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Five Clinical Practice Guidelines for Primary Care Nurses

Clinical Practice Guidelines for Primary Care Nurses

Clinical practice guidelines are a crucial part of providing quality treatment. Primary care nurses need to be familiar with these resources and how to access them. So here’s a look at five guidelines for common conditions:

•Head lice remain a common condition, especially among children from economically disadvantaged homes. Current guidelines recommend the use of a bright flashlight or, preferably, a fine-tooth comb in detecting louses or nymphs. Active infestations are indicated when a nit is 6mm or closer to the scalp. Examining the nape of the neck or the area behind the ears are also excellent ways to find evidence of these pests. The preferred treatment method is a 1% solution of Permethrin, applied to the hair and scalp for 10 minutes then rinsed off. A second application should be administered seven to ten days later.

•Hypertension remains a major cause of chronic health problems such as heart disease and stroke. One method of detecting it is to use automated blood pressure systems. However, these are frequently inaccurate if the patient has an irregular heartbeat, such as the kind that exists with a trial fibrillation. In such cases, manual testing should be performed. Also, if the patient has a measurement above 140/90 at the beginning of his or her appointment, a second check should be performed later during the session. If this one is significantly lower than the first, then a third should be performed later on. The lower of the previous two measurements should be entered in his or her chart.

•Sunburn is a painful condition commonly seen during the summer. In most cases, recommended treatment methods include cold packs, topical analgesics, and prescribing rest and adequate nutrition. Some alternative forms of therapy include oatmeal baths, applying milk and use of vitamin C and E creams. The healthcare provider should also educate the patient on the importance of avoiding prolonged exposure to the sun and of using sunscreen when outside.

•Lower back pain is another commonly reported condition that primary care nurses must deal with. Current guidelines stress certain diagnostic criteria, such as determining how long the patient has suffered pain, how the pain rates in severity from 0 to 10, and whether it causes loss of functionality. Therapeutic intra-articular facet joint injections are not recommended as a treatment method, but caudal epidural steroid injections are advised in some cases. Such measures should only be used if milder forms of therapy, such as exercise and chiropractic adjustment, have been tried first and have failed to give relief of symptoms.

•Rheumatoid arthritis is another condition that a primary care nurse will commonly see. Therapy centers around the management of symptoms, with medicines such as glucocorticoids administered for immediate relief of flare-ups, and paracetamol, codeine or other analgesics used for long-term pain management. Non-steroidal anti-inflammatory agents should be used conservatively on an as-needed basis. Referral to a specialist is warranted when the small joints of the hands or feet are affected.

Clinical practice guidelines should be consulted on a regular basis by the primary care nurse. Guidelines.gov is an excellent free resource where guides for hundreds of conditions can be found. Use of these materials will enable healthcare providers of all types to be more effective in curing illnesses and relieving symptoms for their patients.

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