19 Sep Access CA BRN Website: NP standardized Procedures
Access CA BRN Website: NP standardized Procedures Dementia Chronic Health Problem for the Geriatric population and write a complete SP. Follow guidelines per CA BRN examples. See attachment For the standardized procedure you may use the top portion from the BON. This paper will go through Turnitin. you must CITE your sources. For example list of Diabetes signs and symptoms you get from some book or website, you must reference it. I know it is difficult to do on this assignment, but you must CITE. Even if you give me a bullet point list, please cite your sources at the top title portion.Standardized Procedure for Nurse Practitioners: General PolicyI PurposeII Development and ReviewIII Scope and SettingA NPs may manage those functions outlined in the standardized procedures, within their trained area of specialty and consistent with their experience and credentialing. Such functions include assessment, management and treatment of acute and chronic illness, contraception, health promotion and overall evaluation of health status. Additional functions include the ordering of diagnostic procedures, physical, occupational, speech therapies, diet and referral to specialty care as needed.B NPs are authorized to practice standardized procedures in the organization’s Outpatient Clinics.IV Education and Training/QualificationsA NPs must have the following1 Current California registered nurse (RN) license2 Certification by the State of California, BRN as an NP3 Board certification from the American Nurses Credentialing Center4 NP furnishing number5 DEA registration number6 Current Health Care Provider Card from the American Heart Association7 Credentialed by the organization’s medical staffB In addition to the required education and training all NPs will be required to complete competency validation upon hire and annually. The supervising physician is charged with observing the NP and documenting competency validation. The competency validation checklist is managed, maintained and made available by the Office of Medical Staff as a component of the privilege process. Checklist will be reviewed and updated annually by the IDC.V Supervision and EvaluationA NP is authorized to implement the approved standardized procedures without the direct or immediate observation or supervision of a physician unless otherwise specified within a particular procedure.B Supervising physicians will conduct a weekly case review of a minimum of 10% of each NPs cases for the week. The review will be documented within the electronic medical record and must be completed within 30 days of the visit selected for review. Cases will be selected randomly unless a request for review is received by a medical professional.C No single physician will supervise more than 4 NPs at any one time.VI ConsultationsA Physician consultation is to be obtained as specified in individual procedures or when deemed appropriate.VII Patient RecordsA NPs will be responsible for the documentation of a complete electronic medical record for each patient contact/encounter in accordance with existing clinic and medical staff policies.Protocol:Croup initial visit in the outpatient clinic settingI RationaleTo assist Nurse Practitioners in the outpatient clinic setting in the differentiation betweencroup and other upper airway conditions and to establish guidelines for the management of croup in this setting.II DefinitionSwelling and erythema of the upper airway resulting in narrowing of these airways, usually as a result of viral infection and in some instances bacterial. Most cases are usually mild and self-limiting however, children can be seriously ill or at risk for rapid progression of disease leading to further narrowing of the airways and respiratory compromise.III EpidemiologyA Typically occurs in children between the ages of 6 months to 6 years, with a peakincidence between 6 and 36 months.B Most often occurs in the fall and is usually but not limited to parainfluenza type 1 viral infection.C Cases occurring in winter are usually but not limited to influenza A and B virusesD Risk factors include familiar history, parental smoking and male gender. IV HistoryA Symptoms of upper respiratory infection for several days.B RhinorrheaC CoughD Low grade feverE Symptoms occurring most often at nightF Sore throatG StridorH Intermittent barking, seal like coughV Physical ExamA Barking seal like cough, stridorB TachypneaC Use of accessory muscles for respirationD TachycardiaE WheezingF Low grade fever however, can be elevated to 104FG Visualization of mouth and epiglottis normalVI Diagnostic testsA Diagnosis typically made based on clinical presentationB Plain imaging of soft tissue of the neck may display classic pattern of subglottic narrowing (steeple sign) on posteroanterior view.C Pulse oximetryD Laboratory tests are not necessary for the diagnosis of croup however, may be used to assist with differential diagnosis.1 CBC2 Viral Serology3 Tissue cultureVII Differential DiagnosisA EpiglottitisB Foreign body aspirationC Retropharyngeal or peritonsillar abscessD Compression due to tumors, trauma or congenital malformationsE AngioedemaF Asthma exacerbationG Bacterial traceitisVIII Management – According to severity of disease by means of the Westley Croup Score based on the presence or absence of stridor at rest, degree of chest wall retractions, air entry, the presence or absence of pallor or cyanosis and the mental status.A Mild croup (Westley croup score of ≤2)No stridor at rest (although stridor may be present when upset or crying), a barking cough, hoarse cry, and either no, or only mild, chest wall/subcostal retractions.B Moderate croup (Westley croup score of 3 to 7)Stridor at rest, has at least mild retractions, and may have other symptoms or signs of respiratory distress, but little or no agitation.C Severe croup (Westley croup score of ≥8)Significant stridor at rest, although the loudness of the stridor may decrease with worsening upper airway obstruction and decreased air entry. Retractions are severe (including indrawing of the sternum) and the child may appear anxious, agitated, or pale and fatigued.D Impending respiratory failure (Westley croup score of ≥12)Fatigue and listlessnessMarked retractions (although retractions may decrease with increased obstruction and decreased air entry)Decreased or absent breath soundsDepressed level of consciousnessTachycardia out of proportion to feverCyanosis or pallorE TreatmentMild Croup: 1 Single dose of dexamethasone 0.15 to 0.6 mg/kg orally or parentally to a max dose of 10mg.2 Disposition home with the following instructions:a Fever management with acetaminophen 15mg/kg po every 4-6hrs as needed not to exceed 75mg/kg/day.b Anticipatory guidance of potential worsening and instructions on when to seek care.c Use of humidified air, cool mist or hot streamd Return for follow-up next day.Moderate CroupIf improvedIf no improvementa Consult with supervising physician and prepare to administerb Inhaled racemic epinephrine 0.05 ml/kg per dose (maximum of 0.5 ml) of a 2.25% solution diluted with normal saline for a 3ml total volume via nebulizer.c If pulse oximetry is <92% provide supplemental oxygen at a rate to maintain 02 Sat < 92%d Refer or disposition child via emergency transport to emergency departmentSevere croup and impending respiratory failure a Activate 911 and provide the following until emergency transport arrives:b Ensure open airwayc Administer supplemental 02 to maintain 0s sat 92%d Single dose of dexamethasone 0.15 to 0.6 mg/kg parentally.e Inhaled racemic epinephrine 0.05 ml/kg per dose (maximum of 0.5 ml) of a 2.25% solution diluted with normal saline for a 3ml total volume via nebulizer.f Notify supervising physician of need for emergency transportIX Development and Approval of the Standardized ProcedureThis standardized procedure was developed and approved through the organization’s Interdisciplinary Committee and will be reviewed and approved every 3 years or more often as needed.Revision Date_____________ Review Date______________X Standardized procedure was approved by the following members of the Interdisciplinary Committee._______________________________ Date_______________________Pediatric Department Chair_______________________________ Date_______________________Supervising Physician_______________________________ Date_______________________Director of Nursing Practice_______________________________ Date_______________________AdministrationXI Practitioners authorized to function under this standardized procedure:This list of Nurse Practitioners will be maintained on file in the department in which Nurse Practitioners practice and hospital administration.
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