The Family Nurse Practitioner

Allison Grady, MSN, APNPClinical Instructor College of Nursing University of Wisconsin–Milwaukee Milwaukee, WI, USA Pediatric Nurse Practitioner Medical College of Wisconsin/Children’s Wisconsin Clinics Milwaukee, WI, USA

Millie Hepburn, PhD, RN, SCRN, ACNS‐BCAssistant Professor Quinnipiac University Hamden, CT, USA

Rebecca Hill, DNP, RN, FNP‐C, CNEAssistant Professor School of Nursing MGH Institute of Health Professions Boston, MA, USA Family Nurse Practitioner Family Doctors, LLC Swampscott, MA, USA

Erin Janicek, LCSWSenior Director of Clinical Services Child and Family Agency of Southeastern CT New London, CT, USA

Sara Ann Jakub, MA, SYC, LPCDirector of Clinical Services for School‐Based Health Centers Director of Quality Assurance Child and Family Agency of Southeastern CT New London, CT, USA

Annette Jakubisin‐Konicki, PhD, ANP‐BC, FNP‐BC, FAANPAssociate Professor Director, Family Nurse Practitioner Primary Care Track School of Nursing University of Connecticut Storrs, CT, USA

Erin Janicek, LCSWSenior Director of Clinical Services Child and Family Agency of Southeastern CT New London, CT, USA

Susan M. Jussaume, MSN, APRN, FNP‐BC, AHN‐BCInstructor and Family Nurse Practitioner School of Nursing MGH Institute of Health Professions Boston, MA, USA

Andrew Konesky, MSN, APRNPediatric Nurse Practitioner Child and Family Agency of Southeastern CT New London, CT, USA

Jason R. Lucey, DNP, FNP‐BCAssistant Professor Family Track Co‐Coordinator School of Nursing MGH Institute of Health Professions Boston, MA, USA

Antonia C. Makosky, DNP, MPH, ANP‐BC, ANPAssistant Professor Adult‐Gerontology Primary Care Track Co‐Coordinator School of Nursing MGH Institute of Health Professions Boston, MA, USA

Mikki Meadows‐Oliver, PhD, RN, FAANAssociate Professor School of Nursing Quinnipiac University Hamden, CT, USA

Sheila L. Molony, PhD, APRN, GNP‐BC, FGSA, FAANProfessor of Nursing Quinnipiac University Hamden, CT, USA

Patrice K. Nicholas, DNSc, DHL( Hon), MPH, MS, RN, NP‐C, FAANDistinguished Teaching Professor and Director Center for Climate Change, Climate Justice, and Health School of Nursing MGH Institute of Health Professions Boston, MA, USA

Meredith Scannell, PhD, MSN, MPH, CNM, CEN, SANE‐AClinical Research Nurse and Emergency Nurse Brigham and Women’s Hospital Boston, MA, USA

Sara Smoller, RN, MSN, ANP‐BCAssistant Professor School of Nursing MGH Institute of Health Professions Boston, MA Adult Nurse Practitioner Family Doctors, LLC Swampscott, MA, USA

Sheila Swales, MS, RN, PMHNP‐BCInstructor School of Nursing MGH Institute of Health Professions Boston, MA, USA

Nancy M. Terres, PhD, RNAssociate Professor of Nursing School of Nursing MGH Institute of Health Professions Boston, MA, USA

The purpose of this book is to help clinicians and students better understand how to diagnose and manage typical (and some atypical) patient cases. While the focus is on the nurse practitioner role, this book will be useful to other patient care providers, such as physicians and physician’s assistants. The contributing authors have worked hard to update cases from the first edition of this book to better reflect patient‐centered language and advances in care. We have developed several new cases, such as one on climate change, to assist clinicians with scenarios that were not as predominant as they are today.

We have presented a variety of patients in these cases with regard to age, gender identity, socioeconomic status, family status, and other considerations. However, please don’t hesitate to alter these demographics to tailor the cases for your specific needs.

The contributing authors in this book are all subject matter experts. They have written these cases from real life. Consequently, the cases do not result in cookie‐cutter solutions. Critical thinking questions encourage the reader to think carefully about the case as presented and about potential resolutions to the case given variations that occur in real life. These cases should be used to jump‐start conversations among students, faculty, and clinicians regarding possible treatment options depending on the individual patient. All cases include the most current research and guidelines for treatment.

The cases are presented chronologically from pediatric to adolescent to adult and older adult. Cases in women’s health and men’s health have their own separate chapters. Mental health cases are now in a separate chapter.

For this second edition we moved the case resolutions to the end of the book. The best use of the book is to read and analyze the case, alter the demographics of the patient to view the case from multiple perspectives, and then review and discuss the resolutions. Keep in mind that there is typically more than one way to treat a patient and patients should always be diagnosed and treated on an individual basis, so there is often more than one possible resolution to a case. We have only included one resolution per case in this book.

I am so grateful to the readers of the first edition of this book. Thank you for using it. I hope you will find this second edition even more helpful. Many thanks to the contributing authors of this second edition. Several rejoined me from the first edition and others are new to this edition. All were easy to work with and are consummate professionals and excellent clinicians.

Thanks to all the patients and colleagues who’ve taught me so much throughout the years. Clinical practice and nursing education are my great passions and I’m grateful for all I learn every day.

Finally, thank you to Edward and Natalie Rotkoff, Kevin Boylan, Paul Neal, Corinne Neal, Andrew Neal, and Bonnie Brown.

By Leslie Neal‐Boylan, PhD, APRN, CRRN, FAAN, FARN

Family practice is not simply the practice of caring for individuals across the lifespan. Contrary to the perceptions of many students who enter the world of family practice, it is not simply to care for people “from womb to tomb.” Practice that is guided by that philosophy risks missing so much, not only regarding the individual patient’s own health but the family dynamics and the tangible and intangible aspects of the family that impact the individual patient. If the “family” aspect of family practice is ignored or neglected, then the clinician is simply caring for individuals as any clinician would and cannot really style themselves as a family practice clinician regardless of title or certification.

To practice as a family practice clinician, it is important to have a basic understanding first about what is meant by “family” and then how the family is integrated into the plan of care and ultimately often becomes the “patient.” In previous work about home health clinicians, this author found that home health clinicians care for the “patient entity,” which is defined as all those who impact or potentially impact the patient’s health. In family practice, the clinician also cares for and, at the very least, considers the patient entity when developing and pursuing a plan of care for an individual who seeks health care.

The meaning of “family” has undergone significant societal change. Consequently, it is important that the clinician not make assumptions about who is “family” and who is not. It is important to ask the patient who they consider their family. As I write this, society, both nationally and globally, is undergoing the crisis brought on by the coronavirus. Aside from the medical implications, the virus is already having an impact on how people interact with each other. We are required to practice “social distancing,” which requires us to maintain our relationships, whether personal or professional, in other ways besides close proximity or touching. Neighbors are calling to check in on the elderly, especially those who don’t have family nearby, and older adults are checking on the young parents in their neighborhoods who are working from home while trying to manage children who are unable to attend school due to the pandemic. What is the definition of family during a crisis like this? How will we keep each other from becoming socially isolated?