Vol 13, No. 07 September 18, 2008
The September meeting was held at Peerless, in Johnson City, TN. The meeting was sponsored by Merck and Dr. William McCann of Allergy Partners of Western North Carolina presented the topic, “Assessment and Management of Asthma Control.”
Presentation Highlights
Definition of Asthma: Chronic inflammatory disorder of airways characterized by episodic and reversible airflow obstruction and airway hyper-responsiveness
- Characterized by
- SOB
- Coughing
- Wheezing
- Chest tightness
- Combination of above symptoms
Prevalence: ~ 80% in US. Reason for increase not clear.
Burden
- 1.3 mil hospital visits
- 1.8 mil ER visits
- 4,210 deaths (2004) and falling
- 12.3 mil provider visits
- 504,000 hospital discharges
Response to Therapy: depends on genetic make-up, comorbidities, race and ethnicity, obesity and smoking
Factors
- Genetics (Il-4, HLA alleles)
- Environment (hygiene hypothesis—raising our kids in environments that are “too clean”)
- Triggers (viruses, exposure to allergens, smoke, pollutants, ASA)
- Defects in target organs (bronchial epithelium)
Pathophysiology
- Eosinophils: increased in airways of asthmatics
- Lymphocytes: produce pro-inflammatory cytokines, increase eosinophils, and are involved in the development in airway hyper-responsiveness
- Mast Cells: activation/release of bronchoconstriction mediators
- Neutrophils: increased in airways and sputum of persons with severe asthma, smokers and in acute exacerbations
- Epithelial Cell Injury: exacerbated by presence of abnormal repair process
Leukotrienes (Mast cells)
- Cause bronchoconstriction
- Recruit eosinophils
- Promote inflammatory process by recruiting neutrophils
Airway Remodeling
- Involves charges in the structure of the airways
- Role in the pathophysiology of asthma
- Caused by prolonged inflammation
- Highly variable from person to person
- Can lead to irreversible airflow limitations
- KEY: Adult asthma determined by severity of childhood asthma and how aggressively it was treated (i.e., undertreated may lead to airway remodeling and irreversible airway changes)
GINA and NAEPP Guidelines
- Emphasis on asthma control
- Assessment split into 2 measures: disease severity and intrinsic intensity of disease
NAEPP Goals of Therapy
- Reduce Impairment
- Reduce Risk
**See www.nhlbi.nih.gov/guidelines/asthma/index.htm for the National Heart Lung and Blood Guidelines for Asthma Management and attached PDF of the newest guidelines that you can download for free. This is the website that Dr. McCann based his entire presentation off of and include several charts that would be too complex to include in the newsletter otherwise.**
Non-Pharmacologic Treatments
- Allergen avoidance
- Assess and treat comorbidities (GERD)
Assess inhaler technique (particularly in patients that are not responding as you think they should)
Business Meeting
The regular meeting of the Northeast Tennessee Nurse Practitioners Association was called to order at 7:30 PM on September 18, 2008, at Peerless, in Johnson City by President Vickie Lewis.
Approval of Minutes
- The minutes of the previous meeting were unanimously approved as distributed
Treasurer’s Report
- $12,459.34 as of September 18, 2008
- Includes $1000 contribution to TNPAC and $60 quarterly payment to Mark Hossler for website management
- Paula Countiss (former Treasurer) received a $35 cash payment at the August meeting, but the name was not included. Please let Heather Greene, Secretary (hgreene13@myway.com or Linda Quillen, Treasurer (glassygirl@charter.net) know if you were responsible for this payment so proper credit can be given to you ASAP!
New Business
- Kathy Sharp presents a few topics of interest from the recent JNP (Journal for Nurse Practitioners, Sept 2008) involving the DNP and education for patients on Coumadin:
- President of ACNP, Julie Stanik-Hutt, PhD, ACNP, CCNS reported that in the face of recent challenges (AMA and its Scope of Practice Partnership), NPs have united instead of going against one another (as usual nursing history predicts). Included is the published document, Nurse Practitioner DNP Education, Certification and Titling: A unified Statement.
- In the Letter to the Editor in the same journal, NPs are encouraged to stay abreast of the issue and not argue amongst ourselves in order to prevent a similar situation that fragmented APNs when the dispute among certificate and MSN NPs surfaced many years ago.
- AHRQ Guide helps patients on Coumadin therapy. Go to www.ahrq.gov/consumer/coumadin.htm. A print copy is available by sending an email to ahraqpubs@ahrq.hhs.gov
Old Business
- NETNPA has been solicited by different companies run advertisements, banners, job postings, etc on our website. There are no guidelines in the by-laws regarding this. Vicki Lewis suggested the Executive Committee meet and discuss this further before presenting it back to membership again.
- New board members to take positions this month:
- Linda Quillen to replace Paula Countiss as Treasurer.
- Claudia Corradino and Teresa Martin to co-chair VP position and replace Kay Bone.
- Much thanks to Paula and Kay for their years of excellent service.
Legislative News
Education
- Pressure Ulcer Prevention Seminar at ETSU on October 3, 2008. Dr. Braeden to present (of the Braeden pressure ulcer scale).
- Please consider participating in the National Memory Screening Day November 18, 2008 sponsored by the Alzheimer’s Foundation of America (AFA). Contact 866-AFA-8484 or info@alzfdn.org for more information.
- Practicing Clinicians Exchange (PCE) offers free contact hours on multiple topics in regional cities across the country. This is specifically for NPs and PAs. Teresa Martin has participated and highly recommends it. Please visit the website at www.practicingclinicinas.com for more information. She also recommends Pri-Med (for all levels of providers) and it also offers AANP credit. See www.Pri-Med.com for more info. Online credit is available with both.
Job availability:
- Washington County Health Department in Johnson City position placed on hold until October.
- The Oncology Department at Blue Ridge Medical Specialists is looking for FT NP with Oncology experience preferred, but not necessary. Please call Dr. Sue Prill at 423-968-2311 if interested.
- Johnston Memorial Cancer Center in Abingdon, VA is looking for FT Oncology NP, experience preferred, but not necessary. Please call Joe Davis, practice administrator, at 276-739-2273 for more info.
- Bristol Internal Medicine and Pediatrics (Dr Shelby Olds and Dr Bernie Grunstra) are seeking PT and FT NP. Known to be an NP friendly/supportive group. Contact 423-844-6700 for more info.
Next Meeting:
- The October NETNPA meeting will be held on Thursday, October 16th, at Stir Fry Cafe, 125 Broad Street, Kingsport.
Topic: A Case Study Approach to Managing Insomnia
Speaker: Ashvin Patel, MD
Sponsor: Angie Rasnick, Sepracor
Time: 6:30
RSVP: corradinofnp@charter.net
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