Family Nurse Practitioner

Osgood-Schlatter Disease Example: A 12-year-old boy presents to his pediatrician’s office for right knee pain that started three months ago after starting basketball practices. On physical exam, the boy is tender to palpation over the anterior tibial tubercle. There is no erythema or warmth to the area. A lateral radiograph of the knee reveals elevation of read more…

Example: A 28-year-old woman presents with complaints of double vision and fatigue. These symptoms are generally better in the morning and progress throughout the day. She works long hours and says toward the end of her shift she is extremely fatigued and has difficulty completing her tasks. Which of the following is the most likely etiology?

Multiple Myeloma Patient will be elderly Complaining of back pain PE will show CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions/Back pain Labs will show monoclonal antibody spike X-ray will show lytic lesions Peripheral blood smear: Rouleaux formations Serum protein electrophoresis: M spike Protein electrophoresis urine analysis: Bence-Jones proteins Most commonly caused by single clone plasma cell read more…

Molluscum Contagiosum Patient will be a school-age child Presenting with “warts” PE will show multiple waxy, dome-shaped papules with umbilicated appearance Most commonly caused by poxvirus Treatment is self-limiting

Complex Regional Pain Syndrome Patient will have a history of previous extremity injury or fracture Complaining of light touch causing extreme pain and allodynia (pain felt from a nonpainful stimulus, such as clothes or bed sheets on the skin) Treatment is NSAIDs, gabapentin, sympathectomy

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Causes: adhesions (pelvic surgery) > tumor > hernia (inguinal) Proximal: bilious vomiting  Distal: feculent vomiting High pitched bowel sounds X-ray: dilated bowel, air-fluid levels, “stack of coins” or “string of pearls” sign Modality of choice: CT NGT, surgery

Appendicitis Patient will be complaining of fever, pain that began periumbilical then moved to RLQ, nausea and anorexia PE will show Psoas sign (RLQ pain on extension of right hip), Obturator sign (RLQ pain on internal rotation of flexed right hip), Rovsing sign (right lower quadrant pain when the left lower quadrant is palpated) Diagnosis is made by ultrasound, CT Most commonly caused read more…

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According to Godwin et al., during procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure.

Question: In patients undergoing procedural sedation and analgesia in the emergency department, what is the minimum number of personnel necessary to manage complications?

According to Godwin et al., do not delay procedural sedation in adults or pediatric patients in the ED based on fasting time. No reduction in risk of emesis or aspiration has been shown with any fasting duration. This is a Level B recommendation.

You are planning to perform procedural sedation to reduce a fracture. The patient’s last meal was 4 hours ago. How much additional time should you wait to perform the procedure?