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Otitis Externa Hints

Otitis externa is a common occurrence during the summer due to swimming and increased sweating with the heat. It is an inflammation of the auricle, auditory canal and outer surface of the tympanic membrane. It is intensely painful and often resistant to treatment. The majority of cases are unilateral with itching and pain being the predominant symptoms. Sometimes the swelling can be so severe that one must place a wick so that the medication can actually reach the inner canal.

Medications used to treat the condition include the following:

Ofloxacin otic- 10 drops to affected ear BID x 7 days for adults. (5 drops bid for peds)
Cipro Otic - 3 drops to affected ear BID x 7 days (age older than one year)
Cortisporin Otic- 4 drops to affected ear tid/qid x 10 days. (Pedi Otic 3 drops tid/qid)
Auralgan- 2-4 drops tid/qid prn for pain.

Oral meds may need to be used in diabetic patients who are resistant due to increased glucose levels.

Red Bull gives you wings - and heart trouble?

Red Bull may claim to “give you wings” but drinking too much of the popular energy drink may also lead to heart damage, a study suggests. A study of 30 university students aged between 20 and 24 years old found that drinking just one 250ml sugar-free can of the caffeinated energy drink increased the “stickiness” of the blood and raised the risk...

read more | digg story

Change of Shift is Up!

Check out the latest Change of Shift!

Controlled Substance List from The DEA

Ever wondered what is on a controlled substance list? It's especially hard when you are a new NP and don't normally write for these and patients ask for different meds.
Here's the link!

Sample ARNP Protocol

myflorida - Nursing - ARNP Protocol - Sample Format

ARNP Protocol - (format example)

(Should be no more than 2 to 5 pages)

1. Requiring Authority:

1. Nurse Practice Act, Florida Statutes, Chapter 464
2. Florida Administrative Code, Rules Chapter 64B9-4 Administrative Policies Pertaining to Advanced Registered Nurse Practitioners

II. Parties to Protocol:

(Should only list one ARNP & one Doctor here)

1.

Nancy R. Nurse, ARNP, RN 9999999

123 Main Street

Somewhere, FL 99999
2.

Ian M. Doctor, MD, MX 999999, DEA 999999

Practice Name

456 Center Street

Somewhere, FL 99999

III. Nature of Practice:

This collaborative agreement is to establish and maintain a practice model in which the nurse practitioner will provide health care services under the general supervision of Dr. Ian M. Doctor. This practice shall encompass family practice and shall focus on health screening and supervision, wellness and health education and counseling, and the treatment of common health problems. (Use appropriate description for your specialty and activities) Practice Location(s):

IV. Description of the duties and management areas for which the ARNP is responsible:

A. Duties of the ARNP:

The ARNP may interview clients, obtain and record health histories, perform physical and development assessments, order appropriate diagnostic tests, diagnose health problems, manage the health care of those clients for which she has been educated, provide health teaching and counseling, initiate referrals, and maintain health records. (Specific guidelines for patient care decision making may be referenced here. I.e., ARNP developed practice guidelines, professionally developed guidelines, text books, etc. Do not send these references to the Board of Nursing with protocol agreement.)



B. The conditions for which the ARNP may initiate treatment include, but are not limited to:



Otitis media and externa

Conjunctivitis

Upper respiratory tract infections

Sinusitis

C. Treatments that may be initiated by the ARNP, depending on the patient condition and judgment of the ARNP:

1. Suture of simple and complex lacerations not requiring ligament or tendon repair.
2. Incision and drainage of abscesses.
3. Removal of ingrown toenail.

D. Drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order:

(ARNPs CANNOT PRESCRIBE CONTROLLED SUBSTANCES)

Any prescription medication which is not listed as a controlled substance and which is within the scope of training and knowledge base of the nurse practitioner.

-or –

Antibiotics

Antihypertensives

Etc.

V. Duties of the Physician:

The physician shall provide general supervision for routine health care and management of common health problems, and provide consultation and/or accept referrals for complex health problems. The physician shall be available by telephone or by other communication device when not physically available on the premises. If the physician is not available, his associate, John R. Doctor, MD, MX 999999 (or other description of designated doctor(s) or groups), will serve as backup for consultation, collaboration and/or referral purposes.

VI. Specific Conditions and Requirements for Direct Evaluation

With respect to specific conditions and procedures that require direct evaluation, collaboration, and/or consultation by the physician, the following will serve as a reference guide:

Clinical Guidelines in Family Practice, X Edition, by Constance R. Uphold, ARNP, PhD, and Mary Virginia Graham, ARNP, PhD (or other reference text or practitioner created reference guide)

OR

The physician will be consulted for the following conditions:

3rd degree lacerations

Severe hypertension determined by ____

Etc. (list appropriate conditions)



VII. All parties to this agreement share equally in the responsibility for reviewing treatment protocols as needed and no less than annually.

____________________________/ _______ License # RN9999999

Nancy R. Nurse, ARNP Date



____________________________/ ________ License #ME 999999

Ian M. Doctor, MD Date DEA # 999999



PLEASE NOTE:

Practicing ARNPs must file a protocol at the time of renewal or when there are changes with the Board of Nursing. Alterations or amendments should be signed by all parties and filed with the Board within 30 days.

The protocol and any amendments or changes are to mailed to the ARNP Department, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, FL 32399-3252. If there are no changes to the protocol, only a dated signature page is needed with a statement that there have been no amendments or changes since the last submission. A copy for each review period should be kept by each party for a period of four years. The supervising physician is responsible for submitting a notice to the Board of Medicine that they have entered into a supervisory relationship with an ARNP.

Mystery Health Care Shoppers, What???

Here is a huge waste of medical resource money. The article discusses the use of "fake patients" to assess medical providers.
It boggles my mind that 35,000-60,000 is used to have these so called patients go into a practice and pretend to have symptoms in order to evaluate it. It's some kind of mystery medical shopping. I have patients who can't afford health insurance or the medications that they need and they are throwing money away like this! Send me the check instead and let me use it for my patients who really need the help and are REAL patients. ARGH!!