It's Not a Spider Bite-It's MRSA!

Although there is an increased awareness of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), there remains a bias of the public and health-care workers to blame spiders as a cause of skin and soft tissue infection when there is no valid incriminated evidence for this assumption. MRSA is a formidable infection and remains a threat to human health. Recognition and proper treatment by practitioners remain of utmost importance to improve patient outcomes.

Post-COVID-19 Syndrome: Theoretical Basis, Identification, and Management.

As COVID-19 continues to spread, with the United States surpassing 29 million cases, health care workers are beginning to see patients who have been infected with SARS-CoV-2 return seeking treatment for its longer-term physical and mental effects. The term long-haulers is used to identify patients who have not fully recovered from the illness after weeks or months. Although the acute symptoms of COVID-19 have been widely described, the longer-term effects are less well known because of the relatively short history of the pandemic. Symptoms may be due to persistent chronic inflammation (eg, fatigue), sequelae of organ damage (eg, pulmonary fibrosis, chronic kidney disease), and hospitalization and social isolation (eg, muscle wasting, malnutrition). Health care providers are instrumental in developing a comprehensive plan for identifying and managing post-COVID-19 complications. This article addresses the possible etiology of postviral syndromes and describes reported symptoms and suggested management of post-COVID syndrome.

COVID-19: An Immunopathologic Assault.

When caring for patients with coronavirus disease 2019 (COVID-19), clinicians have noticed some unusual clinical presentations not observed before, such as profound hypoxia and severe hypotension. Scientists are probing the evidence to explain these issues and many other unanswered questions. Severe acute respiratory syndrome associated with coronavirus 2 presents an unchartered acute and critical care dilemma. Some of the theories and proposed interventions that will improve outcomes for these critically ill patients are explored in this article. Various testing procedures for COVID-19 are described so valid results can be obtained. Clinical presentations are discussed but continue to evolve as the pandemic ravages our society. The psychological impact of this devastation is also addressed from multiple perspectives. The health care provider is faced with an unprecedented, harrowing situation that has become an internal war that also must be confronted. Professional dedication has provided a formidable response to this destructive virus.

Hypertension management options: 2017 guideline.

The new hypertension guideline lowers the definition of high BP to 130/80 mm Hg. This means that millions of adults will now be diagnosed with hypertension and that many of those taking antihypertensive drugs are not at goal. The challenge is to communicate the change, the strength of evidence behind the change, and the options available to patients. Healthcare providers must be knowledgeable of the new guideline and must be ready to meet this challenge.

CE: Triglycerides: Do They Matter?

: Since the introduction of HMG-CoA reductase inhibitors, also known as statins, as an adjunct to diet in the treatment of hyperlipidemia and the greater emphasis placed on reducing low-density lipoprotein (LDL) cholesterol levels in the prevention of atherosclerosis and cardiovascular disease (CVD), there has been less focus on the value of lowering serum triglyceride levels. Many patients are aware of their "good" and "bad" cholesterol levels, but they may not be aware of their triglyceride level or of the association between high triglycerides and the development of CVD. In recent years, however, in light of the increasing incidences of obesity, insulin resistance, and type 2 diabetes, lowering triglyceride levels has gained renewed interest. In addition to the focus on lowering LDL cholesterol levels in CVD prevention, clinicians need to be aware of the role of triglycerides-their contribution to CVD, and the causes and treatment of hypertriglyceridemia.

Intravenous Antibiotics Used in the Treatment of Methicillin-Resistant Staphylococcus Aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) continues to cause significant morbidity and mortality. Despite advances in medical care, the prevalence of both community-acquired and hospital-acquired MRSA has progressively increased. Community-acquired MRSA typically occurs in patients without recent illness or hospitalization, presents as acute skin and soft tissue infections, and is usually not multidrug resistant. Hospital-acquired MRSA, however, presents in patients recently hospitalized or treated in long-term care settings and in those who have had medical procedures and is usually associated with multidrug-resistant strains. Both types of infections, if not properly treated, have the potential to become invasive. This article discusses current intravenous antibiotics that are available for the empiric treatment of MRSA infections along with a newer phenomenon known as the "seesaw effect."

Differential diagnosis: correctly putting the pieces of the puzzle together.

Each day, we generate hypotheses about our environment-our perceptions of people, our expectations of events, and our interpretation of images. These hypotheses provide a framework by which we interpret our experiences. The same is true for differential diagnosis by which health care practitioners develop hypotheses or diagnoses from a set of cues provided during an encounter with a patient. For clinicians to be successful at differential diagnosis, they must use a multidimensional and complex process involving nonanalytic and analytic cognitive processes and metacognition-thinking about thinking. Our conclusions, however, can lead to errors in diagnosis. Many of these errors are due to errors in cognition. The purpose of this article is to discuss this complex process, identify common errors in cognition, and offer strategies to prevent these common errors in differential diagnosis.

Managing hyperlipidemia. The updated cholesterol treatment guidelines.

: The ACC/AHA 2013 cholesterol treatment guidelines focus on lowering the risk of heart disease and stroke and not on targeted treatment goals in adult patients. This article offers a synopsis of the new guidelines and how to apply them in clinical practice.

Hypertension in 2014: making sense of the guidelines.

Hypertension, if not appropriately treated, can lead to stroke, kidney failure, myocardial infarction, and death. Substantial evidence from multiple randomized clinical trials demonstrates the benefit of antihypertensive therapy. Healthcare providers seek scientific evidence by which to base treatments. The purpose of this article is to discuss current hypertension guidelines.

Teaching students about the WHO Guide to Good Prescribing.

Although the WHO Guide to Good Prescribing is widely used in medical education to teach rationale prescribing to physicians, this method is less known in graduate nursing education. The purpose of this article is to review the motivation behind this model and to discuss the incorporation of a P (personal) drug assignment into a graduate pharmacology course.

Sinus node dysfunction: recognition and treatment.

Sinus node dysfunction (SND) refers to a wide range of abnormalities involving sinus node and atrial impulse generation and propagation. SND occurs at any age and is commonly encountered in clinical practice. Clinicians must be able to accurately diagnose this syndrome, which can present from asymptomatic bradycardia to atrial standstill.

Defining NP scope of practice and associated regulations: focus on acute care.

PURPOSE: Although the nurse practitioner (NP) role has been in existence for over 40 years, there continues to be uncertainty about the essential components that define NP scope of practice. The purpose of this article is to review definitions and concepts related to NP scope of practice with an emphasis on NPs working in acute care. DATA SOURCES: A synthesis literature review was conducted on defining NP scope of practice. Simultaneous review of authoritative resources including National Council of State Board of Nursing, individual state board of nursing language, and NP scope and standards of practice documents was conducted. CONCLUSIONS: Scope of practice is a legal term used by states to define what activities an individual professional can undertake. The Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation outlines that licensure and scope of practice are based on graduate education within a defined patient population for the APRN role. The APRN Consensus Model further identifies that the services provided by APRNs are not defined or limited by setting but rather by patient care needs. For the acute care NP, this is especially significant, as patient acuity and care requirements can vary across settings. When implemented, the Consensus Model will help to standardize regulation for APRNs as well as ensure congruence between licensure, accreditation, certification, and education. IMPLICATIONS FOR PRACTICE: Providing clarification of the NP scope of practice, especially as it pertains to NPs working in acute care settings, remains needed to support practice based on educational preparation, licensure, certification, and focus of practice.

Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.

The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians' diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain.

Medication use and symptoms in individuals with mitral valve prolapse syndrome.

Mitral valve prolapse (MVP) is a common valvular heart disease associated with a variety of frightening symptoms. Beta-adrenergic blockers along with calcium channel blockers and anxiolytics are widely used to treat symptoms associated with MVPS despite a lack of evidence that supports their efficacy. This study examined the relationship between prescribed medication use and frequency and intensity of MVPS symptoms. A descriptive cross-sectional survey design was used. Descriptive statistics and Cramér's V correlational analysis were used to answer the research questions. Self-completed questionnaires were mailed to 2,282 MVPS individuals older than 21 years of age throughout the United States and Canada previously diagnosed with MVPS. Of the 837 participants, 337 (40%) were taking one or more medications. Although there were significant positive correlations between anxiety and calcium channel blockers, chest pain and digoxin, and mood swings and digoxin, the correlations were very weak.

Mitral valve prolapse syndrome health concerns, symptoms, and treatments.

Individuals with mitral valve prolapse syndrome (MVPS) symptoms seek help in emergency rooms, urgent care centers, and primary care offices. Little is known about the profile and effects of these symptoms on individuals' role status and use of health care services. A descriptive cross-sectional design was used to develop a profile of health concerns, symptoms, and treatments and to examine the relationships of symptoms to functional and role status and use of health care services for MVPS patients. A sample of 837 persons completed an MVPS symptom checklist and survey, Mishel Uncertainty Illness Scale, Short Form Health Survey, State-Trait Anxiety Inventory, Medical Outcomes Study Social Support, and Food Frequency Questionnaire. Descriptive statistics, multiple-regression analysis, and structural equation modeling were used to answer the research questions. Findings suggest that older age, lack of social support, higher anxiety, and lack of regular exercise predict MVPS symptoms. There was limited support for the overall theoretical model.

Noninvasive diagnosis of coronary artery disease in women.

Cardiovascular disease is the leading cause of mortality and significant morbidly among women in the United States. The frequent absence of antecedent symptoms, the potential for an initial fatal cardiac event and the limitations of currently available noninvasive diagnostic tests pose challenges to healthcare practitioners as they try to optimally risk stratify patients. Therefore, the purpose of this article is to discuss the accuracy of noninvasive tests for CAD diagnosis in women.