Description
1. Discuss the importance of Clinical Practice Guidelines and how they are used for nurse practitioners, physician assistants, and medical doctors in clinical practice.
Clinical practice guidelines (CPGs) drive the treatment plan to be developed by the provider. Scientific literature creates the CPGs for healthcare providers such as nurse practitioners, physician assistants, and doctors to help optimize the care being delivered to patients (Verville et al., 2021). Without CPGs, healthcare providers would not have the guidance to ensure evidence-based care was available to their patients. While patient-centered care and shared decision-making are essential in the care of all patients, having an evidence-based guideline to reference that has been researched, tested, and reviewed creates a quality, safe environment and treatment plan for most patients.
2. 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 guideline.
The American Heart Association (AHA), American Diabetes Association(ADA), Infectious Diseases Society of America (IDSA), America Association of Clinical Endocrinology (AACE), and American Thoracic Society (ATS) are all examples of governing bodies providing the latest CPGs for specific health conditions. The AHA offers CPGs for hypertension, hyperlipidemia, and many other cardiac conditions. The ADA delivers CPGs related to diabetes conditions. The IDSA can provide CPGs on most infectious disease processes, such as sexually transmitted infections, cystitis, and pyelonephritis. The AACE provides CPGs on hyperthyroidism, hypothyroidism, and more endocrine disorders. Lastly, the ATS manages CPGs related to asthma, COPD, and additional respiratory conditions.
3. Elaborate on the details that are provided in Clinical Practice Guidelines for the management of patients.
CPGs provide excellent information regarding a condition’s background, pathophysiology, epidemiology, diagnosis workup, treatment plan, and follow-up care. Some guidelines provide easy-to-follow algorithms to review in managing patients, similar to those of basic life support or advanced cardiac life support that healthcare providers are very familiar with. The CPGs provide background to the scientific research and literature reviews to provide context for the guideline being considered best practice or evidence-based.
4. 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 who is presenting for Syphilis and Chlamydia.
The Centers for Disease Control and Prevention (CDC) are the most relevant and appreciated resource when addressing conditions that can have a negative effect on a community if not addressed at a public health level. When researching sexually transmitted infection treatment guidelines, the first website to be pulled up is, in fact, the CDC. As evidenced by the COVID-19 pandemic, the public seeks guidance from the CDC when addressing infectious disease processes that can affect the public nationally.
A healthcare provider could use the clinical practice guidelines presented by the CDC to drive the management of a patient presenting with syphilis or chlamydia. In the management of syphilis, the provider initiates a workup to determine the stage of syphilis if the clinical picture is not definitive. Testing in the form of nontreponemal and treponemal could be performed to help drive treatment goals. The treatment of all stages of syphilis, if determined necessary, is Penicillin G (Centers for Disease Control and Prevention, 2023).
Management of a chlamydia infection per the CDC guidelines includes diagnostic testing through vaginal or cervical swabs for women and first-void or urethral swabs for men. Doxycycline is recommended for most patients with alternative regimens such as azithromycin or levofloxacin (Centers for Disease Control and Prevention, 2021).
5. Sometimes there are slightly different recommendations from different clinical practice guidelines. Discuss the differences between American College of Gynecology (ACOG), United States Prevention Services Task Force (USPSTF), and the American Cancer Society (ACS) for mammogram screening.
ACOG recommends that women start mammogram screening at age 40, with screening performed every one to two years up until age 75 (American College of Gynecology, 2022). The U.S. Prevention Services Task Force (2023) drafted a new recommendation statement for 2023 recommending women to obtain initial mammography screening at age 40 instead of 50 and to be performed every other year. The American Cancer Society (2023) encourages women ages 40 to 44 to consider mammography screening every year, women ages 45 to 54 to have annual mammograms, and women older than 55 to advance to having mammography screening every other year as long as they remain in good health and life expectancy is greater than ten more years.
6. 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 guideline that you are discussing.
First-generation antihistamines such as diphenhydramine are not recommended as first-line agents in treating allergic rhinitis. If loratadine is not working, it may be prudent to prescribe a different second-generation antihistamine, such as cetirizine. Additionally, since the symptoms have not been well-controlled with monotherapy, the initiation of intranasal antihistamines may be necessary. Azelastine or olopatadine are used in the treatment of intermittent allergic rhinitis. If the patient exhibited moderate to severe congestion, pseudoephedrine could be prescribed as an oral decongestant. Lastly, nasal saline should also be recommended to keep the nasal passages moist in combination with an oral antihistamine, intranasal antihistamine, and a decongestant (Dykewicz et al., 2020). The patient should be advised to notify the provider of any adverse reactions with all medication prescriptions. Additionally, the patient should ensure adequate water intake up to 2-3L a day, perform nasal passage flushes with a neti pot or nasal saline, and avoid allergic triggers as much as possible. The patient should also be advised to return to the clinic in one to two weeks if symptoms are not resolving. Lastly, the patient should report to the emergency room with shortness of breath, difficulty swallowing, chest pain, and change in mentation.
References
American Cancer Society. (2023). American Cancer Society for the early detection of breast cancer. Retrieved on January 3, 2024 from https://www.cancer.org/cancer/types/breast-cancer/….
American College of Gynecology. (2022). Mammography and other screening tests for breast problems. Retrieved on January 3, 2024 from https://www.acog.org/womens-health/faqs/mammograph….
Centers for Disease Control and Prevention. (2021). Chlamydia. Retrieved on January 3, 2024 from https://www.cdc.gov/std/treatment-guidelines/chlam…
Centers for Disease Control and Prevention. (2023). Syphilis. Retrieved on January 3, 2024 from https://www.cdc.gov/std/treatment-guidelines/syphi…
Dykewicz, M. S., Wallace, D. V., Amrol, D. J., Baroody, F. M., Bernstein, J. A., Craig, T. J., Dinakar, C., Ellis, A. K., Finegold, I., Golden, D. B. K., Greenhawt, M. J., Hagan, J. B., Horner, C. C., Khan, D. A., Lang, D. M., Larenas-Linnemann, D. E. S., Lieberman, J. A., Meltzer, E. O., Oppenheimer, J. J., … Steven, G. C. (2020). Rhinitis 2020: A practice parameter update. Journal of Allergy and Clinical Immunology, 146(4), 721–767. https://doi.org/10.1016/j.jaci.2020.07.007
U.S. Preventative Services Task Force. (2023). Breast cancer: screening. Retrieved on January 3, 2024 from https://www.uspreventiveservicestaskforce.org/usps…
Verville, L., Côté, P., Grondin, D., Mior, S., Moodley, K., Kay, R., & Taylor-Vaisey, A. (2021). Using technology-based educational interventions to improve knowledge about clinical practice guidelines: A systematic review of the literature. Journal of Chiropractic Education (Allen Press Publishing Services Inc.), 35(1), 149–157. https://doi-org.usu.idm.oclc.org/10.7899/JCE-19-17
Peer Responses:
Length: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
