Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing 1st Edition, (Ebook PDF)
Behavioral Health Services with High-Risk Infants and Families: Meeting the Needs of Patients, Families, and Providers in Fetal, Neonatal Intensive Care Unit, and Neonatal Follow-Up Settings Allison G. Dempsey
“We are not really in doubt about the more serious of our shared aims. We know what they are. We know they are difficult. And we know that we have not achieved them.”
—John Gardner, Excellence, p. 155, as quoted by Martha E. Rogers, Reveille in Nursing, p. 1
This book grew out of a commitment to primary-care practice and a love and valuing of nursing knowledge. Fifty years ago, in 1964, Martha E. Rogers, Chairperson of the Department of Nursing Education, New York University, came out with a small red and white volume, soft-covered and a total of 96 pages, titled Reveille in Nursing, published by F. A. Davis. It was a book, she was later to comment, “that scared the pants off a lot of people” (Martha E. Rogers, personal communication, June 22, 1988). F. A. Davis continues to stand on its commitment to nursing knowledge with its publication of this text. The abandonment of nursing knowledge in some primary-care nurse practitioner programs is not a trend that Martha would have favored. One can hear her saying, “Where’s the nursing in nurse practitioner primary-care practice? ‘Where’s the beef?’”
What we offer here is the “beef,” a text that builds on the Circle of Caring, a holistic, caring-based approach to primary-care practice, consistent with nursing’s historical base. Unit I contains five chapters that provide the theoretical base to a caring-based primary-care practice, which is operationalized in the remainder of the text. In this first unit, in Chapter 1, we provide a theoretical model of primary-care nursing, the Circle of Caring. The caring base of primary-care practice is presented by Drs. Boykin and Schoenhofer in Chapter 2, as a transformative model for our health-care system. A chapter on health promotion by Drs. Dorothy Dunn and Debera J. Thomas provides a base for primary-care practice that situates the patient and family in the context of the community in Chapter 3. Chapter 4, “The Art of Diagnosis and Treatment,” by Dr. Susan K. Chase, describes how primary-care practice in a Circle of Caring is actualized through decision making and management plans. “Evidence-Based Practice,” by Dr. Angela K. Golden, provides essential information for today’s care practice environment. It is essential that all clinicians be able to provide care with a good understanding of the standard of care and the ability to meet that standard in a meaningful way.
Unit II uses the traditional system-based approach to provide the essential information necessary to provide safe and effective primary care to patients. Each systembased chapter begins with “Common Complaints,” a symptom-based approach to phenomena that lays out the associated differential diagnoses of each symptombased complaint a patient may present with. Then each
chapter develops these various differentials under “Common Problems.” Each problem is defined and the associated epidemiology and causes are outlined, as well as the pathophysiological processes. Dr. Brian O. Porter again has provided a thoughtful and in-depth update on the pathophysiology of each disorder developed within the chapters, as well as a thorough review of diagnostic processes and management plans.
The subjective and objective manifestations of each problem are elaborated, as well as the associated diagnostic testing that might be used. A review of potential differential diagnoses is elaborated, as well as the underlying reasoning and critical thinking involved in the decision making used to reach a specific diagnosis, which then determines treatment. As consistent with our model, a holistic database is established, built on the patient’s voice and experience. Management strategies, including pharmacological and surgical therapy, when indicated, are outlined. Again, as consistent with our approach, complementary therapies and psychosocial interventions are elaborated providing a holistic plan of care. Follow-up and referral are included, along with long-term management strategies, and patient education—the important teaching/learning component of caring-based primary-care practice—is also included. Tables, figures, and recurring displays are provided in each chapter in Unit II. Displays include drug charts, therapeutic procedures that a clinician in primary care might be called on to perform, risk factors, screening guidelines, differential diagnosis flowcharts, treatment standards, and guidelines, as well as sidebars on focusing the history and advanced assessment techniques. Also, we provide highlights of complementary therapies and holistically-based advanced practice nursing interventions. Included are “Nursing Situations,” essentially case studies, along with abstracts of nursing-based research, and anecdotes from patients, called “The Patient’s Voice.” The provision of this variety of information will assist any primary-care provider, regardless of disciplinary background, in establishing and implementing a holistic, caring practice base. These features assist the student (or current practitioner) in linking ideas to practice and actualizing a Circle of Caring.
We gained some new and exciting contributors to Unit II, such as Dr. Susan Kelly-Weeder, PhD, FNP-BC, from Boston College, who assisted us in redrafting Chapter 8, “Eyes, Ears, Nose, and Throat Problems.” Building on the excellent work of Lori Martin-Plank, PhD, FNP-BC, GNP-BC, FAANP, we added Terry South, MSN, APRN, FNP-BC to Chapter 15, “Musculoskeletal Problems.” We are also pleased to have added scholar-clinician Michael Zychowicz, DNP, FNP-BC,
FAANP, FAAN, noted specialist in the area of musculoskeletal problems, to oversee and finalize this chapter. We have collaborated with another physician, Michael B. Keller, MD, MS, who added valuable contributions to several chapters, specifically the neurological and cardiac content, and will continue to add his clinical expertise in the future. Dr. Keller is the son of our faculty colleague, Dr. Kathryn B. Keller, who coauthored the cardiac chapter, her area of specialization.
Unit III begins with Chapter 20, “Palliative Care,” by Susan Derby, RN, MA, GNP-BC, ACHPN, and Mary Layman Goldstein, RN, MS, ANP-BC, ACHPN, of Memorial Sloan-Kettering Cancer Center in New York City, a chapter that includes comprehensive information on pain management. We are very pleased to provide our readers with an update of the popular chapter “The 15-Minute Hour: Practical Psychotherapy for Primary Care,” authored by a new contributor, Brandi Parker Cotton, MSN, Psychiatric NP and doctoral student, building on the prior work of Drs. Eliezer Schnall and Marian Stuart. New content includes motivational interviewing as well as current evidence to support practice in this area. These approaches, developed specifically for primary-care practice, will provide primary-care practitioners with additional therapeutic communication skills that will enable them to “hear” the patient’s true concerns, again supporting a holistic and caring practice model. “Ethical and Legal Issues of a Caring-Based Practice” is also an essential for practice, updated by leading nurse-ethicist Dr. Jill E. WinlandBrown. Chapter 22, “The Business of Advanced Practice,” has been completely redone to integrate the information and implications of the Affordable Care Act. The author of this chapter, Dr. Marcella M. Rutherford, has a PhD in nursing as well as an MBA and years of experience in medical practice administration from which to draw. We conclude with essential information in “Putting Caring Into Practice: Caring for Self.” This chapter has also been completely redone, with two new authors from the University of Rhode Island: Mary Lavin, DNP, APRN, FNP-BC, and Rebecca Carley, DNP, APRN, ANP-BC. They have used a different theoretical base from which to examine caring for self, as well as some important ideas for caring for one’s own health.
As long-time nurse practitioner faculty, we remain committed to providing an in-depth book with a comprehensive and holistic approach that can be used across
the curriculum (and in a variety of different curricula) and that includes participation by practitioners from other disciplines, such as medicine. Primary-care curriculum content exists in master’s-level and doctorate of nursing practice programs. While appropriate for either level, we, as authors, are attentive to shifting practice boundaries and feel that the articulation of a largely nursing base for primary care, rooted in caring and holistic approaches, is critical to disciplinary identity and growth. This text provides a high-level pathophysiological base, evidence-based diagnostic and management strategies, and a holistic plan of care that is consistent with this level of practice. The student is able to find a large amount of information in one text. Although we realize that graduate students will always need supplementary texts to provide the currency and depth of information that they require, we nonetheless believe that they (and their faculty!) will appreciate one large, complete text, complemented by an ever-expanding collection of ancillaries for faculty and student use.
What we also provide is the “beef”—the “beef” of caring-based, advanced practice nursing as actualized in the NP role, in the full flowering of all that primary-care practice could be. We are answering the call that Jean Watson sounded in her 1995 article, “Advanced Nursing Practice . . . and What Might Be”: Such a reform calls for nursing to shift its accountability and voice from the medical cure functional tasks and institutional demands and constraints toward making itself directly accountable to the public for its caring, healing, health knowledge, skills, and practices.
—Jean Watson (in Watson, J. “Advanced Nursing Practice ... and What Might Be” in Nursing & Health Care, Vol. 16, Number 2, p. 81)
It is the most exciting time for advanced practice nursing. Health-care reform is a reality. The demand for new service approaches in health care is high. The professional doctorate—the DNP—is providing primarycare practitioners of nursing with a well-grounded base of pathophysiology, diagnosis and management, and follow-up, situated in a nursing-based model. Consumers are informed and powerful. Now it is time for nurse practitioners to provide consumers with the “beef”—advanced nursing primary-care practice within a Circle of Caring.
There are numerous people to thank for helping this book become a reality:
Joanne P. DaCunha, our wonderful, PATIENT, always supportive, always optimistic publisher, whom we have come to know well, and who is, most of all, our friend.
Susan Rhyner, Senior Acquisitions Editor, who joins our team with a fresh eye, an innovative perspective, and infectious motivation.
Echo K. Gerhart, our new Content Project Manager, who has had to work very hard to keep us all in line!
Marcia Kelly, our Developmental Editor from afar, who was efficient, enthusiastic, and patient.
Kelly Boutross of Graphic World Inc., who worked tirelessly to “pull it all together” and maintained her composure at all times, even the most trying!
The entire F. A. Davis production team—all of whom were always patient, flexible, and terrific!
Dr. Marlaine Smith, Dean of the Christine E. Lynn College of Nursing, Professor, and caring scholar, who was quoted in this text far before she came to FAU—for her support for all our work.
Dr. Anne Boykin, Founding Dean of the Christine E. Lynn College of Nursing, who helped shape our vision for nursing and provides the glue that holds it together—caring.
Dr. Mary Sullivan, Interim Dean and Professor of the University of Rhode Island College of Nursing, for her support and encouragement during Dr. Dunphy's years at URI.
All of our students, past and present, who always continue to teach us as much, if not more, than we teach them!
We also acknowledge the following chapter authors of the third edition of this book, without which this new edition would not have been possible:
Sandra Allen, MSN, APRN, FNP-BC
Lisa J. Bedard, MSN, APRN, FNP-BC
Lauren Gallagher, MS, APRN, FNP-BC
Diane Gerzevitz, MSN, APRN, FNP-BC
Ruth McCaffrey, DNP, APRN, FNP, BC
Jacqueline Rhoads, PhD, RN, CCRN, ACNP-CS
Linda Hall Rothery, DNP, MSN, APRN, FNP-BC
Edwin W. Schaefer, ND, APRN, FNP-BC
Karilee Halo Shames, MSN, RN, HNC
Cathy M. St. Pierre, PhD, FNP, BC
And most of all, we acknowledge our patients, who taught us to “hear” their voices.
ABOUT THE AUTHORS
Lynne M. Dunphy, PhD, APRN, FNP-BC, FAAN Dr. Lynne Dunphy recently re-joined the faculty at the Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, in the role of Associate Dean for Practice and Community Engagement. In this role she is coordinating and directing the college’s nurse-managed practices. Dr. Dunphy spent the last eight years at the College of Nursing at the University of Rhode Island, serving as the inaugural Routhier Chair of Practice and Associate Dean for External Affairs. She has been a Robert Wood Johnson Executive Nurse Fellow and was the founding nursing lead of the Rhode Island Action Coalition, dedicated to the implementation of the Institute of Medicine’s recommendations for the Future of Nursing. Dr. Dunphy recently completed four years of service on the Board of the National Organization of Nurse Practitioner Faculties (NONPF).
Jill E. Winland-Brown, EdD, APRN, FNP-BC Dr. Winland-Brown was born in Boston, but raised in Pennsylvania. After high school, she went to Newport Hospital School of Nursing, Salve Regina College, Newport, Rhode Island, for her BSN, Boston College for her MS, and Florida Atlantic University for her EdD and post master’s FNP. Her first teaching position was at the University of Rhode Island, after which she moved to Florida. She teaches ethics in the undergraduate program and teaches in the graduate and FNP programs. Children include his, mine, and ours, although after 30 years, all five are ours. In whatever little free time is left, her loves are the beach and tennis. Dr. Winland-Brown is also on the ANA Center for Ethics and Human Rights Advisory Board.
Brian Oscar Porter, MD, PhD, MPH
Dr. Porter is a triple Board-certified and licensed Allergist and Immunologist, Internist, and Pediatrician. After completing both his MD and PhD in Immunology and Microbiology at the University of Miami School of Medicine (Miami, Florida), as well as his MPH at the Harvard School of Public Health (Boston, Massachusetts), Dr. Porter completed combined residency training in Internal Medicine and Pediatrics at the Virginia Commonwealth University Medical Center (Richmond, Virginia), followed by fellowship training in Allergy and Immunology at the National Institutes of Health (Bethesda, Maryland), where he also served as an Adjunct Intramural Investigator in the Laboratory of Immunoregulation and Principal Investigator on two NIH-based clinical and translational research protocols in primary and acquired immunodeficiency. Dr. Porter then joined the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research as a Primary Reviewer and Medical Officer, before transitioning into the private biopharmaceutical drug development industry as a clinical development physician focusing on biological immunotherapies and global product development strategy. Dr. Porter has held leadership roles in several companies, including Human Genome Sciences, GlaxoSmithKline, and most recently Novartis Pharmaceuticals, where he currently serves as an Associate Global Program Medical Director* (East Hanover, New Jersey). He also continues to work actively as a clinician in the Veterans Affairs New Jersey Health Care System as a Medical House Officer* (Lyons, New Jersey). Dr. Porter credits his multidisciplinary approach to human health largely to the influence and encouragement of his mother,
*The contents of this textbook and the independent contributions of Dr. Porter fall completely outside of his current employment and do not represent official views of Novartis Pharmaceuticals, the U.S. Department of Veterans Affairs, or any other U.S. federal government agency.
Dr. Luz Sobong Porter, a nurse clinician, educator, and researcher, who always involved him in her work and remains one of his primary collaborators to this day.
Debera J. Thomas, DNS, RN, FNP/ANP Dr. Thomas is Professor and Dean of Nursing at Northern Arizona University in Flagstaff, Arizona. Her teaching career began in 1978 at Augustana Hospital School of Nursing in Chicago, Illinois. She has held numerous faculty and administrative positions at institutions including Kent State University, Case Western Reserve University, Florida Atlantic University, University of Connecticut, and Northern Arizona University. In her free time, Debera is a potter. She prefers wheel throwing and functional ceramics and works in high fire clay. On most weekends, you can find her hiking the trails in Northern Arizona and the Grand Canyon.
CONTRIBUTORS
Anne Boykin, PhD, RN
Founding Dean and Professor Emeritus
Florida Atlantic University
Christine E. Lynn College of Nursing
Boca Raton, Florida
Chapter 2 Caring and the Advanced Practice Nurse
Rebecca Carley, MS, DNP, RNP
Assistant Clinical Professor
University of Rhode Island
Kingston, Rhode Island
Chapter 24 Putting Caring Into Practice: Caring for Self
Boston College William F. Connell School of Nursing
Newton, Massachusetts
Chapter 8 Eyes, Ears, Nose, and Throat Problems
Mary Lavin, MS, RNP
Associate Clinical Professor University of Rhode Island
Kingston, Rhode Island
Chapter 24 Putting Caring Into Practice: Caring for Self
Dianne M. Loomis, DNP, FNP-BC
Associate Clinical Professor
State University of New York (SUNY) at Buffalo School of Nursing
Buffalo, New York
Chapter 18 Psychosocial Problems
Lori Martin-Plank, PhD, FNP-BC, GNP-BC, PhD, FAANP
Clinical Assistant Professor, College of Nursing University of Arizona
Tucson, Arizona
Chapter 15 Musculoskeletal Problems
Debbie J. Nogueras, PhD, MSN, ANP/FNP-BC
Associate Professor
Northern Arizona University
Flagstaff, Arizona
Chapter 12 Renal Problems; Chapter 13 Men’s Health Problems
Patricia A. Pastore, MS, FNP-BC
Family Nurse Practitioner
Women’s Wellness Primary Care
Veterans Administration, Western New York Health Care System
Buffalo, New York
Chapter 18 Psychosocial Problems
Brian Oscar Porter, MD, PhD, MPH
Clinical Development Physician
Private Biopharmaceutical Industry and Medical House Officer
Veterans Affairs New Jersey Health Care System–Lyons Campus
Lyons, New Jersey
Chapter 1 Primary Care in the Twenty-First Century: A Circle of Caring; Chapter 7 Skin Problems; Chapter 8 Eyes, Ears, Nose, and Throat Problems; Chapter 9 Respiratory Problems; Chapter 10 Cardiovascular Problems; Chapter 12 Renal Problems; Chapter 13 Men’s Health Problems; Chapter 14 Women’s Health Problems; Chapter 16 Endocrine and Metabolic Problems; Chapter 17 Hematological and Immune Problems; Chapter 19 Emergency Problems
Marcella M. Rutherford, PhD, MBA, MSN
Dean, College of Nursing
Nova Southeastern, Ft. Lauderdale, Florida
Chapter 22 The Business of Advanced Practice
Denese Sabatino, MSN, APRN, NP-C, CCRN
Department of Critical Care Medicine
Cleveland Clinic, Ft. Lauderdale, Florida
Chapter 10 Cardiovascular Problems
Eliezer Schnall, PhD
Clinical Assistant Professor
Yeshiva University
New York, New York
Chapter 23 The 15-Minute Hour: Practical Psychotherapy for Primary Care
Savina O. Schoenhofer, PhD, RN
Professor
Alcorn State University
School of Nursing
Natchez, Mississippi
Chapter 2 Caring and the Advanced Practice Nurse
Terry South, MSN, APRN, NP-C
Spinal Pain Solutions
Harriman, Tennessee
Chapter 15 Musculoskeletal Problems
Marian R. Stuart, PhD
Clinical Professor
Department of Family Medicine
UMDNJ-Robert Wood Johnson Medical School
New Brunswick, New Jersey
Chapter 23 The 15-Minute Hour: Practical Psychotherapy for Primary Care
Debera J. Thomas, DNS, RN, FNP/ANP
Family and Adult Nurse Practitioner
Dean and Professor
School of Nursing
Northern Arizona University
Flagstaff, Arizona
Chapter 1 Primary Care in the Twenty-First Century: A Circle of Caring; Chapter 3 Health Promotion; Chapter 11 Abdominal Problems; Chapter 12 Renal Problems; Chapter 13 Men’s Health Problems; Chapter 14 Women’s Health Problems; Chapter 16 Endocrine and Metabolic Problems
Sharon Thrush, DNP, APRN, FNP-BC
Family Practice of Palm Beach
West Palm Beach, Florida and Adjunct Faculty
Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, Florida
Chapter 8 Eyes, Ears, Nose, and Throat Problems
Jill E. Winland-Brown, EdD, APRN, FNP-BC Professor and Family Nurse Practitioner
Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, Florida
Chapter 1 Primary Care in the Twenty-First Century: A Circle of Caring; Chapter 6 Neurological Problems; Chapter 7 Skin Problems; Chapter 9 Respiratory Problems; Chapter 10 Cardiovascular Problems; Chapter 17 Hematological and Immune Problems; Chapter 19 Emergency Problems; Chapter 21 Ethical and Legal Issues of a Caring-Based Practice
Michael Zycowicz, DNP, FNP-BC, FAANP, FAAN
Associate Professor and Director, Master of Science in Nursing Programs
Duke University School of Nursing
Duke University Health System
Durham, North Carolina
Chapter 15 Musculoskeletal Problems
REVIEWERS
Sallie Coke, PhD, APRN, CPNP, CFNP
Associate Professor
Georgia College and State University
Milledgeville, Georgia
Patricia Murray Given, PhD, RN, FNP, CCRN
Assistant Professor
The College of Staten Island – the City University of New York (CUNY)
Staten Island, New York
Sheila C. Grossman, PhD, APRN, FNP-BC, FAAN
Professor and Coordinator, Family Nurse Practitioner Track
Fairfield University
Fairfield, Connecticut
Joyce Hickey, PhDc, APRN, PMHCNS
Adjunct Faculty
College of Nursing
University of Rhode Island
Kingston, Rhode Island
Eileen McCann, DNP, BC-FNP
Assistant Professor and Program Director
Saint Xavier University Chicago, Illinois
Geri C. Reeves, PhD, APRN, FNP-BC Assistant Professor
Vanderbilt University School of Nursing Nashville, Tennessee
Luann Richardson, PhD, CRNP Assistant Professor, NP/DNP programs; Faculty Duquesne University McKees Rocks, Pennsylvania
Michelle Taylor Skipper, DNP, FNP-BC Director, AGNP and FNP Concentrations East Carolina University Greenville, North Carolina
Jennifer K. Sofie, DNP, FNP-C, ANP-BC Assistant Clinical Professor and DNP/FNP Clinical Coordinator
Montana State University Bozeman, Montana
Terri LaCoursiere Zucchero, PhD, RN, FNP-BC Clinical Assistant Professor Connell School of Nursing, Boston College Chestnut Hill, Massachusetts
I Caring-Based Nursing: The Art 1
Chapter 1 Primary Care in the Twenty-First Century: A Circle of Caring 3
Lynne M. Dunphy, PhD, APRN, FNP-BC, FAAN • Jill E. Winland-Brown, EdD, APRN, FNP-BC •
Brian Oscar Porter, MD, PhD, MPH • Debera J. Thomas, DNS, RN, FNP/ANP
Where We Have Been and Where We Are Going 3
Historical Perspectives on Advanced Practice Nursing 6
Advanced Practice Nursing: Models of Practice 7
Changing Models of Medical Practice 9
A Transformative Template: The Circle of Caring 12
Population-Based Approaches 13
Further Understanding the Circle of Caring 14
Chapter 2 Caring and the Advanced Practice Nurse 18
Anne Boykin, PhD, RN • Savina O. Schoenhofer, PhD, RN
Caring 18
Caring Processes 20
Chapter 3 Health Promotion 24
Dorothy J. Dunn, PhD, RNP, FNP-BC, AHN-BC • Debera J. Thomas, DNS, RN, FNP/ANP
Health 24
Health Promotion 25
Influences on Health Promotion 28
Practical Epidemiology 36
Conclusion 41
Chapter 4 The Art of Diagnosis and Treatment 42
Susan K. Chase, EdD, RN, FNP-BC
The Context of Clinical Judgment in Primary Care 42
The Clinical Process and Its Limitations 45
Diagnostic Process Overview 47
Focus on Elements of Clinical Judgment 49
Documentation 57
Reduction of Medical Error 59
Emerging Technologies 60
Ethics 60
Chapter 5 Evidence-Based Practice 62
Angela K. Golden, DNP, APRN, FNP-C, FAANP
Strategy for Point-of-Care Evidence-Based Practice 62
The Aims of Nursing Research for Clinical Application 62
Applying Research-Based Evidence to Clinical Practice 64
Examples from the Field: Studies of Implementing Practice Guidelines 68
Using a Framework to Evaluate Health Science Literature 70
Nursing Science: Building the Evidence for Practice 71
Clinical Decision Making and the Patient’s Health-Care Decisions 73
Caring-Based Nursing: The Science
Chapter 6 Neurological Problems 77
Jill E. Winland-Brown, EdD, APRN, FNP-BC • Michael B. Keller, MD, MS
Jill E. Winland-Brown, EdD, APRN, FNP-BC • Brian Oscar Porter, MD, PhD, MPH
COMMON COMPLAINTS 149
Alopecia 149
Pigmentation Changes 152
Pruritus 153
Rash 156
Urticaria 160
COMMON PROBLEMS 162
PARASITIC INFESTATIONS 162
Scabies 162
Pediculosis 165
FUNGAL INFECTIONS 169
Candidiasis 169
Dermatophytoses 173
Onychomycosis 181
BACTERIAL INFECTIONS 184
Impetigo 184
Folliculitis 187
Furuncles and Carbuncles 191
Cellulitis 194
VIRAL INFECTIONS 198
Warts 198
Herpes Simplex Infections 202
Acne Vulgaris 206
Rosacea 213
DERMATITIS 215
Atopic Dermatitis 215
Contact Dermatitis 221
Seborrheic Dermatitis 224
Psoriasis 226
SKIN LESIONS: BENIGN 235
Seborrheic Keratosis 235
SKIN LESIONS: PREMALIGNANT 239
Actinic Keratosis 239
SKIN LESIONS: MALIGNANT 241
Malignant Melanoma 241
Nonmelanoma Skin Cancers 246
Chapter 8 Eyes, Ears, Nose, and Throat Problems 252
Susan Kelly-Weeder, PhD, APRN, FNP-BC • Sharon Thrush, DNP, APRN, FNP-BC • Brian Oscar Porter, MD, PhD, MPH
COMMON COMPLAINTS 252
Dry Eye 252
Excessive Tearing (Epiphora) 252
Eye Pain 253
Red Eye 253
Visual Disturbances and Impaired Vision 253
Ear Pain (Otalgia) 254
Impaired Hearing 255
Tinnitus 256
Mouth Sores 256
Hoarseness 256
Sore Throat 256
COMMON PROBLEMS 257
LID PATHOLOGY 257
Blepharitis 257
Hordeolum/Chalazion 259
Dry Eye 260
Excessive Tearing (Epiphora) 263
Red Eye/Conjunctivitis 265
VISUAL DISTURBANCES AND IMPAIRED VISION 269
Refractive Errors 269
Cataracts 269
Glaucoma 274
Diabetic Retinopathy 278
Chapter 9
Macular Degeneration 280
EAR PROBLEMS 283
Hearing Loss 283
Tinnitus 285
Ménière’s Disease 287
Otitis Externa 290
Otitis Media 295
COMMON NOSE AND THROAT PROBLEMS 302
Epistaxis 302
Rhinitis 305
Sinusitis 313
Stomatitis and Glossitis 318
Pharyngitis and Tonsillitis 323
Hoarseness 329
Temporomandibular Joint Disease 331
Respiratory Problems 340
Jill E. Winland-Brown, EdD, APRN, FNP-BC • Brian Oscar Porter, MD, PhD, MPH
COMMON COMPLAINTS 340
Cough 340
Dyspnea 342
Hemoptysis 344
COMMON PROBLEMS 345
Upper Respiratory Infections 345
Asthma 348
Chronic Bronchitis and Emphysema (Chronic Obstructive Pulmonary Disease [COPD]) 358
Pneumonia 367
Nosocomial Pneumonia 377
Tuberculosis 378
Lung Cancer 390
Interstitial Lung Disease 402
Sleep Apnea 410
Smoking Addiction 417
Chapter 10
Cardiovascular Problems 430
Kathryn B. Keller, PhD, RN • Denese Sabatino, MSN, APRN, NP-C, CCRN • Jill E. Winland-Brown, EdD, APRN, FNP-BC • Brian Oscar Porter, MD, PhD, MPH • Michael B. Keller, MD, MS
