The Family Nurse Practitioner

Crises like these imply a new definition of family. Technology allows us to keep in contact despite the prohibition on being physically within six feet of another human being. A crisis like this reminds us how vulnerable we are as human beings, not only to disease but to loneliness and despair. Knowing that others care about us takes on even greater significance. We are reminded that “family,” however we define it, is crucial to our survival.

As clinicians, we are just as vulnerable but have the advantage of a vast store of medical knowledge. As laypersons disseminate misconceptions about how to prevent and treat the virus, nurse practitioners and our health professions colleagues are stepping up to make sure the public has accurate health care information.

Our care of individuals and families does not just take place in the clinic or health care setting. It occurs via every encounter we have with the people in our communities and across cyberspace. The coronavirus crisis illustrates that while we have better means of communication than in years past, we are also vulnerable to more misinformation.

The cases in this book were chosen in an attempt to illustrate mostly typical (and some atypical) cases that occur in family practice. Remembering the impact “family” has on our physical and mental health and that the patient is part of a subsystem within the larger family system can help the reader see that the patient’s illness or condition not only impacts the patient but potentially has a ripple effect on many others both within and outside of the family system.

AAA:Abdominal aortic aneurysm AACE:American Association of Clinical Endocrinologists AAP:American Academy of Pediatrics ABG:Arterial blood gas ABI:Ankle brachial index ACC:American College of Cardiology ACIP:Advisory Committee on Immunization Practices ACL:Anterior cruciate ligament ACS:Acute coronary syndrome ADHD:Attention‐deficit hyperactive disorder ad lib:At liberty or whenever the patient wants to do something AGS:American Geriatrics Society AHA:American Heart Association AMI:Acute myocardial infarction or heart attack ANA:Anti‐nuclear antibody AP:Anterior‐posterior APA:American Psychiatric Association Apgar:The score given to newborns at 1 minute and 5 minutes after birth. The newborn is scored on activity (muscle tone), pulse, grimace (reflex irritability), appearance (skin color), and respirations. AS:Active surveillance BD:Blastomycoses dermatitidis BDI:Beck Depression Inventory BMI:Body mass index BMP:Basic metabolic panel BP:Blood pressure BS:Bowel sounds BUN:Blood urea nitrogen CAD:Coronary artery disease CAM:Complementary and alternative medicine or Confusion Assessment Method CBC:Complete blood count, with or without diff (differential) CBT:Cognitive behavioral therapy CCB:Calcium channel blocker CCRC:Continuing care retirement community CKD:Chronic kidney disease CLI:Critical limb ischemia CLIA:Clinical Laboratory Improvement Amendment CMP:Complete metabolic panel CMT:Cervical motion tenderness COC:Combined oral contraceptive pill COPD:Chronic obstructive pulmonary disease COWS:Clinical Opiate Withdrawal Scale CRP:C‐reactive protein C‐SSRS:Columbia–Suicide Severity Rating Scale CT:Computed tomography CTA:Clear to auscultation CVA:Cerebrovascular accident CXR:Chest X‐ray D&C:Dilatation and curettage DASH:Dietary Approaches to Stop Hypertension DDVAP:Desmopressin acetate vasopressin DEA:Drug Enforcement Agency DFA:Direct fluorescent antibody (testing) DMARD:Disease‐modifying antirheumatic drug DMPA:Depo‐Provera DoD:Department of Defense DOE:Dyspnea on exertion DRE:Digital rectal examination DVT/PE:Deep vein thrombosis/pulmonary embolism DXA:Dual‐energy absorptiometry EBV:Epstein‐Barr virus ECG:Electrocardiogram ED:Emergency department EEG:Electroencephalogram ELISA:Enzyme‐linked immunosorbent assay EM:Erythema migrans EMA:Endomysial antibody EMDR:Eye movement desensitization and reprocessing ENT:Ear, nose, and throat EOB:Explanation of benefits EOM:Extraocular movement EPT:Expedited partner therapy ESPGN:European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ESR:Erythrocyte sedimentation rate ETOH:Alcohol (drinking kind) FBG:Fasting blood glucose FBS:Fasting blood sugar FIT:Fecal immunochemical test FM:Fibromyalgia FROM:Full range of motion FTT:Failure to thrive GABHS:Group A beta‐hemolytic streptococci GAD:Glutamic acid decarboxylase GC/CHL:Gonorrhea/chlamydia GCA:Giant cell arteritis GCS:Glasgow Coma Scale GDMT:Guideline‐directed medical therapy GDS:Geriatric Depression Scale GERD:Gastroesophageal reflux disease GFR:Glomerular filtration rate GI:Gastrointestinal GINA:Global Initiative for Asthma HA1c:Hemoglobin A1c HCV:Hepatitis C virus HPV:Human papilloma virus HR:Heart rate HRI:Heat‐related illness HSDD:Hypoactive sexual desire disorder HSM:Hepatosplenomegaly HSV:Herpes simplex virus HT:Hormone therapy HTN:Hypertension HZO:Herpes zoster opthalmica IBD:Inflammatory bowel disease IBS:Irritable bowel syndrome IgA:Immunoglobulin A IgE:Immunoglobulin E ITP:Idiopathic thrombocytopenic purpura IUC:Intrauterine contraception IUD:Intrauterine device KOH:Potassium hydroxide KUB:Kidneys, ureters, and bladder LARC:Long‐acting reversible contraceptives LDH:Lactic acid dehydrogenase LEAP:Learning Early About Peanut LFT:Liver function test LLSB:Left lower sternal border LMP:Last menstrual period LNMP:Last normal menstrual period LR:Light reflex LRI:Lower respiratory infections LROM:Limited range of motion MCI:Mild cognitive impairment MCP:Metacarpal phalangeal (joint) MCV:Mean corpuscular volume MDD:Major depressive disorder MDI:Metered dose inhaler MGF:Maternal grandfather MGM:Maternal grandmother MI:Myocardial infarction or motivational interviewing MMSE:Mini‐Mental State Examination MoCA:Montreal Cognitive Assessment MRI:Magnetic resonance imaging MRSA:Methicillin‐resistant Staphylococcus aureus MSSA:Methicillin‐susceptible Staphylococcus aureus MSU:Monosodium urate MTP:Metatarsophalangeal (joint) MVI:Multiple vitamin NAAT:Nucleic acid amplification test NAD:No apparent distress NAPNAP:National Association of Pediatric Nurse Practitioners NARES:Nonallergic rhinitis with eosinophilia syndrome NIAAA:National Institute of Alcohol Abuse and Alcoholism NICU:Neonatal intensive care unit NIDA:National Institute on Drug Abuse NKDA:No known drug allergies NKFA:No known food allergies NOF:National Osteoporosis Foundation NP:Nurse practitioner NPH:Normal pressure hydrocephalus NSAID:Nonsteroidal anti‐inflammatory drug NSTEMI:Non‐ST elevation myocardial infarction NSVD:Normal spontaneous vaginal delivery NT/ND:Nontender/nondistended OA:Osteoarthritis O2 sat:Oxygen saturation OCP:Oral contraceptive pill ODD:Oppositional defiant disorder OGTT:Oral glucose tolerance test OP:Osteoporosis OSA:Obstructive sleep apnea OTC:Over‐the‐counter (medication) OUD:Opioid use disorder PAD:Peripheral artery disease PCOS:Polycystic ovarian syndrome PCR:Polymerase chain reaction PDA:Patent ductus arteriosus PE:Pulmonary embolism PEG:Polyethylene glycol PEP:Post‐exposure prophylaxis PERRLA:Pupils equal, round, reactive to light and accommodation PGF:Paternal grandfather PGM:Paternal grandmother PH/G:Pubic hair/gonads PHN:Postherpetic neuralgia PHQ:Patient Health Questionnaire PID:Pelvic inflammatory disease PIP:Proximal interphalangeal (joint) PLP:Phantom limb pain PMDD:Premenstrual dysphoric disorder PMR:Polymyalgia rheumatica PMS:Premenstrual syndrome PNE:Primary nocturnal enuresis PPD:Postpartum depression PPI:Proton pump inhibitor PRN:As needed PSI:Pneumonia Severity Index PTSD:Post‐traumatic stress disorder PVD:Peripheral vascular disease QD:Once daily RAI:Radionucleotide uptake scan with iodine RED‐S:Relative energy deficiency in sports REM:Rapid eye movement RICE:Rest, ice, compression, and elevation ROS:Review of systems RR:Respiratory rate RRR:Regular rate and rhythm RSV:Respiratory syncytial virus RUQ:Right upper quadrant SAFE‐T:Suicide Assessment Five‐Step Evaluation and Triage SAMHSA:Substance Abuse and Mental Health Services Administration SANE:Sexual assault nurse examiner SART:Sexual assault response team SBHC:School‐based health center SBIRT:Screening, Brief Intervention, and Referral for Treatment SEM:Systolic ejection murmur SERM:Selective estrogen receptor modulator SGA:Small for gestational age SIB:Self‐injurious behavior SJS:Stevens‐Johnson Syndrome SLE:Systemic lupus erythematosus SM:Stroke mimic SNRI:Serotonin norepinephrine reuptake inhibitor SSP:Syringe services program SSRI:Selective serotonin reuptake inhibitor STI:Sexually transmitted infection SUD:Substance use disorder SWS:Slow‐wave sleep TANF:Temporary Assistance for Needy Families TBI:Traumatic brain injury or toe brachial index TBSA:Total body surface area TCA:Tricyclic antidepressant TEN:Toxic epidermal necrosis TENS:Transcutaneous electrical nerve stimulation TM:Tympanic membrane TPO:Antithydroperoxidase antibody TRAb:Thyrotropin receptor antibody TRUS:Transrectal ultrasound TSH:Thyroid‐stimulating hormone tTG:Tissue transglutaminase TTN:Transient tachypnea of the newborn TTP:Tenderness to palpation ULT:Urate‐lowering therapy URI:Upper respiratory infection USPSTF:U.S. Preventive Services Task Force UTI:Urinary tract infection VA:Veterans Administration VCF:Vertebral compression fracture VCUG:Voiding cystourethrography VDRL:Venereal disease research laboratory VZV:Varicella zoster virus WBC:White blood cell WHI:Women’s Health Initiative WIC:Women, Infants, and Children Supplemental Nutrition Program