Continuing Education

A broader look at insulin

Approximately 34 million people in the United States have diabetes; 90% to 95% of them have type 2 diabetes. Insulin saves lives and helps people with both type…

A warming planet and human health

Although most Americans voice concern about climate change (climate breakdown), many remain unaware that they’re experiencing its effects today. In fact, those born in the 1980s or later…

Acute kidney injury: A nursing challenge

The renal system comprises the kidneys, ureters, and urethra, which maintain homeostasis via filtration and excretion of waste products, participate in acidbase balance, produce renin for maintaining hemodynamics,…

Addressing patient and caregiver suffering

Suffering—it’s a powerful word that evokes a visceral response. Actually, patient means “one who suffers” in Latin. To reduce patient suffering, we need to consider the experience of nurses and other caregivers, because patient…
arrhythmogenic-cardiomyopathy

An overview of arrhythmogenic cardiomyopathy

Arrhythmogenic cardiomyopathy (ACM) is a description given to various rare conditions that can lead to life-threatening arrhythmias in the absence of ischemic, hypertensive, or valvular heart disease.
anesthesia

An overview of neuraxial anesthesia

Understand the basics so you can effectively manage your patients. Takeaways: Neuraxial anesthesia is the administration of medication into the subarachnoid or epidural space to produce anesthesia and…
anxiety in primary care

Anxiety in primary care: A primer for APRNs

Anxiety disorders commonly present in primary care settings, and advanced practice RNs (APRNs) will benefit from understanding treatment options that promote positive outcomes. Several effective nonpharmacologic options exist…

Breast cancer care gets personal

Learning objectives 1. State how breast cancer is diagnosed and evaluated. 2. Identify the implications of genetics for patients with breast cancer. 3. Discuss targeted therapy for breast…

Cancer immunotherapy update

Review of immune checkpoint inhibitor and CAR T-cell therapy adverse effects and treatments. Takeaways: The U.S. Food and Drug Administration has approved several immunotherapy agents to treat cancer,…
Caring for diverse patient populations in their homes

Caring for diverse patient populations in their homes

CS/PC strategies enhance the three essential skills of home health nursing: building a caring-trusting relationship with the patient, holistic and advanced assessment and care planning skills, and effective…

Caring for individuals with sickle cell disease

Nurses play a pivotal role in ensuring optimal care.  Takeaways: Sickle cell disease is an inherited chronic condition that affects nearly every system in the body. Early recognition…

Caring for patients in respiratory failure

Respiratory failure is one of the most common reasons for admission to the intensive care unit (ICU) and a common comorbidity in patients admitted for acute care. What’s…
Caring for patients with spinal cord injuries

Caring for patients with spinal cord injuries

Spinal Cord Injuries (SCIs) are a significant cause of disability, with profound—and in many cases devastating— consequences. According to recent data, about 12,000 SCIs occur annually in the United States, and up to 250,000 Americans are living…

Central vascular access device complications:

APPROXIMATELY 5 million central vascular access devices (CVADs) are inserted into U.S. patients every year, and at least 85% of hospitalized patients receive some form of I.V. therapy.…

Climate change interventions

Addressing climate change through corporate social responsibility is urgent and timely in the COVID-19 disaster recovery period for the nursing profession.

Coaching and evaluating new graduate nurses

Ongoing research shows a decline in new graduate nurses’ clinical judgment. Effective mentorship plays a crucial role in ensuring patient safety while new nurses develop clinical judgment skills.…

Community-acquired pneumonia

Community-acquired Pneumonia (CAP) is exactly what it sounds like—a lung infection acquired while out and about in the world. The cause may be a virus, bacteria, or fungus.…
Concussion: Prevention, assessment, and management

Concussion: Prevention, assessment, and management

Concussion, a subset of mild traumatic brain injury, can lead to long-term effects, including chronic traumatic encephalopathy. (See Con­cussion’s impact.) The Centers for Disease Control and Prevention (CDC)…
Continuous glucose monitoring: the basics

Continuous glucose monitoring: THE BASICS

Blood glucose self-monitoring helps patients with diabetes understand the interrelationships among food, activity, and medication to achieve their glycemic targets. It also aids treatment effectiveness assessment. Patients continue…

Decoding the oxyhemoglobin dissociation curve

Mrs. Glenn, a 72-year-old female on a medical-surgical floor, was hospitalized 3 days ago for pneumonia. Since her admission, she has been on continuous pulse oximetry and is…
diabetes ribbon cardiovascular disease deadly duo

Diabetes and cardiovascular disease: A deadly duo

Eugene Jones, age 66, has a 10-year history of type 2 diabetes mellitus; 1 year ago, he suffered a myocardial infarction (MI). During today’s routine clinic appointment, his…
diabetes pharmacologic management update ant

Diabetes— Pharmacologic management update

When large volumes of insulin are injected subcutaneously, inadequate absorption, poor adherence, insulin leaking at the site of injection, and increased drug and supply costs can occur. Concentrated…
DKA

Diabetic ketoacidosis and hyperglycemic hyperosmolar state

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are endocrine emergencies. Hospitalizations for diabetes and DKA are rising, possibly because of increased diabetes prevalence and higher insulin costs.
AML

Differentiation syndrome: An emerging oncologic complication

Nurses are critical to recognizing and managing this life-threatening condition.  Learning Objectives  Identify the pathophysiology of differentiation syndrome (DS). Compare DS with tumor lysis syndrome. Discuss DS management.…

ECMO and nurse-led mobilization

Early mobilization involves the early application and intensification of physical therapy within the first 2 to 5 days of a critical illness.

End-tidal CO2 monitoring

ETCO2 monitoring, a tool once used almost exclusively in patients receiving anesthesia, has proven useful in various settings, including the emergency department, medical–surgical units, critical care, ambulatory care,…

Evidence-based epilepsy care

EPILEPSY is one of the most common disorders of the central nervous system, affecting 65 million people worldwide—3.4 million in the United States. It can occur with or…

Evidence-based practices for osteoarthritis management

Osteoarthritis is a chronic disorder of the joints that is painful, prevalent, costly, and a leading cause of disability.· Management of osteoarthritis is multifaceted and includes nonpharmacologic, pharmacologic,…

Evidence-based update on chest tube management

CHEST thoracotomy tubes (CTTs) have been around for centuries, but not until the late 1950s did they become standard of care for treating empyema, pneumothorax, hemothorax, hemopneumothorax, and…

Families and post-intensive care syndrome

Post-intensive care syndrome (PICS) is defined as new or increased physical, cognitive, or mental health impairment in a patient after hospitalization in a critical care unit. Similarly, post-intensive…

Frequently asked questions about palliative care

Nurses can serve as leaders as they help patients and families through a difficult time. Takeaways: All nurses must be competent in providing palliative and end-of-life care. Nursing…

From surge plans to a culture of readiness

The more resource options available for day-to-day surge events, the more effectively hospital operations can withstand imbalances in supply and demand. Proactively addressing the financial impact of surge…
genetics clinical setting ant

Genetics in the clinical setting

This article explains basic genetic terminology and processes and describes assessment steps to help clinical nurses care for and manage patients at risk for inherited adult-onset diseases.
Gestational diabetes

Gestational diabetes

Gestational diabetes mellitus (GDM) re­fers to any degree of glucose intolerance that starts or is first recognized during pregnancy. Frequently, GDM represents pre-existing hyperglycemia and indicates underlying β-cell…

Gut microbiome and health

Some researchers describe the bacteria, fungi, protozoa, and other microbes in our digestive system (the gut microbiome) as the newest discovered body organ. Each person’s balance and mix…
heart

Heart failure management: Updated guidelines

Heart failure (HF), a clinical syndrome that results from changes in the cardiac structure, leads to impaired ventricular filling or reduced blood ejected with each heartbeat. Primary prevention…

Home care safety

Home care is unique, placing nurses and other healthcare professionals in patients’ homes and personal space, and doesn’t include typical healthcare organization requirements.

Knee Osteoarthritis: Assessment and management

CNE: 1.5 contact Hours Learning Objectives: Describe causes and risk factors of knee osteoarthritis (KOA), related health assessments, diagnostic tests that may be recommended by providers, and patient education…

Known fallers

Patients who arrive in the emergency department (ED) because of a fall or with a medical condition or after an accident that resulted in a fall, require prevention…

Living donor liver transplant coordinator

Living donor liver transplant has helped overcome the global shortage of donor organs. Live liver donors who electively undergo major abdominal surgery require specific care and expertise to…

Living with atopic dermatitis

A healthy 4-month-old baby boy of Eurasian descent is exclusively breastfed. This morning, his mother changes him and finds crusty, red oozing blisters covering his back. She calls…

Lung cancer: Not just a smoker’s disease

Jill Smith, a 58-year-old waitress in a local bar, comes to the clinic complaining of shortness of breath and a persistent cough for the last month. She reports…

Managing chronic pain in cancer survivors

Key takeways Patients may experience cancer pain even after their cancer has been adequately treated and is in remission or cured. Proper assessment is key to pain management…

Managing pain in frail elders

Managing pain in any older adult poses unique challenges. But older adults who are frail are more likely to experience chronic pain, acute pain, or both. What’s more, they stand a greater chance that…

Medical Cannabis: What Nurses Need to Know

Nurses frequently care for patients who use or are considering using medical cannabis. In 2018, the National Council of State Boards of Nursing (NCSBN) released guidelines for nurses…

Medication adherence in underserved populations

Bridging the gap requires nurse intervention. Individuals within underserved populations face many hurdles to healthcare. They lack access, experience disparities in health literacy, and must consider how they…

Medication safety

In 2023, the CDC reported that the most common types of adverse drug events are associated with allergic reactions, side effects, over-medication, medication errors, and drug–drug interactions. Healthcare…

Mentorship: A strategy for nursing retention

The limited pool of qualified nursing staff readily available to provide safe, quality care taxes the human capital management of healthcare organizations worldwide. To maintain an adequate workforce…

Mitigating melanoma

Mela­noma, which was once thought to be uncommon, is the most serious type of skin cancer. It accounts for 75% of deaths associated with cutaneous cancers.

Moisture-associated skin damage: The basics

Moisture-associated skin damage (MASD), inflammation and erosion of the skin, results from prolonged exposure to different sources of moisture such as feces or urine, sweat, saliva, wound exudate,…

Mpox: Be prepared for the next outbreak

Knowledge can help reduce stigmatization and improve access to care. Takeaways: Cases of human Mpox had been considered rare, but current data show rapid spread from human-to-human transmission.…

My patient is a victim of human trafficking

The growth of human trafficking increases the odds that you’ll encounter a patient who’s a victim. We can’t afford to miss any opportunity to provide aid to this…

Navigating Long COVID

Long COVID, a stigmatized and somewhat controversial condition, has begun to gain the public’s attention as some who previously had acute COVID-19 began reporting a unique constellation of…
np medication treatment opioid disorder

NP role in medication-assisted treatment for opioid use disorder

Combine medication and counseling with shared decision-making to treat addiction. Takeaways: Medication-assisted treatment (MAT), an evidence-based intervention for opioid use disorder and withdrawal symptom management, combines medication with counseling…

Nurses can help improve outcomes in severe sepsis

The body’s systemic response to an infection, sepsis can progress to severe sepsis and, in some cases, to septic shock. More than 1 million Americans suffer from severe sepsis annually. This number may grow in the…

Nursing ethics and shared governance model

Through shared governance, nurses are encouraged to participate in organizational decision-making to satisfy professional obligations. Incorporating ethical competence and professional development into everyday nursing practice is imperative to…
opioid non-opioid analgesia surgery ant

Opioid and non-opioid analgesia during surgery

Understanding how and why anesthesia providers select analgesic agents. Takeaways: Many options exist for managing intraoperative and postoperative surgical pain. Medications used for pain management can be broken…

Oral anticoagulants: Pharmacologic management update

Stay-up-to-date to avoid complications and achieve the best treatment for patients. Takeaways:  This article discusses the use of oral anticoagulants.  Indications, side effects and dosing of oral anticoagulants. …

Oral Chemotherapy: Not just an ordinary pill

Fran, a triage nurse in a busy primary care office, receives a call from Marla Rodriguez, whose mother is a long-time patient. Marla says her mother has an intense red rash over most of her…

Outpatient care of patients with COPD

Controlling symptoms and preventing exacerbations are the key to patient quality of life. Takeaways: Nurses must be able to identify patients with chronic obstructive pulmonary disease (COPD) early…

Patient care in the dawn of the genomic age

Application of genetics and genomic science to health care is emerging in full force and having a powerful effect on nursing practice. Genomic medicine—using an individual’s genomic information to…
Pediatric pain management

Pediatric pain management

An individualized, multimodal, and interprofessional approach is key for success. Takeaways: Many pediatric patients experience unnecessary pain because of undertreatment and inadequate pain management after surgery. Barriers to…
postmenopausal women urinary incontinence ant

Postmenopausal women and urinary incontinence

According to the American Congress of Obstetricians and Gynecologists, about 6,000 women in the United States enter menopause every day. During menopause (which is defined as the cessation…
Nurse,With,Patient.,Routine,Health,Check,And,Putting,Elderly,Patient

Pressure injury prevention in long-term care

The Centers for Medicare and Medicaid Services report that pressure injuries (PIs) affect millions of patients each year, with incidence rates ranging from 2.2% to 23.9% in long-term…
preventing falls hospitalized patients

Preventing falls in hospitalized patients

Fall prevention “bundles” applied to all patients are ineffective; fall prevention interventions must be tailored to each individual patient’s fall risk factors.

Preventing hospital-acquired pneumonia

Hospital-acquired pneumonia (HAP) is a serious complication of an acute care admission, particularly for patients noted to be at risk. HAP can be reduced when infection prevention measures…
medication errors

Preventing medication errors by empowering patients

Preventable medication errors cost the U.S. healthcare system more than $21 billion annually, according to the National Priorities Partnership and National Quality Forum. This number has risen significantly…
pulmonary embolism

Pulmonary embolism: Surveillance is key

Pulmonary embolism (PE) occurs when a clot (thrombus) that formed somewhere in the body dislodges, travels through the right side of the heart to the lungs and blocks…

Recognizing oncologic emergencies

The American Cancer Society estimates that in 2023 over 1.9 million individuals will receive a diagnosis of some form of cancer. Many will seek care for oncologic emergencies…

Reducing intracranial pressure in patients with traumatic brain injury

Traumatic brain injury (TBI) refers to blunt or penetrating head injury that disrupts normal brain functioning, causing impaired thinking and memory, personality changes, and possible sensory and motor changes. Some people recover completely with no cognitive deficits;…

Reducing readmissions in in COPD patients

A preventable and treatable lung disorder of adults, chronic obstructive pulmonary disease (COPD) is one of the most common causes of hospitalizations and readmissions. It affects 15 million Americans; nearly one in five hospital patients older than age…
reducing readmissions in stroke patients

Reducing readmissions in stroke patients

Stroke readmissions are multifaceted and complex. In addition to recognizing risk factors for recurrent stroke, nurses should focus on impacting potentially preventable readmission complications such as medication adherence…

Right-sided heart failure

Right-sided heart failure (HF) doesn’t get the attention that left-sided HF receives, but it’s an important factor in HF symptom severity and mortality. Right-sided HF, which can cause…
Secondary stroke

Secondary prevention of stroke

Every 40 seconds, a stroke occurs in the United States. This translates to approximately 795,000 strokes annually; of these, about 25% are recurrent strokes. Although stroke has declined…

Short peripheral and midline catheter complications

The nurse’s role at point of care Takeaways:  Short peripheral and midline catheters can be essential to accomplishing patient therapeutic regimens.   Nurses must be competent to recognize signs…

Skin failure: A historical perspective

Kennedy terminal ulcer. Kennedy lesion. Skin failure. Skin changes at life’s end. Terminal ulcers. Trombley-Brennan terminal tissue injury. End-stage skin. Skin changes associated with dying. Decubitus ominosus. Unavoidable…

Sleep and the glymphatic system

Dr. Rafael Pelayo, a sleep physician from Stanford University, shared this insight into how he explains the sleeping brain: “My mother worked in a factory sewing clothes and…

Time is brain

According to the American Heart Association (AHA), more than 795,000 Americans experience a stroke each year, and first-time strokes account for over three-quarters of them. An acute stroke,…

Transitional care can reduce hospital readmissions

Avoidable hospital admissions are a key patient safety and quality concern. A significant cause of preventable readmissions is poor communication and coordination of care during transitions. Transitions between…

Treating pain while mindful of opioid risks

Nurses can help avoid negative effects of opioids while ensuring patient pain is managed. Takeaways: Pain management can be complicated by individual patients’ previous pain experiences, genetics, ability…

Urgent care for stroke patients: Timing is everything

  While relaxing at home at about 4 PM, Alan Sarangelo, a retired 62-year-old respiratory therapist, feels the left side of his face growing numb. His wife, a nurse, suspects he may be having…

UTI revisited: Optimizing best practices

Urinary tract infection (UTI) continues to attract clinical attention as one of the world’s most prevalent infections. UTI broadly describes several clinical conditions, including cystitis, pyelonephritis, and renal…
venous thromboembolism troubling events

Venous thromboembolism: Very troubling events

Venous Thromboembolism (VTE) is the number-one cause of preventable death in hospitalized patients. (See VTE facts.) A thrombus is a clot that forms in a blood vessel, most…
Venous Ulcer Care

Venous ulcer care

Prompt, proper care will help reduce complications and improve quality of life.  Venous ulcers are the most common lower extremity wounds in the United States. Patients experience poor…

Ventilator-associated events: A new outcome measure

Learning objectives 1. Differentiate the three tiers used to identify ventilator-associated events (VAEs). 2. Identify key elements of VAE surveillance. 3. Discuss the practice implications of VAEs. Purpose/goal:…
Elderly Senior In a Hospital Bed

When up is down: Delirium superimposed on dementia

How do we differentiate delirium and dementia and assess for DSD and prevent DSD and manage individuals with the condition? Distinguishing between the two conditions can help ensure…
women cardiovascular disease ant

Women and cardiovascular disease

Understand women’s unique risks and symptoms to ensure early identification and treatment of CVD. Takeaways: Cardiovascular disease (CVD) remains the leading cause of mortality in women; women of…

Women and HIV pre-exposure prophylaxis

Why are new HIV cases still occurring when we have preventive treatment? One reason could be a lack of knowledge and experience among healthcare professionals to discuss, prescribe,…

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