Advanced Practice Nursing Procedures

561 Pages·2020·80.017 MB·English

by  Margaret R. Colyar

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ADVANCED PRACTICE

NURSING
PROCEDURES

SECOND EDITION
Margaret R. Colyar , D SN , APRN , C - FNP
Family Nurse Practitioner
Hannibal Clinic
Hannibal, Missouri
F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2020 by F. A. Davis Company
Copyright © 2020 by F. A. Davis Company. All rights reserved. Th is book is protected by copyright.
No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from
the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher: Susan R. Rhyner
Manager of Project and eProject Management : Catherine Carroll
Content Project Manager: Amanda Minutola
Design and Illustration Manager: Carolyn O’Brien
As new scientifi c information becomes available through basic and clinical research, recommended
treatments and drug therapies undergo changes. Th e author(s) and publisher have done everything
possible to make this book accurate, up to date, and in accord with accepted standards at the time
of publication. Th e author(s), editors, and publisher are not responsible for errors or omissions or for
consequences from application of the book, and make no warranty, expressed or implied, in regard
to the contents of the book. Any practice described in this book should be applied by the reader in
accordance with professional standards of care used in regard to the unique circumstances that may
apply in each situation. Th e reader is advised always to check product information (package inserts)
for changes and new information regarding dose and contraindications before administering any drug.
Caution is especially urged when using new or infrequently ordered drugs.
Library of Congress Control Number 2014959076
ISBN: 978-0-8036-9813-0
Authorization to photocopy items for internal or personal use, or the internal or personal use of
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Th is book is lovingly dedicated to Stephen Colyar, Andrea
Brown, Michelle Helm, and Courtney Kaul.

Preface
Th e new nurse practitioner and the practicing nurse practitioner in the ambulatory
care setting must be prepared to perform an increasing array of skills competently
to meet patient care needs. Th e inspiration for this book came when, on graduat-
ing from a nurse practitioner program, I found no procedural resources directed
toward the needs of the nurse practitioner in ambulatory care. Th e need to perform
many procedures—those not taught in my nurse practitioner program—was appar-
ent. Th e physician I practiced with required a knowledge base in procedural skills
greater than the one I possessed. Fortunately, this physician was willing to teach
me the necessary procedures. Th is improved care to our patients and decreased the
necessity to refer many patients for procedures easily performed in the ambulatory
care (outpatient) setting.
Th is text was developed to assist in the many demands on the newly graduated
nurse practitioner and the nurse practitioner currently in practice. We believe the
procedures outlined will improve the marketability of the nurse practitioner and
serve as a good reference tool for family and/or adult nurse practitioners in an
ambulatory care setting. Prerequisites for this book are basic anatomy and physiol-
ogy, microbiology, pharmacology, principles of aseptic technique, and basic nursing
skills. Th is book would be an appropriate text for incorporation of procedural
techniques throughout a family or an adult nurse practitioner curriculum. It also
would be appropriate for an elective on minor surgery and diagnostic procedures
and interpretation. Another potential use for this book would be as part of the
protocol/guidelines in the nurse practitioner ’ s practice.
Many procedures performed by primary care physicians are not currently appro-
priate for the nurse practitioner to perform. Th e procedures in this book were
chosen based on a comprehensive study of types of procedures currently used in the
nurse practitioner ’ s practice. Many of the procedures can be used in any ambulatory
setting.
Some of the procedures need specialized equipment, and some use equipment
commonly found in any offi ce. A few of the procedures—fl exible chest tube
insertion, colposcopy, endometrial biopsy, IUD insertion and removal, sigmoid-
oscopy, and thrombosed hemorrhoid removal—require additional training. Th ey
are included for reference only. Check with your state board of nursing if you are
unsure whether or not a certain procedure may be performed by nurse practitioners
in the state in which you practice.
Th e major theme of this book is clinical application of knowledge and clini-
cal skills. Th ere are seven sections in the book. Th ese sections are based on body
systems for ease of classifi cation. Each major section begins with diagnostic proce-
dures the nurse practitioner performs with the basis for their interpretation. Next
vii
viii Preface
in each section, listed in alphabetical order, are procedures performed in an ambu-
latory care setting.
Each procedure contains seven parts. First, an Overview is presented, outlining
causes, incidence, and other specifi c information intrinsic to each procedure. Th e
Health Promotion/Prevention section gives tips to the nurse practitioner to pass on
to the client to help promote health or prevent the need for the procedure in the
future. Options lists one to four methods of performing the procedure and gives
a choice of how to perform the procedure. Th e Rationale section gives reasons to
perform the procedure. I ndications tell the nurse practitioner when the procedure
should be performed, and Contraindications tells the nurse practitioner when not
to perform the procedure. Th e Procedure section lists the necessary equipment and
gives step-by-step instructions for performing each procedure listed under O ptions .
Client Instructions assist the nurse practitioner with postprocedure instructions,
listing what the client must and must not do to have an optimal recovery period.
At the end of each is a bibliography for further information gathering.
We hope you will fi nd this text to be a good learning tool and a great resource
in your practice.
Acknowledgments
We acknowledge the following people for their contributions, assistance, and
patience while compiling this book: Susan Rhyner, Publisher at F.A. Davis, for
believing in the merits of this book, and Denise Melomo, artist, for her expertise
in sketching the line drawings that guided the illustration team who created the
artwork in the fi rst edition of this text.
Many colleagues at Tri County Family Health Care in Madison, Florida, and
Family Health Service in Ocala, Florida, were instrumental in this book. Colleagues
at Rapides Regional Medical Center, Alexandria, Louisiana; Jackson Parish Hospital,
Jonesboro, Louisiana; Hannibal Clinic, Hannibal, Missouri; and Stansbury Medical
Center, Stansbury Park, Utah, posed for the photographs in the book. Th ese models
include Linda Alby, Steve Colyar, Hugh Gentry, Cindy Grappe, Aleene Hale, Lane
Helm, Debra Lefl er, Anne Martin, Mitzi Buckman, Cathy Taylor, and Shaneal
Wright.
ix