NETNPA
June 21, 2007

Our June 2007 meeting was held Thursday, June 21, at 6:30 PM at the Peerless in Johnson City.  The speaker Dr. Phillip Jones, discussed the topic "Management of Inflammation and Brochoconstriction in Adults and Children with Asthma."  Our generous sponsor was Aaron Cruise from Glaxo/Smith/Kline.

Meeting Highlights

Reminder that the Partnership for Prescription Assistance is available for patients who have trouble with their donut hole, or who do not have prescription coverage.  Call
1-888-4PPA-NOW (1-888-477-2669) for information

Asthma – Chronic inflammatory disorder of airways with variable obstruction, recurrent symptoms, and which involves mast cells, eosinophils, T lymphocytes, and neutrophils.

Affects 8 to 10% of pediatric population and causes 5000 deaths per year.
Results in 2 million ER visits per year and 500,000 hospitalizations per year.
Direct care cost is $11.5 billion per year.  Indirect cost is $5 billion per year.

Asthma is a combination of 3 pathological events:
            1) Hyperactive airways
            2) obstruction
            3) inflammation
This can progress from acute inflammation to chronic inflammation to remodeling of airways to potentially irreversible damage.

Control:  The definition of control varies whether it is the patient, the parent, or the healthcare provider’s viewpoint.  Providers more interested in the # of episodes, while patient may be more focused on activity interruptions and symptoms.  Parents may be interested in overall school attendance and performance, as well as severity of symptoms. 

Control is measured by:
           1) patient report,
           2) day/night symptoms,
           3) lung function,
           4) missed work/school,
           5) healthcare utilization (urgent and unscheduled visits),
           6) Inflammation (measured by eosinophils in sputum)

Poor control usually has more than one cause.
Control is generally overestimated by patients and healthcare providers.

The newest guidelines say:
            1) prevent symptoms day and night,
            2) minimize the need for rescue inhalers,
            3) work toward normal or near normal PFTs,
            4) maintain normal activity. 

To do this the healthcare provider must:
            1) Identify and decrease risk factor exposure,
            2) identify allergens
            3) manage symptoms appropriately. 

Use the rule of “2’s” – more than albuterol 2 nights a week, 2 days a month or > 2 refills of inhaler per year indicates poor control.

If there is poor control: 
           1) confirm diagnosis of asthma,
           2) look at poor monitoring by pt,
           3) provider may be underestimating severity,
            4) underuse of inhaled steroids,
           5) continued exposure to smoke, allergens, etc.,
           6) other factors such as GERD, sinus disease, allergic rhinitis, unknown occupational exposure {especially in new onset asthma in adults}, or taking ASA

Global Initiative for Asthma Control released in 11/06.  Now classified as
            1) controlled – goal is find lowest dose of meds to maintain
            2) partly controlled – step up meds to achieve control
            3) uncontrolled – find out what results in response

General Treatment Steps
            1) low dose inhaled steroids
            2) low dose inhaled steroids plus long-acting beta agonist
            3) medium or high dose inhaled steroids plus long-acting beta agonist
            4) oral steroids

Allergic Rhinitis

1. affects 40 million Americans
2. 6th most prevalent chronic illness
3. Is a quality of life burden with work-activity interruptions, fatigue and daytime sleepiness
4. Is the most common reason for dcreased work productivity

Veramyst is newest treatment:
            It has an exact amount in delivery system
            It is scent free
            Is a potent steroid with low volume in each dose
            Unique delivery system allows viewing of the amount left in bottle
                          

President Kathy Sharp welcomed the speaker, the sponsor, and the members, and expressed thanks to the sponsor and speaker. 

SECRETARY REPORT:  Minutes were posted on the website and accepted as correct
TREASURER REPORT:  Current balance is $12,991.35

OLD BUSINESS       
           
Congratulation to our NP of the Year , Kay Bone, who received her award on May 8th at the Nurses Day celebration. 

Reminder:  NETNPA will have the positions of President and Secretary up for  election in August.  Nominations will be accepted now and up until the next meeting.  Ballots will be sent email to all paid members after the July meeting .  New officers will be notified so they have an opportunity to be mentored for a month by the outgoing officers.  Jeannie Walls has been nominated for president but declined due to other obligations.

Survey on the DNP.  Members asked to do the survey at www.npjournal.org
           
NEW BUSINESS

Discussion on the DNP in North Carolina

Copies of the recently completed salary survey article were shared with those present.  The article will be in the summer issue of the Tennessee Nurse, scheduled to come out next week.

Communication from Cheri Glass at TNA announcing a special on-hour documentary titled “A Profession and a Passion:  Nursing in Tennessee.  It will premier tomorrow in the 3 major markets, Memphis, Nashville, and Knoxville on Comcast Cable Channel 50.  Cheri stated that the producer is working on getting the video aired on our local channels.  We will communicate that to you when we have more information.

TNA will be hosting a conference for next year with planning input provided by the 3 NP organizations, ie Greater Memphis, Middle Tennessee and us.  I will be participating in the planning stages and would like input on topics of interest. What is a reasonable cost, what is the best day, etc.

JOBS – Details of all jobs are on the website

            Cardiovascular Associates in Bristol – Full-time Nurse Practitioner for office
            and hospital.  Contact their office for more details.

            Buchanan Health Center – NP for small family clinic

            Washington County Health Department – primary care NP for TN disenrollees.
            M-F 8:30-5 pm with an hour for lunch.  No narcotic prescriptions handled.  Good
            benefits.  Applicant must go onto the State Registrar through the internet. 
            Contact Linda McClure at 423-979-4682 or via email at
            Linda.McClure@state.tn.us. 

            Jonesboro Elementary School – NP for 1 day per week from 8 am to 3 pm,
            Contact Jeannie Walls at ETSU for more information.