PNP Corner

CAR T-cell therapy offers pediatric patients hope, but also can bring numerous physical and emotional roller coaster experiences for the family.

A commitment all healthcare professionals must make to their individual professions, the interprofessional community and patients, and to themselves is to become life-long learners.

I recommend trying “Riddle me this! – as pediatric providers we tend to enjoy playing and many of us enjoy the challenges of active engagement in online learning that is also informative.

‘Quality diagnostic reasoning’ curbs medical diagnostic errors.

Mental health is a critical component of pediatric overall health. Early recognition of subtle signs and symptoms of mental health problems followed by immediate treatment is an equally critical element to ensure the establishment of normal mental health throughout development.

Drs. Bass and Valasek’s article in the August 2018 issue of Contemporary Pediatrics titled “Sports-related concussion: When it’s OK to return to play” provides a comprehensive review of sports-related concussions (SRC).

No one wants to make an error, let alone an error that is life threatening. How can individual or group providers create a culture of safety within their practices?

I recommend reviewing and strongly considering the implementation of the pilot project of Drs Dickson and Fontana including the six-step approach for oral health care in pediatric practices.

Jane Mendle, PhD’s research at Cornell University in Ithaca, New York, investigating the long-term psychological effects of early puberty has significant implications for our practices as pediatric nurse practitioners-and for all healthcare providers.

There are two articles in the March 2018 issue of Contemporary Pediatrics that merit your attention: Dr. Bass’ article on “Is it the flu?” and Ms. Zimlich’s article on “Major vaccines addressed in updated ACIP guidelines.”

Is the overwhelming problem of too many opioid and narcotic pain prescriptions related to the identification of ‘pain’ as the ‘fifth vital sign’?  Was the intention for the designation, the ‘fifth vital sign’, an expectation that individuals would be pain free during hospital stays, eg, after a surgical procedure, or after visiting ambulatory centers for an injury?

Pediatric providers need to help patients and their parents develop critical thinking about their personal healthcare and the long-term outcomes from their decisions.

Ms. Hester presents a heartwarming story describing the puppy brigade program’s design and its process for helping children to heal at Akron Children’s Hospital in Ohio while receiving both inpatient and outpatient care.

Dr. Bass’ recent article in Contemporary Pediatrics, “Personalized medicine, right drug, right patient, right time,” provides a miniature but profound view of what may be the future of pediatric healthcare: focusing on healthcare that is truly individualized through precision science in the areas of diagnosis and treatment, rather than generalized, population-based treatment guidelines.

I highly recommend reading his article, and then reflecting on your current office- and hospital-based practices surrounding prescribing medications for children to determine areas to apply these best practice initiatives in your personal work settings.

Opioids have impacted every population served by all healthcare providers in the United States and by now every nurse practitioner (NP) has been exposed to the opioid scourge. Perhaps it’s time to reassess the role for NPs in caring for their individual populations confronting an opioid crisis.

Every nurse practitioner should review the AAP guidelines and include an action plan in each of their practice settings. All providers should communicate information to all school, camp, and field nurses who are often the first to assess a child presenting with symptoms of anaphylaxis outside a medical facility.

Goals for NPs caring for children and adolescents with weight problems are early identification and referral to treatment in order to prevent the well-known adverse effects the diagnosis of eating disorders places on the child, adolescent, and family members-and, in time, the overall health of the adult population.

Traditionally, first positions for graduating registered nurses (RNs) are hospital based, where many have expertise and experience in emergency management. However, when RNs attend graduate school to become primary care nurse practitioners, planning for managing emergencies in an outpatient medical office may or may not have been a part of graduate education.

Children in the foster care system are exposed early in life to adverse experiences by living within dysfunctional families and specific facts have not changed. What has changed is the recognition of the need for the healthcare system to change its care for these vulnerable children to prevent the adverse effects that traumatic stress imposes on their physical and emotional development and well-being.

Dr Bass’s article on “Factoring the Metabolic X Syndrome” in the latest issue of Contemporary Pediatrics provides us with information on the emergence of Metabolic X syndrome in the pediatric/adolescent populations, previously a syndrome seen only in adults. How can we, as nurse practitioners (NPs) prevent children from developing the symptoms for a diagnosis of Metabolic X Syndrome?

In their article, “Kid care on the slopes,” in the latest Contemporary Pediatrics, Drs. Brown and Fishman draw on their many years of caring for kids in Colorado ski country to provide this special primer on managing pediatric injuries sustained while skiing and snowboarding.

The article “National hospital initiative targets preventable injuries,” in the most recent issue of Contemporary Pediatrics, describes 35 years of impressive work by a nationwide coalition of concerned pediatricians and pediatric trauma surgeons who have championed hospital, school-based, and community-wide initiatives to reduce the prevalence and incidence of unintentional injuries in children.

I truly fear a day when parents are asked to consent to every routine newborn screening. The outcomes for newborns whose parents refuse newborn screening would be disastrous.

Opioids are known for their powerful pharmacokinetics for pain relief, but are now well recognized for their overuse and abuse through prescriptions provided by healthcare providers. This has created a medical oxymoron: well-meaning pain management as a valued, caring practice for successful recovery from both medical problems and surgical procedures, juxtaposed by the alarming growth of opioids' prescriptive footprint.

Many of today’s practicing PNPs grew up during the “difficult and rebellious” adolescent years when teenagers were trying alcohol, marijuana, drag racing, and attempting to access birth control. In retrospect, that adolescent lifestyle was simplistic in comparison to the complex, tumultuous adolescent life of today.

Significant gaps in the knowledge of EBP are evident as new diagnostic criteria are recognized and evolve in clinical practice. An example of this EBP knowledge gap is the diagnosis of nonsuicidal self-injury (NSSI) that was identified in 2013 as a separate diagnosis in Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Over the past several months, we have received information from news reports, local and state departments of health, and from the Centers for Disease Control and Prevention (CDC) about the Zika virus, a mosquito-transmitted disease, and the devastating outcomes experienced by some pregnant women who contracted the Zika virus during pregnancy.