Module 4: RN Management of Common Chronic and Acute Complaints in the Primary Care Setting

Introduction

The purpose of this module is to provide an overview of the common RN skills used in the primary care care setting, including taking a patient’s history and conducting a physical examination. This course follows the United States Preventive Services Task Force (USPSTF) screenings recommendations. The module reviews common chronic and acute chief complaints related to body systems. RN skills, management, and patient education related to these common complaints are also reviewed.

Learning Outcomes

prepare for a complete history and physical exam using USPSTF recommendations for age-appropriate primary care screenings
describe the RN’s clinical skills and management of patient’s common chief complaints and patient education required in the primary care setting
describe the RN’s role related to common referrals and patient education

Reading Assignment

Module 4: Registered Nurse Management of Common Chronic and Acute Complaints in the Primary Care Setting

Read the chapter in your textbook, then review the content in this online module. When you are ready, take the final exam for this module in Sakai.

History-taking and Physical Exams

Watch the following video, Primary Care – Periodic Health Exam: By Ted Osmun M.D. (YouTube video), as a review of the types of examinations and physicals that should occur throughout the lifespan.

[ add images of the three key populations for periodic exams: babies, teens, and middle age ]

Review preventive services that have an A or B grade from the US Preventive Services Task Force (USPSTF) that are relevant for implementing the Affordable Care Act. The recommendations are presented in alphabetical order and by release date of current recommendation.

Then, review information on the Affordable Care Act and Preventive Services.

A standardized physical exam is required for interstate commercial motor vehicle drivers. In order to maintain a license, commercial motor vehicle drivers require a current Medical Examiner’s Certificate to drive. View an example of the Medical Examination Report Form the US Department of Transportation (DOT). The current form expires on 8/31/2018.

A screening examination is also required by the North Carolina High School Athletic Association for high school sports participation. Review the Sport Participation Examination form [PDF]. The schools will often have parents also complete a Concussion Information Sheet.

BMI and Weight

Watch the following video on maintaining a healthy weight.

Below is an explanation of BMI for adults provided by the CDC website:

For infants and children/teens, height/weight/BMI are calculated based on growth charts and percentages. The CDC recommends that health care providers use the World Health Organization (WHO) growth charts for infant up to 2 years of age children and CDC provides growth charts for 2 years and old. Here are the recommended CDC links for infants and children.

Recommended growth charts for infants and children

Use the WHO growth standards to monitor growth for infants and children ages 0 to 2 years of age in the U.S.
Use the CDC growth charts for children age 2 years and older in the U.S.

The CDC also has a calculator for BMI Percentile Calculator for Child and Teen.

Hypertension and Million Hearts Resources

NC Start with your Heart provides a free blood pressure refresher course that is “intended to update health care providers on current concepts in hypertension detection, evaluation and treatment,” which is available at: Start with Your Heart: Blood Pressure Refresher Course.

Review the example of a quality improvement project using “Starting the Conversation” brochures and resources for self-management support for hypertension is available at: Start with Your Heart.

Watch the following video, which presents a clinic that works with patients with hypertension through a care-managed organization.

Provider toolkits and patient information on cardiovascular disease is also available online via the Million Hearts website.

Vaccinations

The following video is about teaching patients the importance of childhood vaccinations.

For further information and training, visit the NC Immunization Branch at The North Carolina Immunization Registry (NCIR). The Recommended Immunization Schedule for Persons Aged 0 Through 18 Years, United States, 2016, can be found and downloaded at Center for Disease Control and Prevention website.

It’s important to be vaccinated across the lifespan. The following video outlines the vaccinations that are recommended for older adults.

Recommendations and the suggested schedule for adults can be found on the CDC website. For questions on BCG, the CDC is a good resource, but any positive tuberculosis (tb) skin tests must be reported and follow up with your local health department, communicable disease division.

Chronic Disease Self-management Support

Substance Use and Abuse

Recommended screening, prevention and management of addiction to alcohol and drugs can be found in this report: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health.

Currently, there is an opioid epidemic in the United States. This informational video on the causes of opioid abuse and its origins is helpful to the nurse. Nurses should work with the primary care team to develop a comprehensive plan and treatment protocol in the office.

The nurse’s role in using screening tools in a primary care setting. One reason identification of problem drug and alcohol use is so important.

Care of the Patient with Chronic Illness

The National Institute of Health (NIH) provides evidence-based guidelines and resources for asthma, COPD and other chronic diseases such as hypertension. These guidelines and resources are available at Systematic Evidence Reviews and Clinical Practice Guidelines.

The NCDHHS also has The North Carolina Asthma Plan 2013-2018 – NC Asthma Program. For asthma self-management, ask about asthma triggers, night time symptoms and normal peak flows; the NC Community care has an easy to follow Asthma Action Plan for patient self-management education.

The Community Guide website provides additional information on how to manage diabetes, arthritis and other chronic diseases in the community.

The North Carolina Division of Aging and Adult Services (DAAS) and the Division of Public Health (DPH) offer North Carolina’s Initiative to Implement Stanford’s Chronic Disease Self-Management Program (CDSMP) and Diabetes Self-Management Program (DSMP).

This video provides an overview of the way health care workers can assist patients to manage their chronic disease.

Unfolding Case Study: Headache

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Key Points

In primary care, RNs are expected to use their skills to be able to:

complete a comprehensive or focused health history
document subjective findings in an organized manner
perform a comprehensive physical assessment
document objective findings from the physical assessment using correct medical terminology and abbreviations
plan patient care based on the patient’s health history, risk assessment and physical assessment across the life span to provide evidence based nursing care and health promotion for disease prevention

For health promotion and disease prevention, RNs should:

use age appropriate primary care recommended screenings (USPSTF)
document immunization history and follow recommended age appropriate vaccines based on CDC’s schedule for infant, child and adults
use nursing skills to assist in screening, diagnostic tests and management of patient’s common chief complaints seen in primary care
educate, promote, and support patients in evidence-based self-management care
assist with referrals for continuity of care as appropriate

Additional Sites

The following websites include information that expands on the information contained in this module and may be helpful in understanding it.

References

See the corresponding textbook chapter for a full list of references consulted in the development of this module.