J Am Acad Nurse Prac
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J Am Acad Nurse Prac · Dec 2003
Review Case ReportsAn approach to postmenopausal osteoporosis treatment: a case study review.
To review and discuss the clinical evaluation and therapeutic options for a postmenopausal woman with osteoporosis. ⋯ Drugs currently approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis include the bisphosphonates risedronate and alendronate; the selective estrogen receptor modulator, raloxifene; and intranasal calcitonin-salmon spray. Bisphosphonates have demonstrated the most impressive fracture risk reduction in prospective clinical trials of women with postmenopausal osteoporosis. Risedronate has consistently demonstrated significant reductions in vertebral fracture risk at 1 year and in vertebral and nonvertebral fracture risk at 3 years. Alendronate has demonstrated significant reductions in vertebral and nonvertebral fracture risk after 3 years.
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J Am Acad Nurse Prac · Dec 2003
ReviewDiagnosis and management of neuropathic pain: a balanced approach to treatment.
To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. ⋯ Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.
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To discuss the causative factors, clinical course, and current treatment modalities for Ludwig's angina, a submandibular cellulitis, and to raise nurse practitioners' (NPs') awareness of this condition. ⋯ Education and awareness are crucial for successful diagnosis of and management of treatment for Ludwig's angina. Although NPs have a limited role in the treatment of Ludwig's angina, their ability to recognize the signs and symptoms will prompt emergency care and treatment and facilitate better outcomes for their clients.
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Migraine headaches are the source of significant disability for many individuals and their management can present a considerable clinical challenge. The American Academy of Family Physicians (AAFP) and American College of Physicians--American Society of Internal Medicine (ACP-ASIM) "Pharmacologic Management of Acute Attacks of Migraine and Prevention of Migraine Headaches," provides a succinct, evidence-based resource for primary care nurse practitioners. In addition to reviewing this clinical practice guideline, this column describes related supporting documents.