Latest Comments by reeya

reeya 5,379 Views

Joined: Jan 23, '11; Posts: 122 (24% Liked) ; Likes: 56
from US

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    Her Sm antibodies were negative as well. She might have other underlying condition. ACA and anti RNA pol I/III was not run last time but good to know to differentiate the type of scleroderma. I am her PCP and very aware of compromised immune system. She never had any other medical issues ever except occasional cold/cough/fever/allergies. She was not taking any meds regularly. Very healthy person. When she came in this time, she had multiple vague symptoms. It is very scary people can be very healthy and all of a sudden can be so sick.

    Thank you so much for your help. You answered all my questions.

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    Thank you for your response. If you don't mind telling me how were you able to distinguish from the series that it is diffuse scleroderma and not limited scleroderma? Patient is in her early 40s (F). I have already referred her to a rheumatologist. It is good to know about the HLA gene sequencing. I will discuss about it on her next visit. So safe to say from the above series she does not have SLE right?

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    Its bad everywhere. I waited 6 months before getting hired. I moved out of state to get my first job. But, sadly with my first NP job, I lasted only 2.5 months. I quitted because as a new grad there was no supervision and the internist wanted me to see about 32 patients in a 8 hrs shift. Immediately, 3 days after quitting the first job, I got another job which I love and currently working (still out of state) but learning a lot. Never get more than 26 patients in a 10 hr shift.

    Even 2.5 months experience counted.

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    Thyroid peroxidase antibody (TPO Ab) is initially drawn along with TSH w/ reflex to T4, T3 total, Free T3, Reverse T3 when a person is suspected for Hashimoto thyroiditis, idiopathic myxedema, Graves disease, and Riedel thyroiditis. TPO Ab is also drawn initially along with aldosterone, cortisol, ACTH when a person is suspected of adrenal crisis. Once a diagnosis is established, TPO Ab is not oftenly rechecked unless pt. quit taking meds for at least more than 6 months to yrs or in case of overdose of meds.

    Synthroid and cytomel dosages are adjusted based on TSH, T4, T3. In the same way, steroids and vasopressors are based on cortisol, ACTH level for adrenal crisis. TPO Ab helps to diagnose severe hypo or hyper extremes of thyroid or adrenal gland and is not used to adjust dose.

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    How would you interpret the following lab?

    ANA: positive.
    dsDNA: negative
    SSA: positive
    SSB: negative
    SCL-70: positive
    RNPe: negative.

    My understanding was chances of Lupus (SLE) is low if Sm antibodies and dsDNA is negative? My reference book tells me otherwise. The antibodies overlap in each disease. I am having difficulty how to distinguish between Lupus with secondary Sjogren's (Vs.) primary Sjogren's?

    Based on above lab, my diagnosis is Scleroderma and Sjogren's Syndrome? I might be wrong but help me out here.

    Q 1. But could it be primary SLE with secondary Sjogren's?
    Q 2. Could it be just SLE? (which I doubt but help me please)
    Q.3. Could it be just Sjogren's?

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    LuxCalidaNP, myelin, zmansc, and 1 other like this.

    More training hours, advanced anatomy & physiology, lab pathology, introduction to radiology would be a nice replacement to current courses like introduction to adv. nursing practice, adv role and policy, community health, nursing theory/ethics etc.

  • 2
    SnowShoeRN and Tinabeanrn like this.

    Please look into APEA...its geared towards AANP. With limited time, I would recommend APEA course. Go to her website. There's live, cd or online review course.

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    Anyone applied to Duke DNP for fall 2013? I am about to apply there but would like to hear from anyone who've applied there already? Any advice or tips to be a successful candidate? I will send my completed packet sometime by the end of this week.

    I am also going to apply CSU-consortium colleges, UNLV in addition to Duke. Vanderbilt is just too expensive but have heard good things about Vanderbilt.

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    Any thoughts on these schools, experience applying or as a current student? Any pros and cons.

  • 1
    Tinabeanrn likes this.

    I joined CANP today. Thank you Juan for detail information.

  • 0

    Quote from Tinabeanrn
    Hi Reeya! So are NPs now independent in California? Do you all still need a collaborative agreement?
    To be honest, I don't know? I don't think so. I want to ask the same question to Juan, are NP independent in CA? like in Arizona, New Mexico etc.

    Also, I got a letter from CA board that I need to take additional 3 cr hour pharm course to be able to prescribe schedule 2&2N drugs. My DEA was approved for other schedule drugs. Which CE pharm courses fulfills this board requirement. The board says it approves courses approved by CA NP Association but I don't see any pharm courses specific to schedule 2&2N.

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    What is the percentage of chart check a MD should perform for an NP in California? I know for PA its 5% in CA but I hear different numbers from different people for NP. There is confusion lately since MD supervision for NPF license was removed effective this January. Does that mean once a NP gets all NP/NPI/NPF/DEA licenses no supervised chart check is required from this January??

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    Oh well, didn't see your previous comment. Good luck with your program since you've already started it.

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    OHSU has a pretty good program (both MD and NP). My precepting MD for my internal medicine rotation was OHSU med school grad. He was great and taught me so much during my clinicals. I love PNW and its culture.

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    I moved out of state because I was not getting job as a new grad. Look beyond your city and state. NP market is so saturated these days. No one wants to train a new grad