|
 Provided by: Clinician 1
I admit, recently I’ve been more fired up about the blogs and responses about NP practice than in all my years of practice combined. I’ve mentioned many times before that we need to educate patients about all of the things we do and about our important role in health care...one patient at a time.
Of course, dealing with this day-to-day, patient-to-patient, is time-consuming and often frustrating. (I’m preaching to the choir, I know.)
This week, I had two moments that I had to savor, in the quiet early-morning hours of my insomnia. Allow me to share…
Case One:
An older male patient, history of CHF, cor pulmonale, and advanced lung CA, severe COPD, without prior CAD, former 50-plus pack-year smoker, presents to the office with pleuritic, substernal chest pain, orthopnea, shallow breathing for several days. Temp 100.5; recent tooth abscess 2 weeks ago. Supposed to wear home oxygen, but doesn’t like to carry the canister out in public, so he comes without it. Lungs severely decreased, crackles only at the right base, non-reproducible chest pain. The differential diagnoses, of course, circle in my head as my staff does his EKG: acute coronary syndrome, pericarditis/endocarditis, pneumonia, exacerbation of COPD, etc. EKG shows new inferior wall ST elevation in all 3 leads. Call 9-1-1, give O2, ASA, bye-bye to the ER.
The moment I savor: the paramedics made a special trip BACK to my office after the run, to tell me “great call” on the EKG...patient had an emergent cardiac cath. The fact that they made that extra trip back was very humbling to me. My staff and collaborating doctor joke and call me “Cardiac Kim,” since I routinely send patients to the ER for cardiac emergencies. However, to have seasoned medics say something was great.
Case Two:
A 52 year old peri-menopausal female went to the ER a few weeks ago with SOB and chest pain. Had a 23-hour observation with negative troponins, no EKG changes, normal labs otherwise. Told to schedule an out-patient nuclear stress test, which she did and which was completely normal. Came in to see me for follow-up, as my boss in on vacation. She rightfully wanted to know why she is still having SOB and chest pain. I asked her detailed questions and surmised that she also has had epigastric discomfort and heartburn. PFTs in my office confirmed no airway obstruction or restriction. No reproducible chest pain. Definite epigastric tenderness on exam. Hmmm, I tell her...I’m suspicious for GERD.
She is surprised...not at what I said, but because she had mentioned her symptoms in the hospital to the cardiologist...and he did not acknowledge them. Now, to be fair, I told her that we must rule out the worst-case scenario first, and cardiac issues trump GI things every time.
So, she left with a prescription for omeprazole, a list of foods to avoid, precautions for eating...and most importantly, some hope. The moment she gave ME was her acknowledgment that I was the first person who actually LISTENED to everything she said and tried to put the pieces together.
And isn’t that what we NPs and PAs do best?
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
