A Near Miss in the Emergency Department: Atypical Presentation of Acute Coronary Syndrome.

Acute coronary syndrome is an umbrella term encompassing three types of coronary artery disease that affect millions worldwide annually. Despite the availability of diagnostic tests (blood analysis, imaging, electrocardiogram, and screening tools), the diagnosis of myocardial infarction (MI) is still sometimes missed. According to the Centers for Disease Control and Prevention, the reported prevalence of heart disease is higher among males than females, with adults over the age of 75 having the highest prevalence. Typical "heart attack" features include chest pain that feels like pressure or squeezing, pain or discomfort in one or both arms that can radiate to the neck or jaw, shortness of breath, diaphoresis, nausea, vomiting, and lightheadedness. However, there are three subgroups where the typical warning signs do not always present: the elderly, individuals with diabetes, and females. The following is an atypical case presentation of unstable angina and non-ST-elevation MI.

Priapism in a Young Adult With Sickle Cell Disease.

This article presents a case study focusing on priapism in a patient with sickle cell disease, with repeated emergency department (ED) visits and hospitalizations. The patient was successfully identified and treated by the ED nurse practitioner (NP) with aspiration of the corpus cavernosum. Priapism is a persistent penile erection that continues for an extended time. There is some argument about what that length of time is, but generally, the consensus is more than 4 hr beyond sexual stimulation or unrelated to sexual stimulation or sexual interest (Bivalacqua et al., 2022). Priapism is a fairly common but underrecognized complication of sickle cell disease. It represents a urological emergency in which timely diagnosis and appropriate treatment are vital to preserving penile tissue and sexual function. The diagnosis is made clinically with a comprehensive history, physical examination, and appropriate laboratory test values. Initial management can be conservative with hydration and analgesics or, if necessary, more invasive with needle aspiration to promote detumescence. Permanent tissue damage or erectile dysfunction can result if priapism is unrecognized, untreated, or not treated immediately. The NP plays an integral role in treating and preventing permanent damage. Patient education should focus on instructions for preventing priapism and managing episodes at home.

Ureterolithiasis in Adolescents: A Case Report.

A 13-year-old patient presented to the emergency department with a history of abdominal pain and right flank pain. Two days before, she was evaluated at her pediatrician's office and was diagnosed with acute gastroenteritis and sent home. In the emergency department, the patient was diagnosed with ureterolithiasis after a physical examination, laboratory work, and imaging findings. She was treated successfully with conservative medical management. Symptomatic presentation of ureterolithiasis can include abdominal pain, flank pain, hematuria, dysuria, urgency, nausea, and vomiting. Nurse practitioners need to recognize nonspecific symptoms of ureterolithiasis for accurate diagnosis and treatment. Risk factors, signs and symptoms, prevention, and treatment options for ureterolithiasis are discussed.

Improving Telehealth Knowledge in Nurse Practitioner Training for Rural and Underserved Populations.

BACKGROUND: Telehealth is an emerging technology for the delivery of health care services. Providers need to be trained to maximize the potential benefits for rural and underserved populations. METHOD: A quality improvement approach to curricular redesign was used to integrate telehealth in a family nurse practitioner program. The intervention consisted of telehealth learning outcomes and a lecture-style presentation in a role transition course. A Plan-Do-Study-Act cycle informed faculty decision making in a small test of change. Self-reported confidence in telehealth knowledge was measured with a knowledge survey to determine whether the change was an improvement. RESULTS: Student confidence in telehealth knowledge increased following the intervention. The change provided an opportunity for faculty to consider additional approaches to integrating telehealth learning experiences in practicum courses. CONCLUSION: This project provided an improvement framework on which faculty can build and test effective pedagogical approaches to training graduate nursing students on the use of telehealth technology. [J Nurs Educ. 2019;58(1):57-60.].

Atypical or Incomplete Kawasaki Disease in a Young Child: A Case Report.

This case report describes an atypical or incomplete presentation of Kawasaki Disease. Kawasaki Disease is an inflammatory process that can affect all blood vessels and result in cardiac complications; particularly coronary artery aneurysms. Patients are typically young children, usually younger than 5 years of age, who initially present with a high fever and nonspecific rash. The child in this case presented with an atypical or incomplete presentation, and was diagnosed with Kawasaki disease after multiple provider encounters. Signs and symptoms of Kawasaki disease versus atypical or incomplete Kawasaki disease, differential diagnoses, and potential complications from Kawasaki disease are discussed in this case report.

Helping children gain asthma control: bundled school-based interventions.

Following the success of a community asthma quality improvement initiative to improve outcomes for children with asthma attending Cincinnati Public Schools with school-based health centers (SBHC), several members of the original initiative formed a new asthma improvement collaborative to spread the initiative's improvement work to inner-city children with asthma attending other schools with and without SBHCs. This article describes the collaborative's plan, which features a nurse practitioner using bundled, evidence-based, school-based interventions to improve asthma control for inner-city children in high poverty schools.