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FNP591 Discussion Question 2 Week 1
Discuss the importance of Clinical Practice Guidelines and how they are used by nurse practitioners, physician assistants, and medical doctors in clinical practice.
Clinical practice guidelines (CPG) are evidence-based recommendations by medical experts from their respective fields of medicine to help providers treat and educate their patients (Guerra-Farfan et al., 2023). Along with clinical judgment, providers such as nurse practitioners, physician assistants, and medical doctors can reference CPG quickly to find the most current evidence-based practice for most disease processes (De Leo et al., 2023). According to De Leo et al. (2023) CPG are “upheld as the gold standard of high-quality healthcare” (De Leo et al., 2023, para. 5).
List at least 5 different governing bodies for Clinical Practice Guidelines, and for each Clinical Practice Guideline that you list, discuss a health condition that can be managed by the clinical practice guidelines.
The Global Initiative for Asthma, also known as GINA, manages asthma. https://ginasthma.org/wp-content/uploads/2023/07/G…
The American College of Gastroenterology manages irritable bowel syndrome. https://journals.lww.com/ajg/Fulltext/2021/01000/A…
The American Urological Association manages benign prostatic hyperplasia. https://www.auanet.org//guidelines-and-quality/gui…
The Centers for Disease Control and Prevention manages immunization recommendations. https://www.cdc.gov/vaccines/
The Joint National Committee manages hypertension.
Elaborate on the details provided in Clinical Practice Guidelines for patient management.
Clinical practice guidelines typically include an abstract, introduction (background of the condition, population affected, prevalence, and general facts about the condition), scope of the guidelines and methodology, recommendations that can include pharmacological, education, non-pharmacological, summary, list of conflict of interests, acknowledgments, and references. The recommended treatments are usually supported by case studies, statistical data, scenarios, side effects, and suggestions on how to use them. Some of these recommendations list alternative dosages for different ages or with comorbidities, and alternative treatments if the patient is pregnant. Non-pharmacological recommendations may include avoidance of irritants that cause reactions, lifestyle modifications, and dietary suggestions.
Which clinical practice guideline(s) would you anticipate using in a Public Health Department for Sexually Transmitted Infection visits? Why? Discuss the details of the clinical practice guidelines to manage a patient presenting with Syphilis and Chlamydia.
Due to the communicable nature of a sexually transmitted infection (STI), this condition is related to public health and well-being. The clinical practice guidelines I would use for STI visits would be whatever my state’s public health department suggests. Since I am from California, I would be using the California Department of Public Health (CDPH) guidelines.
For primary, secondary, and early latent syphilis, the recommended treatment is one intramuscular dose of benzathine penicillin G 2.4 million units (CDPH, 2023). For syphilis that is either late latent, with an unknown infection length of time, or tertiary syphilis without cerebrospinal fluid (CSF) involvement, then the treatment is three intramuscular doses of benzathine penicillin G 2.4 million units done one week apart for a total of 7.2 million units (CDPH, 2023). Finally, for neurosyphilis and ocular syphilis, the recommended treatments are “aqueous crystalline penicillin G 18–24 million units daily, administered as 3–4 million units IV q 4 hrs or as continuous infusion x 10–14 d” (CDPH, 2023, Tables Syphilis in Non-Pregnant Patients). The CDPH treatment recommendation for non-pregnant patients with chlamydia is a seven-day course of doxycycline 100 mg PO BID (CDPH, 2023). If the patient is pregnant and has chlamydia, the recommended treatment is one dose of azithromycin 1 gram PO (CDPH, 2023).
Sometimes there are slightly different recommendations from different clinical practice guidelines. Discuss the differences between the American College of Gynecology (ACOG), United States Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) for mammogram screening.
The American College of Obstetricians and Gynecologists (ACOG) recommends women with an average risk of breast cancer should have a mammogram starting at the age of 40 (ACOG, 2023). ACOG suggests women should not wait to have their first mammogram past 50 years old (ACOG, 2023). Also, a mammogram should be done every one to two years until the age of 75 (ACOG, 2023).
The United States Preventive Services Task Force (USPSTF) recommends women between the ages of 50 to 74 to get a mammogram screening every two years (USPSTF, 2016).
The American Cancer Society (ACS) recommends mammograms are optional for women between the ages of 40 and 44 (ACS, 2023). The ACS suggests a mandatory annual mammogram for women between the ages of 45 to 54 with an average risk of breast cancer (ACS, 2023). For women 55 and older, mammograms can be done annually or extended out to once every two years, if the “woman is in good health and is expected to live at least 10 more years” (ACS, 2023, para. 5).
Clinical Scenario: A Nurse Practitioner Student is seeing a 31-Year-Old Male patient that presents with seasonal allergic rhinitis. The symptoms include post-nasal drip, rhinorrhea, itchy nose, and itchy eyes, and the symptoms have not been controlled with diphenhydramine nor loratadine. Based on the clinical practice guidelines, discuss the treatment(s), including education and non-pharmacological recommendations for the patient. Be sure to cite the clinical practice guidelines that you are discussing.
For seasonal allergic rhinitis, I will be referring to the American Academy of Otolaryngology-Head and Neck Surgery guidelines for the suggested treatments, education, and non-pharmacological recommendations.
Treatment options:
Topical intranasal steroids such as triamcinolone acetonides (Nasacort Allergy 24HR), budesonide (Rhinocort AQ), flunisolide (Nasalide or Nasarel), fluticasone propionate (Flonase), mometasone furoate (Nasonex), ciclesonide (Omnaris), fluticasone furoate (Veramyst), Qnasl, and ciclesonide (Zetonna) (Seidman et al., 2015). The dosage recommendations for this patient would be: triamcinolone acetonides (Nasacort Allergy 24HR), two sprays (55 µg/spray) in each nostril QD or BID, budesonide (Rhinocort AQ) two sprays (32 µg/spray) in each nostril BID or four sprays in each nostril qAM, flunisolide (Nasalide or Nasarel) two sprays (25 µg/spray) in each nostril BID or TID, fluticasone propionate (Flonase) two sprays (50 µg/spray) in each nostril QD, mometasone furoate (Nasonex) two sprays (50 µg/spray) in each nostril BID, ciclesonide (Omnaris) two sprays (50 µg/spray) in each nostril QD, fluticasone furoate (Veramyst) 2 sprays (27.5 µg/spray) in each nostril QD, Qnasl two sprays (80 µg/spray) in each nostril QD, and ciclesonide (Zetonna) one spray (37 µg/spray) in each nostril QD (Seidman et al., 2015).
An oral second-generation antihistamine such as “fexofenadine, cetirizine, levocetirizine, loratadine, and desloratadine” (Seidman et al., 2015, section 7). The dosages for the second-generation antihistamines are as follows: cetirizine (Zyrtec) PO 10mg QD, levocetirizine (Xyzal) PO 2.5-5mg QD, fexofenadine (Allegra) PO 60mg BID or 180mg QD, Loratadine (Claritin, Alavert) PO 10mg QD, and desloratadine (Clarinex) PO 5mg QD (Seidman et al., 2015).
Intranasal antihistamines such as olopatadine (Patanase), azelastine (Astelin), azelastine (Astepro), and azelastine plus fluticasone (Dymista) (Seidman et al., 2015). The recommended dosages for each intranasal antihistamine are: olopatadine (Patanase) two sprays BID, Azelastine (Astelin) one to two sprays BID or two sprays QD, azelastine (Astepro) one to two sprays BID or two sprays QD, and azelastine plus fluticasone (Dymista) one spray in each nostril BID.
The only FDA approved leukotriene receptor antagonist to treat seasonal allergic rhinitis is montelukast (Seidman et al., 2015).
Education
According to Seidman et al. (2015), to reduce the occurrence and severity of season allergic rhinitis, patients should remove pets from their environment, or wash their “pets twice a week, [use] acaricides to kill dust mites, [use] impermeable covers for bedding, [use] air filtration, and combined use of multiple control measures” (Table 8).
Non-pharmacological
Some non-pharmacological recommendations for the season of allergic rhinitis are acupuncture, turbinate reduction surgery, and herbal therapy (Seidman et al., 2015).
References
California Department of Public Health. (2023, November 17). California sexually transmitted infections (STI) treatment guidelines for adults and adolescents. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/California-STI-Treatment-Guidelines.aspx#SYPHILIS
De Leo, A., Bloxsome, D., & Bayes, S. (2023). Approaches to clinical guideline development in healthcare: a scoping review and document analysis. BMC Health Services Research, 23(37). https://doi.org/10.1186/s12913-022-08975-3
Guerra-Farfan, E., Garcia-Sanchez, Y., Jornet-Gibert, M., Nuñez, J. H., Balaguer-Castro, M., & Madden, K. (2023). Clinical practice guidelines: The good, the bad, and the ugly. Injury, 54(3), S26–S29. https://doi.org/10.1016/j.injury.2022.01.047
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E.,…Nnacheta, L. C. (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology – Head and Neck Surgery, 152(S1). https://doi.org/10.1177/0194599814561600
The American Cancer Society. (2023, December 19). American cancer society recommendations for the early detection of breast cancer. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
The American College of Obstetricians and Gynecologists. (2023, January). Reducing your risk of cancer: Lifestyle changes and screening tests. https://www.acog.org/womens-health/faqs/reducing-your-risk-of-cancer-lifestyle-changes-and-screening-tests#:~:text=Finding%20breast%20cancer%20early%20makes,years%20until%20at%20least%2075.
The United States Prevention Services Task Force. (2016, January 11). Breast cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#fullrecommendationstart
Peer Responses:
Length: A minimum of 200 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Relate to another journal article.
