Moderator ventana Posted March 25, 2022 Moderator Share Posted March 25, 2022 Two cases this week by fnp urgent care 1) three days of cold. Dx viral uri. Given augmentin! 2) pt goes to UC with cold complaints. Long story short on Cxr really decent new onset cardiomegally (about 65-70% width). Notes she had two other people look at it and they didn’t think it was big. No ekg. Sent home with doxycycline. I see in follow up. EKG is ugly and send (via ambulance) to ER. Spent day there. Cards consult and definity U/S and labs to dc home with close follow up. Abx do not cure virus! huge heart on CXR (new finding compared to old film) in younger person is a non sh** moment. Not give doxycycline and send home. they have enough rope they might just hang themselves. Just watch. There is going to be studies coming out demonstrating inferior care and outcomes from “mid-levels”. Then we get to fight both AMA and ANA. Gawd I hope we are independent with mandatory fellowships or I am retired. I honestly would hesitate to see an NP that I did not know. 4 Quote Link to comment Share on other sites More sharing options...
MediMike Posted March 25, 2022 Share Posted March 25, 2022 11 hours ago, ANESMCR said: Requested a plavix hold clearance for endoscopy on a pt recently. H/o CABG, PCI x7 stents on DAPT. It was being Rx’d by an FNP. Got the clearance back today telling us to hold his plavix for TEN flipping days……wtf. To top it off, at the very bottom under the FNPs name header and credential, she took the time to literally hand write in “Autonomous Nurse Practitioner” Ya know what? Know what Imma do for you? Imma give you two weeks. Not 5 days like everyone else would do, not 10 days like some schmuck, but 14 days! Howza that sound eh? 2 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted March 25, 2022 Share Posted March 25, 2022 (edited) Ok one more anecdote and I'm punching out of this conversation... About 7 or 8 months ago I spontaneously developed wracking chills and no other obvious symptoms. Went to the local UC. Young NP sees me (maybe not that young. the older I get the harder to tell) does a fairly cursory exam and offers me... you guessed it.... antibiotics and a steroid. I asked what he was treating. Why your symptoms of course! No labs...no xray. I politely suggest we at least do a CBC. Why sure! I won't have it back until tomorrow. No problem say I...I'll hold off on meds for now. Next morning the phone rings.... good morning your WBCs are 24 k. Ready for those antibiotics and steroids now? Nope.... going to the ER. At the ER I am evaluated by another NP. Cursory exam but a butt load of tests. I'd say some weren't necessary but I'm happy to be getting a workup. WBCs now 28k, everything else unremarkable. We just aren't sure what is going on but here's a rx for antibiotics and steroids. Really? How about we look at my urine? That is the one basic test you didn't order. I had no urinary symptoms but my urine was yup. Loaded with WBCs etc. I actually asked if he had ever probed a prostate. Nope..... OK here's 10 days worth of Cipro. Close but no cigar. I say treatment should be 4 to 6 weeks. He is shocked! We NEVER give antibiotics for that long. I take his prescription so I can get started and call my PCP who orders the rest of the treatment. Certainly not indicative of all NPs but probably emblematic of the shake and bake schools. That's my best recollection at this point. I may have missed a couple of details. Edited March 25, 2022 by sas5814 1 3 Quote Link to comment Share on other sites More sharing options...
kettle Posted March 25, 2022 Share Posted March 25, 2022 32 minutes ago, sas5814 said: I had no urinary symptoms but my urine was yup. Loaded with WBCs etc. I actually asked if he had ever probed a prostate. Nope..... OK here's 10 days worth of Cipro. Close but no cigar. I say treatment should be 4 to 6 weeks. He is shocked! We NEVER give antibiotics for that long. Hope you are feeling better! Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 26, 2022 Share Posted March 26, 2022 12 hours ago, sas5814 said: OK here's 10 days worth of Cipro. Close but no cigar. I say treatment should be 4 to 6 weeks. He is shocked! We NEVER give antibiotics for that long. I take his prescription so I can get started and call my PCP who orders the rest of the treatment. Interesting, EMRA says 2-4 weeks of treatment. Assuming that you've lived approximately the same number of decades as me, did you get any information about the risks associated with flouroquinolones? Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 26, 2022 Moderator Share Posted March 26, 2022 On 3/24/2022 at 9:03 PM, ANESMCR said: Requested a plavix hold clearance for endoscopy on a pt recently. H/o CABG, PCI x7 stents on DAPT. It was being Rx’d by an FNP. Got the clearance back today telling us to hold his plavix for TEN flipping days……wtf. To top it off, at the very bottom under the FNPs name header and credential, she took the time to literally hand write in “Autonomous Nurse Practitioner” Ugh I think I would politely call her and ask for a reference on where she came up with 10 days and why she would want to expose her patient to stent occlusion more then necessary? An autonomous NP should know this.... 1 Quote Link to comment Share on other sites More sharing options...
sk732 Posted March 27, 2022 Share Posted March 27, 2022 On 3/25/2022 at 8:02 AM, sas5814 said: Ok one more anecdote and I'm punching out of this conversation... About 7 or 8 months ago I spontaneously developed wracking chills and no other obvious symptoms. Went to the local UC. Young NP sees me (maybe not that young. the older I get the harder to tell) does a fairly cursory exam and offers me... you guessed it.... antibiotics and a steroid. I asked what he was treating. Why your symptoms of course! No labs...no xray. I politely suggest we at least do a CBC. Why sure! I won't have it back until tomorrow. No problem say I...I'll hold off on meds for now. Next morning the phone rings.... good morning your WBCs are 24 k. Ready for those antibiotics and steroids now? Nope.... going to the ER. At the ER I am evaluated by another NP. Cursory exam but a butt load of tests. I'd say some weren't necessary but I'm happy to be getting a workup. WBCs now 28k, everything else unremarkable. We just aren't sure what is going on but here's a rx for antibiotics and steroids. Really? How about we look at my urine? That is the one basic test you didn't order. I had no urinary symptoms but my urine was yup. Loaded with WBCs etc. I actually asked if he had ever probed a prostate. Nope..... OK here's 10 days worth of Cipro. Close but no cigar. I say treatment should be 4 to 6 weeks. He is shocked! We NEVER give antibiotics for that long. I take his prescription so I can get started and call my PCP who orders the rest of the treatment. Certainly not indicative of all NPs but probably emblematic of the shake and bake schools. That's my best recollection at this point. I may have missed a couple of details. I have to ask, what is this fascination with ordering steroids for something if you don't know what you're phuquing treating? 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 27, 2022 Moderator Share Posted March 27, 2022 1 hour ago, sk732 said: I have to ask, what is this fascination with ordering steroids for something if you don't know what you're phuquing treating? I wanna know too cause they give them out like dinner mints locally. 1 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted March 28, 2022 Share Posted March 28, 2022 13 hours ago, sk732 said: I have to ask, what is this fascination with ordering steroids for something if you don't know what you're phuquing treating? This is just speculation but steroids give sort of an energy boost and if, like me, you have aches and pains it generally makes them feel better for a while. Its a feel good drug most of the time. Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted March 28, 2022 Share Posted March 28, 2022 If you think the NPs will be bad, wait until more pharmacists throw a hat in the ring. https://www.chronicleonline.com/news/local/pharmacists-to-diagnose-and-treat-sick-relieving-other-health-care-professionals/article_0029747b-d80a-5a9f-b0da-aaee337ab4b2.html From the article: Quote Florida requires pharmacists to take one additional 20-hour class to perform the diagnostic service, but nothing more. 20 hours. LOLOL. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 28, 2022 Moderator Share Posted March 28, 2022 2 hours ago, sas5814 said: This is just speculation but steroids give sort of an energy boost and if, like me, you have aches and pains it generally makes them feel better for a while. Its a feel good drug most of the time. yeah and fast forward 20 years and everyone has brittle bones, and the DM are obese...... from recurrent pred packs, over and over and over..... just stop the madness!! Quote Link to comment Share on other sites More sharing options...
Hope2PA Posted March 28, 2022 Share Posted March 28, 2022 8 hours ago, CAAdmission said: If you think the NPs will be bad, wait until more pharmacists throw a hat in the ring. https://www.chronicleonline.com/news/local/pharmacists-to-diagnose-and-treat-sick-relieving-other-health-care-professionals/article_0029747b-d80a-5a9f-b0da-aaee337ab4b2.html From the article: 20 hours. LOLOL. Assuming they will not be dependent providers like assistants. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 29, 2022 Share Posted March 29, 2022 "physician's assistant" - can't even get our profession right Quote Link to comment Share on other sites More sharing options...
sk732 Posted April 3, 2022 Share Posted April 3, 2022 On 3/28/2022 at 7:44 AM, sas5814 said: This is just speculation but steroids give sort of an energy boost and if, like me, you have aches and pains it generally makes them feel better for a while. Its a feel good drug most of the time. I can get that...I do use them on a few occasions (wicked tonsilitis most commonly), but it almost sounds like quackery and gives folks unrealistic expectations of getting better quicker than they really are. This I suspect is a byproduct of McMedicine practices around both our countries. 1 Quote Link to comment Share on other sites More sharing options...
CAdamsPAC Posted April 5, 2022 Share Posted April 5, 2022 On 3/24/2022 at 11:28 PM, ventana said: Two cases this week by fnp urgent care 1) three days of cold. Dx viral uri. Given augmentin! 2) pt goes to UC with cold complaints. Long story short on Cxr really decent new onset cardiomegally (about 65-70% width). Notes she had two other people look at it and they didn’t think it was big. No ekg. Sent home with doxycycline. I see in follow up. EKG is ugly and send (via ambulance) to ER. Spent day there. Cards consult and definity U/S and labs to dc home with close follow up. Abx do not cure virus! huge heart on CXR (new finding compared to old film) in younger person is a non sh** moment. Not give doxycycline and send home. they have enough rope they might just hang themselves. Just watch. There is going to be studies coming out demonstrating inferior care and outcomes from “mid-levels”. Then we get to fight both AMA and ANA. Gawd I hope we are independent with mandatory fellowships or I am retired. I honestly would hesitate to see an NP that I did not know. They were just practicing "Advanced Nursing" who are we to judge nursing practice? Quote Link to comment Share on other sites More sharing options...
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