Advanced Practice Nursing Procedures

Advanced Practice Nursing Procedure Fitzgerald      Examination and Practice Preparation Winland-Brown & Dunphy Adult-Gerontology and Family Nurse         Review Questions and Strategies Goolsby Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses Kennedy-Malone Advanced Practice Nursing in the Care of Older Adults Perese Psychiatric Advanced Practice Nursing A Biopsychosocial Foundation for Practice McCaffrey & Youngkin NP Notes Nurse Practitioner’s Clinical Pocket Guide www.FAD BUY YOURS TODAY! 42 v Preface The new nurse practitioner and the practicing nurse practitioner in the ambulatory care setting must be prepared to perform an increasing array of skills competently to meet patient care needs. The inspiration for this book came when, on graduating from a nurse practitioner program, I found no procedural resources directed toward the needs of the nurse practitioner in ambulatory care. The need to perform many procedures—those not taught in my nurse practitioner program—was apparent. The physician I practiced with required a knowledge base in procedural skills greater than the one I possessed. Fortunately, this physician was willing to teach me the necessary procedures. This improved care to our patients and decreased the necessity to refer many patients for procedures easily performed in the ambulatory care (outpatient) setting. This text was developed to assist in the many demands on the newly graduated nurse practitioner and the nurse practitioner currently in practice. We believe the procedures outlined will improve the marketability of the nurse practitioner and serve as a good reference tool for family and/or adult nurse practitioners in an ambulatory care setting. Prerequisites for this book are basic anatomy and physiology, microbiology, pharmacology, principles of aseptic technique, and basic nursing skills. This book would be an appropriate text for incorporation of procedural techniques throughout a family or an adult nurse practitioner curriculum. It also would be appropriate for an elective on minor surgery and diagnostic procedures and interpretation. Another potential use for this book would be as part of the protocol/ guidelines in the nurse practitioner’s practice. Many procedures performed by primary care physicians are not currently appropriate for the nurse practitioner to perform. The procedures in this book were chosen based on a comprehensive study of types of procedures currently used in the nurse practitioner’s practice. Many of the procedures can be used in any ambulatory setting. Twenty-eight new procedures have been added to this edition: Suture selection, ulcer debridement, compartment syndrome and pressure testing, bladder catheterization, breast examination, administration of vaginal medications and condoms, Nexplanon insertion and removal, vaginal examination, fetal assessment, Leopold’s maneuver, fundal assessment, obstetric ultrasound, emergency delivery, teaching breast feeding, eye drop insertion, laryngoscopy, nasal lavage, cardiac stress testing, type of pacemakers, defibrillation, assessing for respiratory distress, pulmonary stress test, hemoccult, urea breath test, perianal skin tags and external hemorrhoidal skin tabs, pilonidal cyst, prostate massage, and rectal prolapsed reduction. Some of the procedures need specialized equipment, and some use equipment commonly found in any office. A few of the procedures—flexible chest tube insertion, circumcision, colposcopy, endometrial biopsy, IUD insertion and removal, lumbar puncture, occipital nerve block, paracentesis, sigmoidoscopy, and vi Preface thrombosed hemorrhoid removal—require additional training. They are included for reference only. Check with your State Board of Nursing if you are unsure whether or not a certain procedure may be performed by nurse practitioners in the state in which you practice. The major theme of this book is clinical application of knowledge and clinical skills. There are seven sections in the book. These sections are based on body systems for ease of classification. Each major section begins with diagnostic procedures the nurse practitioner performs with the basis for their interpretation. Next in each section, listed in alphabetical order, are procedures performed in an ambulatory care setting. Each procedure contains seven parts. First, an Overview is presented, outlining causes, incidence, and other specific information intrinsic to each procedure. The Health Promotion/Prevention section gives tips to the nurse practitioner to pass on to the client to help promote health or prevent the need for the procedure in the future. Options lists one to four methods of performing the procedure and gives a choice of how to perform the procedure. The Rationale section gives reasons to perform the procedure. Indications tell the nurse practitioner when the procedure should be performed, and Contraindications tells the nurse practitioner when not to perform the procedure. The Procedure section lists the necessary equipment and gives stepby-step instructions for performing each procedure listed under Options. Client Instructions assist the nurse practitioner with postprocedure instructions, listing what the client must and must not do to have an optimal recovery period. At the end of each is the Bibliography for further information gathering. We hope you will find this text to be a good learning tool and a great resource in your practice