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No barrage from here, just support and praise. While teaching residents,
med students and NP students, I preach a common theme, especially with
urgent care visits.
Take a thorough history and let it guide your exam. Never, repeat never be
proud of the "big find" on a PE. The suprise finding on PE usually means
you missed a vital piece of the history.
Look at the patients before the diagnostics. Diagnostic testing should hone
not lead your diagnosis.
And last, I really do not care if the Sa02 is OK- if you have an exhausted
parent and tachycardic, tachynpneic child, you have a recipe for disaster.
Best case in point- 3 month old with bronchiolitis. SaO2 fine, kid
breathing very rapidly with good color and reasonable hydration. baby
hypervigilelant with easy startle. #3 of 3 kids with a very together
attentive mom who had been up three nights with the child. While I examined
the baby, mom fell asleep in the chair. After an arguement (one of the very
few I have with the great FPs I work with) with the attending FP, the child
was admitted...and crashed about 1 hour later. She did well in the long
run.
Margaret A. Fitzgerald, MS, RN, CS-FNP USPS Mailing Address:
Fitzgerald Health Education Associates | 11 Appletree Ln
| Andover, MA 01810-4101
Home of Nurse Practitioner | Voice Mail:978.470.3412
Certification Exam Review
Offered coast to coast in 1998
| FAX:978.470.2312
Join us for NP Pharmacology Update
Honolulu, HI, January 29- 30, 1998
| http://www.fhea.com