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Aortic regurgitation (AR) is a valvular disease characterized by retrograde blood flow from the aorta to the left ventricle. Various etiologies result in either an acute or chronic clinical presentation of AR and affect the severity of disease progression. Acute AR is a medical emergency caused by sudden increases in left ventricular volume. Immediate surgical intervention, vasoactive agents, and antibiotics are crucial for management. Chronic AR progresses gradually, leading to heart failure symptoms due to left ventricular remodeling. Diagnoses of both acute and chronic AR rely on electrocardiography, chest radiographs, and echocardiography. Cardiac magnetic resonance imaging may be incorporated in chronic AR diagnosis. Medical management of chronic AR aims to control hypertension and delay left ventricular dysfunction. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers are recommended for chronic AR. ß-Blockers are cautioned against because of their potential negative effects. This article emphasizes the importance of early diagnosis and prompt surgical intervention in AR. This review provides a comprehensive overview of the pathophysiology and clinical manifestations of acute and chronic AR and a medication regimen for treating chronic AR in the adult population. [ABSTRACT FROM AUTHOR]

The article describes the case of a 65-year old male patient with a medical history of COPD, hypertension, type 2 diabetes mellitus and stage 3A chronic kidney disease and was diagnosed with rectus sheath hematoma (RSH). The patient demonstrated cardiomegaly, progressive abdominal pain, ecchymosis, abdominal distension and metabolic acidosis. The clinical presentation and classification of RSH, complications, common signs and symptoms, and treatment are discussed.

Drug therapy for patients with systemic lupus erythematosus (SLE) aims to decrease symptom severity. Pharmacologic interventions are divided into four categories: antimalarials, glucocorticoids (GCs), immunosuppressants (ISs), and biological agents. Hydroxychloroquine, the most commonly used antimalarial treatment for this disease, is a mainstay in treating all patients with SLE. The multitude of adverse reactions of GCs has led clinicians to minimize their dosages or discontinue them whenever possible. To speed up the discontinuation or minimization of GCs, ISs are used for their steroid-sparing properties. Furthermore, certain ISs such as cyclophosphamide are recommended as maintenance agents to prevent flares and reduce the reoccurrence and severity of the disease state. Biological agents are recommended when other treatment options have failed due to intolerance or inefficacy. This article presents pharmacologic approaches for managing SLE in patients based on clinical practice guidelines and data from randomized controlled trials. Drug therapy for patients with systemic lupus erythematosus (SLE) aims to decrease symptom severity. Pharmacologic interventions are divided into four categories: antimalarials, glucocorticoids, immunosuppressants, and biological agents. Hydroxychloroquine, an antimalarial, is a mainstay in SLE treatment. Glucocorticoids should be tapered or discontinued whenever possible due to their multitude of adverse reactions. Immunosuppressants are often used for their steroid-sparing properties and as maintenance agents to prevent flares and reduce disease severity. Biological agents may be used for refractory disease. This article presents pharmacologic approaches for managing SLE in patients based on clinical practice guidelines and data from randomized controlled trials. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Understanding factors that affect integration of NPs is likely to address barriers and provide reform strategies that shape a cost-effective, sustainable, accessible, and efficient health care system. There are a limited number of current and high-quality studies examining the transition process of registered nurses (RNs) to nurse practitioners (NPs), especially in Canada. PURPOSE: To explore the experiences of RNs transitioning to NPs in Canada. METHODOLOGY: Thematic analysis of audio-recorded semi-structured interviews was conducted to explore the experiences of 17 RNs as they transitioned to NPs. A purposive sampling of 17 participants was completed in 2022. RESULTS: Six main themes emerged from analysis of 17 interviews. The content of themes varied according to NPs' years of experience and the NP school they attended. CONCLUSIONS: Peer support and mentorship programs were facilitators in the transition from RN to NP. Conversely, shortcomings in education, financial stressors, and the lack of NP role definition were seen as barriers. Legislation and regulations supportive of NPs, diverse and comprehensive education, and improved availability of mentorship programs may strengthen transition facilitators and help NPs overcome related barriers. IMPLICATIONS: Legislation and regulations supportive of the NP role are needed, focusing on defining the NP role and establishing an independent and consistent remuneration structure for NPs. A more in-depth and diversified educational curriculum is needed, with increased support from faculty and educators and continual encouragement of initiation and perpetuation of peer support. A mentorship program is beneficial to reduce transition shock from the role of the RN to the NP. [ABSTRACT FROM AUTHOR]

Effective management of dyslipidemia is of paramount importance to prevent cardiovascular (CV) complications. Using current clinical practice guidelines is recommended to correct lipid levels and prevent further pathologic processes. This article presents an overview of treatment options for patients with dyslipidemia and CV disease, with a special focus on the following drug classes: HMG-CoA reductase inhibitors (also called statins), cholesterol absorption inhibitors (ezetimibe), bile acid sequestrants, fibrates, icosapent ethyl, and PCSK9 inhibitors. [ABSTRACT FROM AUTHOR]

In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed. In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed. [ABSTRACT FROM AUTHOR]

Selecting noninvasive diagnostic tests for coronary artery disease can be a daunting task to acute care NPs. This article provides an overview of the pathophysiology of coronary artery disease, relevant noninvasive diagnostic imaging modalities, and an evidence-based approach to guide subsequent diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Acute pulmonary embolism is a challenging and potentially fatal disease that requires prompt assessment and precise management. Due to the lack of specific symptoms, NPs need to know how to identify a pulmonary embolism to manage it safely. This article discusses risk factors, initial approach, and diagnosis of acute pulmonary embolism using pretest probability and risk stratification tools. A mnemonic is proposed to guide medical management. [ABSTRACT FROM AUTHOR]

Background: The scope of practice of nurse practitioners (NPs) is expanding, and an increasing number of registered nurses (RNs) are advancing their careers to become NPs. Nurse practitioners are prepared to improve access to high-quality care and enhance care standards. The barriers and facilitators in the transition of RNs to NPs have been seldom studied in the Canadian context. Objective: To conduct a scoping review to identify systemic barriers and facilitators affecting Canadian RN experience in transitioning to independent practice as NPs. Data Sources: Four electronic databases were searched for primary studies, and several search engines were used to retrieve gray literature. Keywords included NP, transition, novice, Canada, barriers, obstacles, facilitators, and their variations. Eligible studies are those published from the inception of each respective database to 2021. Conclusions: Four research studies and one report in the gray literature were located. Three themes were identified from the literature review, including inconsistencies in education and the need for mentors, need for legislation supportive of NP practice, and inconsistent remuneration structures for NPs. Implications for Practice: Addressing systemic barriers and employing systemic facilitators are likely to facilitate the transition of RNs to NPs. The lack of primary evidence to explore the factors that affect the transition process from an RN to an NP in Canada indicates that further research must be done. Findings from the future research are likely to furnish a better understanding of the transition process so that the integration of new NPs into the health care system can be achieved efficiently. [ABSTRACT FROM AUTHOR]

Acute pulmonary embolism (PE) is a potentially fatal condition that is often underdiagnosed due to its ambiguous and generalized symptoms. As such, nurse practitioners (NPs) may struggle to respond in a timely and accurate manner to clients presenting with acute PE. Given the complexities of diagnosing and managing PE, we propose a visual clinical care pathway to support NPs in recognizing and stratifying clients' risks of PE. The article provides guidance regarding PE diagnostic testing and offers a summary of effective, evidence-based treatment options for adult clients, including those with cancer. [ABSTRACT FROM AUTHOR]

Contrast-induced nephropathy is the leading cause of acute kidney injury in hospital settings. Practitioners must have a comprehensive understanding of preventive interventions. This article provides a mnemonic NPs can use to prevent contrast-induced nephropathy. The mnemonic, CHIPS, addresses C ontrast minimizations, H emofiltration, I so-osmolar/low osmolar contrast, P harmacologic interventions, and S aline I.V. hydration. Contrast-induced nephropathy is the leading cause of acute kidney injury in hospital settings. Practitioners must have a comprehensive understanding of preventive interventions. This article provides a mnemonic NPs can use to prevent contrast-induced nephropathy. The mnemonic, CHIPS, addresses Contrast minimizations, Hemofiltration, Iso-osmolar/low osmolar contrast, Pharmacologic interventions, and Saline I.V. hydration. [ABSTRACT FROM AUTHOR]

The article focuses on the management strategies for ST-segment elevation (STE)-acute coronary syndrome (ACS). Topics discussed include Persistent electrocardiographic (ECG) STE-ACS reflects an ongoing transmural myocardial ischemia and necrosis; and Acute care NPs are in an ideal position to diagnose and manage STE-ACS by implementing guideline-driven medical interventions.

Aim: To develop a substantive theoretical explanation that makes sense of the decision‐making process that clinical instructors use to place students on a learning contract. Background: Clinical instructors are challenged with the task of objectively evaluating students using subjective tools such as anecdotal notes, diaries, unstructured observations and verbal feedback from other nurses. Clinical instructors' assessment decisions have a considerable impact on a variety of key stakeholders, not least of all students. Design: Grounded theory method and its heuristic tools including the logic of constant comparison, continuous memoing and theoretical sampling to serve conceptualisation were used in the process of data collection and analysis. Methods: Seventeen individual semi‐structured interviews with clinical instructors in one university in Western Canada were conducted between May 2016–May 2017. Data were analysed using open, axial and selective coding consistent with grounded theory methodology. The study was checked for the Standards for Reporting Qualitative Research (SRQR) criteria (See Appendix S1). Findings: Three subcategories, "brewing trouble," "unpacking thinking" and "benchmarking" led to the study's substantive theoretical explanation. "Gut feeling" demonstrates how clinical instructors reason in their decision‐making process to place a student on a learning contract. Conclusion: Placing a student on a learning contract is impacted by personal, professional and institutional variables that together shift the process of evaluation towards subjectivity, thus influencing students' competency. A system‐level approach, focusing on positive change through implementing innovative assessment strategies, such as using a smart phone application, is needed to provide some degree of consistency and objectivity. Relevance to clinical practice: Making visible the objective assessments currently being done by clinical instructors has the potential to change organisational standards, which in turn impact patient and clinical outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the approaches for management of diabetic ketoacidosis. Topics discussed include life-threatening diabetic emergency involving homeostatic imbalance and damaging compensatory processes; acute care Nursing Practitioners require a standardized protocol that implements best evidence and prioritizes care; and triglycerides within adipose tissue are hydrolyzed, creating a surge in free fatty acid delivery to the liver.