Editorial Board iii
Contributors v
Preface: Applying Words and Concepts to Transform Nursing Practice xxv
Linda J. Keilman
Introduction: A Celebration of Words xxix
Linda J. Keilman
Adult/Gerontology
Recognizing, Diagnosing, and Treating Posttraumatic Stress Disorder in Older Adults
Deborah A. Kernohan, Linda J. Keilman, and Tamatha (Tammy) Arms
Posttraumatic stress disorder (PTSD) is a mental health condition that is triggered by a disaster or traumatic event the individual has experienced or witnessed. Symptoms may include depression, anxiety, insomnia, nightmares, regularly reliving or thinking about the distressing memories or event, and severe emotional distress. These symptoms and others can affect daily life, work–life balance, relationships, and quality of life. Older adults are at higher risk for PTSD and have gone undiagnosed for months or years. Knowing how to recognize and screen for PTSD is important for primary care providers such as advanced practice registered nurses.
A historical perspective 2
Older adults and posttraumatic stress disorder 3
Recognizing posttraumatic stress disorder 4
Case study 6
Resilience factors 8
Impact of coronavirus disease 2019 on the development of posttraumatic stress disorder 8
Comorbidity posttraumatic stress disorder and dementia 9
Advanced practice registered nurse role 9
Treatment 10
Implications for practice 11
Clinics care points 11
Disclosure 12
The Impact of Food Insecurity on Chronic Disease Management in Older Adults
Vallon Williams, Pamela J. LaBorde, and Jyrissa Robinson
Food insecurity among the older adult population not only centers on finances to purchase food. Food insecurity is impacted by the functional status of the individual to access food, to afford medical care in addition to food, and to have the needed social support to assist with access to food and decrease social isolation often caused by the lack of social support. Food insecurity in the aging population seriously impacts health conditions associated with increased disease burden.
Case presentation 15
Introduction 16
Food security 16
Food insecurity 16
Associated factors 17
Mobility-related conditions and disabilities 17
Economic factors 17
Food insecurity and chronic disease 18
Food insecurities and cardiovascular disease 18
Food insecurity and diabetes 19
Food insecurities and depression 19
Health care assessments 20
Interventions 22
Advanced practice registered nurse role 22
Summary 23
Clinics care points 23
Disclosure 23
Immunosenescence and Infectious Disease Risk Among Aging Adults: Management Strategies for FNPs to Identify Those at Greatest Risk
Deanna Gray-Miceli, Kathy Gray, Matthew R. Sorenson, and Barbara J. Holtzclaw
Age-related immune changes increase the risk for viral infections such as coronavirus disease-2019, its mutant variants, and common influenza outbreaks in long-term care settings. Utilization of evidenced-based nursing interventions such as cohorting practices and implications for testing and screening aims to reduce risk of infection and improve quality of life. Incorporating an infection control manager will add leadership in maintaining currency of information and case tracking.
Introduction 28
Pathophysiology 28
Innate and adaptive immune systems 28
Conceptual framework 30
History 30
Family and adult nurse practitioners 31
Assessment: testing and screening 32
Clinical management: maintaining a screening and testing plan: staffing 32
Management: isolation and cohorting 35
Summary 37
Clinics care points: immunosenescence 38
Clinics care points: implications for leadership 38
Disclosure 39
Mild Cognitive Impairment in Older Adults
Melodee Harris, Janet Rooker, and Linda J. Keilman
Mild cognitive impairment (MCI) is more prevalent than dementia. The global population of older adults is growing and therefore the prevalence of MCI will continue to grow. MCI is not dementia. Cognition in persons diagnosed with MCI may progress to dementia, stay the same, or revert to normal cognition. More research is needed to prevent the progression of MCI to dementia.
Introduction 41
Definition 42
Risk factors 42
Prevalence 44
Pathophysiology 44
Symptoms 44
Screening 44
Differential diagnoses 46
Diagnosis 46
Workup 47
Treatment 47
Supplements and medications 47
Nonpharmacological interventions 50
Coronavirus disease-2019 51
Transition to dementia 51
Summary 51
Clinics care points 52
Disclosure 52
Heart Failure in Older Adults
Margaret T. Bowers
There is an increasing prevalence of heart failure in older adults. Early recognition and intervention are important to enhance the quality of life and moderate heart failure symptoms. Universal definitions of heart failure provide a framework to tailor therapies that include new medications. Addressing goals of care should guide therapeutic treatments that may include pharmacologic agents, devices, referral for advanced therapies as well as lifestyle changes.
Introduction 55
Pathophysiology 55
Definitions and classifications 56
History 57
Assessment 58
Diagnosis 59
Management 59
Medications 59
Polypharmacy 60
Devices 61
Advanced therapies 61
Goals of care 62
Discussion 62
Implication for advanced practice nurses 63
Summary 63
Clinics care points 64
Disclosure 64
A Life Course Approach to Understanding Urinary Incontinence in Later Life
Thanchanok Wongvibul
Urinary incontinence (UI) is a highly prevalent condition that affects individuals at any stage of life, especially in older adults. The presence of UI can seriously affect the overall quality of life, leading to feelings of shame, embarrassment, as well as stigmatization. To prevent or delay the progression of this condition, it is very important to understand the risk factors that contribute to the development of UI across the life span. A better understanding of UI will help indicate the development of interventions to reduce UI.
Introduction 67
Background and significance 67
A life course approach to continence care 68
Bladder health and urinary incontinence across the life span 68
Associated factors of urinary incontinence across the life span 70
Potentially modifiable factors 71
Management principles of urinary incontinence 71
Summary 72
Clinics care points 72
Implication for advanced practice registered nurses 73
The Three-Generation Pedigree: Elucidating Family Disease Patterns to Guide Genetic Screening, Testing, and Referral
Laura Hays
A family history pedigree, a three-generation pedigree of a person’s biological relatives with attached pertinent health information, is a standard tool used to more readily recognize patients who may benefit from genetics services. The depiction of both relationships and disorder traits advantage the pedigree over a simple genealogy for identifying patterns of disease expression and risk of disease inheritance.
Introduction 77
Definition/Description 78
Phenotype versus genotype 80
Modes of inheritance 81
Older adults: when is it “STnormal”? 81
Population and extended pedigrees versus three-generation pedigrees 82
Precision medicine 83
History 84
Issue management 85
Enhanced data input 86
Discussion 86
Limitations 87
Summary 88
Clinics care points 89
Disclosure 89
Peripheral Arterial Disease in Primary Care
Kara Elena Schrader, Kristin Castine, and Pallav Deka
Peripheral artery disease is the stenosis of the peripheral arteries due to atherosclerosis that reduces perfusion to the extremities. The risk is increased in older adults aged 65 and older. Complications include claudication, nonhealing ulcers, gangrene, critical limb ischemia, and amputation. PAD is underrecognized, with diagnosis occurring late in the condition. Patients have an elevated risk for atherosclerotic cardiovascular disease and require evidence-based management strategies to reduce risk. Strategies include the management of associated conditions such as smoking, diabetes, hypertension, and hyperlipemia. It is essential for nurse practitioners to identify risk factors and symptoms to institute early guideline-directed medical treatment.
Introduction 94
Background and significance 94
Racial disparities 94
Quality of life 95
Health care cost 95
The American Heart Association pad national action plan 95
Pathophysiology 95
Risks factors 96
Assessment 96
Diagnosis 98
Classification 100
Management in primary care 100
Lifestyle changes 101
Nutrition 102
Pharmacology 103
Chronic disease management 103
Referral 104
Management summary 104
Implications for nurse practitioner practice 104
Summary 104
Clinics care points 104
Disclosure 104
Women’s Health
Assessment and Management of Pelvic Organ Prolapse for the Rural Primary Care Provider
Lisa S. Pair and William E. Somerall
Pelvic organ prolapse is a common condition occurring in more than 50% of female patients. Patients may be asymptomatic or have complaints of pelvic pressure, pelvic fullness, or bulging around the vaginal opening. They may also have urinary, bowel, or sexual function complaints including urinary incontinence or voiding or bowel dysfunction. Educating rural primary care providers in the assessment, diagnosis, and nonsurgical management of pelvic organ prolapse including lifestyle modifications, pelvic floor muscle training, and the use of a vaginal support device can provide access to care for rural patients and increase their quality of life.
Introduction 107
Pelvic organ prolapse 108
Transgender surgery and pelvic organ prolapse 108
Risk factors for pelvic floor prolapse 110
History 111
Physical examination 111
Summary of initial management from primary care provider 117
Clinics care points 117
Disclosure 117
Care for Women with Past Trauma Using Trauma-Informed Care
Patricia M. Speck, LaQuadria S. Robinson, Karmie Johnson, and Lauren Mays
Violence against women is prevalent in all societies. Healthcare providers have the opportunity to care compassionately by implementing person-centered trauma-informed care practices, furthering safety and trustworthiness by using methods that encourage transparency, mutuality, and collaboration during all aspects of healthcare. The article promotes interventions for recognition of the person with traumatic experiences, assisting healthcare providers in the delivery of trauma-informed care, suggesting interventions to address person-centered cultural, historical, and gender issues. Using trauma-informed person-centered approaches, authors propose intervention tools to assist the healthcare provider in recognition and intervention, promoting self-efficacy and confidence in persons overcoming their complex personal traumas.
Introduction 119
Introduction to trauma-informed care 119
Vulnerable populations: women 125
Vulnerable populations: healthcare providers 125
Mental health and recovery 125
Provider interventions 128
Discussion 128
Summary 133
Clinics care points 133
Disclosure 133
Care for Women with past Trauma: The Physiology of Stress and Trauma
Patricia M. Speck, LaQuadria S. Robinson, Karmie Johnson, and Lauren Mays
When traumas are continuous or toxic, the body increases the hormonal response, and the sensory perception is that environments are unsafe and unpredictable. In these situations, increasing anxiety and fear are the overarching demonstrative emotions. The initial trauma responses release hormones to preserve life. The sensory memory is activated and the next time the senses detect a similar stimulus, the hormones release again. When the environment is toxic, there is continuous release of hormones that manifest in early organ system failure and muted memories. This article discusses the physiologic response to trauma, explaining formative causes of disease and inheritance.
Introduction 137
Trauma and stress 138
Trauma and biology 140
Discussion 145
Summary 145
Clinics care points 146
Disclosure 147
Cannabis Use in Pregnancy and Postpartum: Understanding the Complicated History and Current Recommendations to Facilitate Client-Centered Discussions
Elizabeth Muñoz, Ellen Solis, and Stephanie Mitchell
Cannabis use in pregnancy can lead to poor pregnancy outcomes and negatively affect the health of the pregnant person and fetus. Its use is also highly stigmatized and can even lead to legal ramifications for the pregnant person in some states. Health care professionals need to be ready to answer questions from clients regarding cannabis use in pregnancy and be able to do so in a bias-informed and evidence-based manner using client-centered language. This article examines the history of cannabis use and explores care considerations if a client is using the substance in pregnancy.
History of cannabis 152
Components of the plant 152
Medicinal timeline 153
Common medicinal uses of cannabis 153
Legality of cannabis 154
The dangers of unregulated cannabis 155
Fentanyl 155
Considerations from US history and policy 156
Policies surrounding pregnancy 156
Cannabis use in pregnancy and postpartum 157
Nausea and vomiting 157
Sleep 159
Mood disorders 159
Evidence review 160
Limitations to the evidence 160
Considerations for care 161
Scripting for health care professionals to have bias-informed discussions 161
Counseling on legal consequences 165
Summary 165
Clinics care points 166
Disclosure 166
Gaps in Social Determinants of Health History Taking, Clinical Documentation, and Billing/Coding Errors During Women’s Health Patient Encounters
Melissa LeBrun, Kim Brannagan, and Antiqua N. Smart
Defining social determinants of health (SDOH) and identifying key areas in which they influence health is pertinent in health care and health-care education. The objectives of this article are to define SDOH and identify key areas in which they affect health, discuss SDOH as they relate to issues faced primarily by women, common screening tools used to assess SDOH, clinical documentation pearls for health assessment, including areas specific to preventative care for women, and SDOH Z-codes used for billing purposes. Common SDOH documentation errors are also addressed along with solutions to reduce them.
Introduction 169
Social determinants of health defined 170
Social determinants and health equity in Women'SGCIs health 172
Screening tools for assessing social determinants of health 173
Common documentation pearls for social determinants of health and coding in Women'SGCIs health 174
Clinical documentation components for Women'SGCIs health and social determinants of health screening 175
Insufficient documentation 177
Preventative medicine service coding for Women’s health 178
Billing and coding social determinants of health 178
Common clinical documentation errors related to social determinants of health 179
Solutions to reduce social determinants of health clinical documentation errors 180
Summary 180
Clinics care points 181
Disclosure 181
Sexual Dysfunction in Biologic Females for Family Practice Providers: Assessment, Diagnosis, and Treatment
Christina M. Wilson
Sexual health is an important part of many individuals’ lives, and when there are problems with sexual function, it can disrupt or have a significant impact in their life. Sexual dysfunction typically occurs in one of the areas of the sexual response cycle (desire, arousal, orgasm) or is related to a lack of lubrication and/or pain. Sexual dysfunction affects a substantial proportion of both premenopausal and postmenopausal women. Both nonpharmacologic and pharmacologic options are available to help treat sexual dysfunction but are commonly used in conjunction with one another depending on the diagnosis.
Introduction 183
Approach to care 184
Assessment 184
Diagnosis 187
Treatment Options 188
Summary 189
Clinics care points 189
Declaration of Interests 190
Pediatrics
The Importance of Sleep for Normal Growth and Development
Ann Sheehan
Sleep is a period of intense brain growth and restoration. Quality sleep is an important part of physiologic, emotional, and cognitive development. Individual variability in sleep need is influenced by behavioral, medical, environmental, and cultural factors. This article provided an overview of the development of the sleep-wake cycle, how achievement of developmental milestones can affect the sleep-wake cycle, and the elements for creating a bedtime routine that support quality and quantity of sleep throughout childhood and adolescence. The consequences of poor sleep results in chronic health conditions, mood dysregulation, school failure, obesity, and an increase in risk taking behaviors.
Introduction 193
Sleep basics 194
Circadian rhythm process 194
Homeostasis process 194
Ultradian rhythm process 195
Sleep and development 195
Newborns (0 to 2 months) 196
Infants (2 to 12 months) 196
Toddlers (12 to 36 months) 197
Preschool (3 to 5 years) 197
School age (6 to 12 years) 198
Adolescents (12 to 18 years) 199
Healthy sleep promotion 199
Cultural and family practices 200
Sleep hygiene 201
Consequences of poor sleep quality and quantity 202
Advance practice registered nurse implications for advanced practice registered nurses 202
Summary 204
Clinics care points 204
Disclosure 204
Fever of Unknown Origin in Pediatrics
Emily Davis and Teresa Whited
Fever of unknown origin (FUO) is defined as fever lasting at least 3 weeks without an apparent source after 1 week of investigation. The cause of FUO includes infectious, autoimmune, malignancy, neurologic, genetic, pharmacologic, and iatrogenic. Workup for FUO includes a comprehensive history from the patient, a thorough physical examination, and discontinuance of any nonessential medications. Initial laboratory and radiology workup include a complete blood count with differential, blood culture, C-reactive protein, erythrosedimentation rate, procalcitonin, liver enzymes, renal function tests, lactate dehydrogenase, urinalysis, urine culture, and chest radiograph.
Pathophysiology 207
Evaluation 208
Neonates (8–21 Days) 210
Infants 1 to 3 Months old 211
Infants and toddlers 3 Months to 3 Years of age 212
Children aged older than 3 Years 212
Implications for advanced practice registered nurses 214
Clinics care points 214
Disclosures 214
Pediatric Asthma for the Primary Care Provider
Sarah Ann Keil Heinonen, Amanda C. Filippelli, and Nancy Banasiak
Asthma, one of the most common pediatric chronic diseases, disproportionately affects children living in low-income households. Characterized by airway hyperresponsiveness, inflammation, and obstruction, asthma causes symptoms including wheezing, coughing, chest tightness, and shortness of breath. Asthma control remains a primary goal through guidelines, education, appropriate medication, specialist referrals, asthma action plans, and access to health care providers. Poorly controlled asthma remains the leading cause of absenteeism from school and work and an economic burden despite medical advances. This review article provides an overview of pediatric asthma, diagnosis, and the most current guideline-based management for the primary care provider.
Introduction 217
Pathophysiology 218
Diagnosis 218
Differential diagnoses 220
Asthma classifications 220
Asthma management 220
Single maintenance and reliever therapy 224
Exacerbations 224
Severe cases 224
When to refer 225
Summary 225
Implications for advanced practice providers 226
Clinics care points 226
Disclosure 226
The Weight of Body Image
Elizabeth R. Silvers and Kimberly J. Erlich
Prevalence of eating disorders (EDs) in the adolescent and young adult (AYA) population has increased since the start of the COVID-19 pandemic, which correlates with increased engagement with social media and negative body image in AYAs. In addition, increased severity of EDs at presentation is evidenced by higher rates of hospitalization since the start of the pandemic, underscoring the need for health-care providers to obtain further training in managing EDs and appropriately referring to higher levels of care when indicated.
Introduction and relevance to primary care 229
Impact of the COVID-19 pandemic on eating disorders in adolescents and young adults 230
Pathophysiology: relationship of body image to eating disorders 230
History 232
Screening 233
Assessment 233
Diagnosis 233
Management 234
Discussion 236
Implication for advanced practice nurses 237
Clinics care points 237
Disclosure 237
Emerging Mental Health Issues in Children and Adolescents Secondary to the Coronavirus Disease-2019 Pandemic
Kellie Bishop and Teresa Whited
This article examines and compares the incidence and prevalence of mental health issues, including depression, anxiety, and suicide, among adolescents before and during the coronavirus disease-2019 pandemic. It discusses contributing factors, clinical presentation, screening tools, treatment options, and implications for advance practice nurses. This article prepares the advance practice nurse to promote mental wellness and identify, screen for, and appropriately manage emerging mental health issues in this vulnerable population.
Background 242
Significance 242
Discussion 242
Coronavirus disease-2019 242
Depression 243
Anxiety 243
Suicide 245
Summary 251
Clinics care points 252
Disclosure 252
Attention-Deficit/Hyperactivity Disorder Update 2022: New Medications Are Here!
Erin O’Connor Prange
Over the last 5 years, there has been an explosion of new attention-deficit/hyperactivity disorder (ADHD) medications US Food and Drug Administration approved and available for clinical use on the market. Trying to discern what is the same, different, and best for a specific patient can prove challenging. To ease this burden, this article will review the pharmacokinetics of stimulants and non-stimulants and highlight the benefits of these newly available medications. In addition, the article will discuss the most common side effects and describe options to manage these potential concerns. It is not the intention of this article to review the diagnostic criteria for an ADHD diagnosis.
Medication overview 256
Choosing stimulant versus non-stimulant medication 257
Choosing methylphenidate versus amphetamines in a stimulant nave patients 258
Changing stimulant medication 260
Managing side effects 260
Summary 264
Clinics care points 265
Disclosures 265
Primary Care Management of Autonomic Dysfunction
June Bryant
Autonomic dysfunction (AD) in the primary care setting can often be masked by other conditions or met with provider bias due to subjectivity of symptoms. Without specific diagnostic test markers, underdiagnosis or misdiagnosis is common in those conditions that fall under the umbrella of dysautonomia. This article gives a broad overview of the common types of AD presenting in the primary care setting, how advanced practice nurses should recognize, diagnose, and manage these types of AD, as well as when and what patients should be referred to a specialist.
Introduction 267
Pathophysiology 269
History 269
Assessment 271
Important elements of history taking 271
History of present illness 272
Past medical history 272
Trigger identification 272
Diagnosis 273
Valsalva maneuver 273
Tilt table testing 273
Orthostatic intolerance testing 274
Management 274
Nonpharmacological 274
Pharmacologic 277
Referral 279
Special population considerations 279
Long-COVID 279
Pediatrics 279
Summary 279
Clinics care points 280
Disclosure 280
When It Is Not Just Attention-Deficit Hyperactivity Disorder: Coexisting Depression and Anxiety in Pediatric Primary Care
Valerie C. Martinez
Attention-deficit hyperactivity disorder (ADHD) often exists along with other psychiatric disorders, such as depression and anxiety, but these conditions may be misdiagnosed or undertreated due to often overlapping symptomatology. Because of significant systemic and structural barriers to accessing specialized mental health care, pediatric primary care providers (PCPs) must possess a comprehensive understanding of ADHD and coexisting depression and/or anxiety to effectively diagnose and treat their patient’s symptoms. The purpose of this article is to review the prevalence of ADHD with coexisting depression and anxiety and outline assessment, diagnostic, and management considerations for PCPs when it is not just ADHD that requires clinical decision-making.
Introduction 283
Prevalence 284
Clinical practice guidelines 284
Assessment 285
History 285
Screening and diagnostic assessment tools 285
Physical examination 287
Diagnosis 288
Management 288
Psychoeducation 288
Nonpharmacologic treatment approaches 290
Pharmacologic treatment approaches 293
Suicide risk 294
Referral to mental health specialists 294
Follow-up monitoring 294
Implications for clinical practice 295
Summary 295
Clinics care points 295
Disclosure 296
