o ccurred in unvaccinated persons. 3 I n the recent California outbreak, 45% of cases were unvaccinated and another 43% had unknown or undocumented vaccination status. 1 I nside Clinical Update ................. 1 Review Courses............... 10 Certification Q&A............; 11 U pdate: Immunization ... 15 News Briefs ..................... 17 Fitzgerald Faculty in the N ews .............................. 23 2015 Live Courses Pharmacology Update ( 2-day course) The Art of Wound Repair (1-day course) NP Certification Exam Review Course Tracks F amily, Adult-Gerontology, and Adult Primary Care Acute Care, Adult- Gerontology Acute Care Pediatric Primary Care Psychiatric-Mental H ealth W omen's Health Click or see page 10 Look for bold orange text for clickable web links. F itzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 9 78 •7 94 •8 366 Volume 15, Issue 3, March 2015 Continued on page 3 Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. Certification Q&A; Caring for Asian Patients: Cultural Factors That Can Influence Patient Care Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC I R ECENTLY LEARNED that issues related to culture and health care are included o n the exam. What are some key cultural issues pertaining to the care of A sian patients that I should know as I prepare for the exam? Asians are the fastest-growing ethnic group in the United States, with a population that in- c reased from 11.9 million in 2000 to 17.3 million persons in 2010. 1 The largest Asian groups—Chinese, Indian, Fil- ipino, Vietnamese, Korean, and Japanese—account for over three-quarters of the Asian pop- ulation in the United States, and the remaining quarter is distrib- uted among 19 other detailed groups counted in the 2010 census. Asian Americans as a group are ethnically and linguistically diverse. However, individuals from the various ethnic groups can experience similar problems when accessing health care in Western health systems. Especially for first-generation immigrants, these problems are generally r elated to language barriers and differing styles of communicating, holistic health beliefs and practices that differ from the Western health care model, and reliance to some extent on traditional therapies. By learning about Asian cul- tures, communication patterns, and traditional health practices, NPs can better position themselves to provide culturally competent care to their Asian I nside C ertification Q&A; ............. 1 Review Courses ................ 6 Malpractice ....................... 7 Update: Patient Satisfaction ...................... 13 Update: Tobacco Use...... 15 News Briefs ..................... 18 2015 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair ( 1-day course) NP Essentials (4-day course) N P Certification Exam Review Course Tracks Family, Adult-Gerontology, a nd Adult Primary Care Adult-Gerontology Acute Care P ediatric Primary Care Psychiatric-Mental H ealth W omen's Health F itzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 4, April 2015 March 2015 April 2015 February 2015 Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. Expanding NP Scope of Practice: An Update E a rlier this year, Nebraska and Maryland joined 19 other states that allow NPs to practice to the fullest extent of their education by enacting new full prac- tice authority licensure and practice laws for NPs. For new NP graduates as well a s practicing NPs, this means more opportunities for NPs to use the full set of skills acquired through education and clinical experience. In many states, how- e ver, there remains a gap between the care that NPs are educated and clinically prepared to provide and the care that state practice laws allow NPs to provide. T ypes of State Practice Laws The American Association of Nurse Practitioners (AANP) has been at the fore- f ront of efforts to expand NPs' scope of practice. As the AANP notes, full practice authority is "the collection of state practices and licensure laws that allow for NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, initiate and manage treatments—including prescribing medications—under the exclu- sive licensure authority of the state board of nursing." 1 With full practice authori- t y, NPs are responsible only to a state board of nursing for meeting the stan- dards of care. The AANP also defines two categories of state practice and licensure limits on NP scope of practice: reduced practice and restricted practice. In states with a reduced practice regulatory structure, NPs are required by law to have a collabo- r ative agreement with an outside health discipline in order to provide patient Inside NP Scope of Practice ....... 1 Review Courses ................ 6 Certification Q& A ............. 7 Diagnostic Challenge ...... 15 News Briefs ..................... 17 FHEA Faculty News ..........24 2 015 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) N P Essentials ( 4-day course) NP Certification Exam Review Course Tracks Family, Adult-Gerontology, and Adult Primary Care A dult-Gerontology A cute Care Pediatric Primary Care Psychiatric-Mental Health W omen's Health Fitzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 5, May 2015 Full Practice Reduced Practice Restricted Practice Used with permission from AANP. DC May 2015 Look for bold orange text for clickable web links. Our " i " information icon is a clickable web link. Avoiding Malpractice: A Case Analysis A Twist on the Consequences of Not Following Payer Rules Carolyn Buppert, NP, JD I am apprehensive when I hear about nurse practitioners who practice in organi- zations that have not dotted every "i" and crossed every "t" to conform to the letter of the law when it comes to rules about provider supervision, board cer- tifications, and Medicare and Medicaid payer rules. Everyone may be blissfully ig- norant—until something goes wrong. Here is a case that justifies paying attention to all these legal details. CASE A teenager was having behavior problems in school and the school referred her to a mental health clinic for counseling. Medicaid covered the girl's healthcare. The school notified the parents that the girl would not be allowed to take classes unless she saw a psychiatrist. At the clinic, the patient was referred to a cli- nician, "Dr. O," who is a nurse practitioner. The NP diagnosed bipolar disorder and prescribed oxcarbazepine, an anticon- vulsant. The girl had an adverse reac- tion to the medication. Her parents tried to call the NP twice, but phone calls were not returned. The parents decided to stop the girl's medication, and she had a seizure, which required hospitalization. After speaking with the NP, the girl resumed the medication. Five months later the girl had another seizure and died. The parents filed complaints with various state agen- cies, and, in doing so, learned that the NP was not a psychiatrist. State regulations re- quire that a psychiatric NP be supervised by a board-certified psychiatrist and that Inside A voiding Malpractice ...... 1 Diagnostic Challenge........ 5 Review Courses ................ 8 Certification Q& A ............. 9 Update: STD Treatment Guidelines.........................15 News Briefs ..................... 19 2015 Live Courses Pharmacology Update (2-day course) The Art of Wound Repair (1-day course) NP Essentials (4-day course) NP Certification Exam Review Course Tracks Family, Adult-Gerontology, and Adult Primary Care Adult-Gerontology Acute Care Pediatric Primary Care Psychiatric-Mental Health Women's Health Fitzgerald Health Education Associates, Inc. fhea.com Committed to the success of nurse practitioners 1 Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 6, June 2015 June 2015