The 2022 American Association of Nurse Practitioners (AANP) national conference provided more than 350 sessions on topics ranging from treatment of obesity in primary care to delivery of virtual neurology care. As Clinical Advisor’s roving reporter, the following are my pick of the top 5 sessions based on feedback from NPs at the conference as well as applicability to everyday practice for nurse practitioners.
Possible Rhabdomyolysis Case
As we enter the summer season, we start with A Curious Case of Rhabdomyolysis by Sara Edmund, DNP, FNP-C, PMHNP-BC. This presentation received some of the highest reviews from conference attendees. This topic is particularly relevant for sports physicals and primary care. Dr Edmund presented the case of a 19-year-old college student who presented to the emergency department (ED) with complaints consistent with rhabdomyolysis. The patient, however, had no risk factors for rhabdomyolysis, did not participate in activities that generally lead to rhabdomyolysis, and his urine drug screen was negative.
The patient was seen in the ED twice more without an etiology uncovered. The presentation covered the patient’s laboratory values, other diagnostic tests, eventual diagnosis, referral outcomes, and treatments. The session serves as a reminder for NPs to be keenly aware of the importance of considering rhabdomyolysis in the differential diagnosis of summer season pathologies.
As NPs, we are aware of the importance of understanding autism spectrum disorder in everyday practice. A great review of the practical diagnostic process was provided by Alyssa Burkhart, MSN, FNP-C, in the session Autism Spectrum Disorder: Training for HealthCare Providers.
Autism spectrum disorder is the fastest-growing developmental disability in the US and a growing number of these patients are being seen in our offices. “Health care providers receive very little, if any, education on how to care for these patients in health care settings,” said Burkhart, who is also a mother of a child with autism spectrum disorder. This lack of education and training can result in an escalation of preventable behaviors during office visits, resulting in missed diagnosis, preventable injury, and poor treatment plans.
Burkhart outlined strategies to prevent and manage challenging behaviors in children and adults on the spectrum with adjustments to the physical examination, examination room accommodations, and sensory tools. Examples included giving patients the choice of where and how they are examined or allowing them to play, talk, sing or draw to distract themselves from the examination. Additionally, providing patients with a sensory box (filled with sensory and fidget balls) and visual aids (such as communication boards for nonverbal individuals) may make visits more enjoyable and understandable.
Practical tools presented in the session included a list of appropriate strategies and accommodations for managing challenging behaviors and children and adults with autism spectrum disorder. When patients with autism spectrum disorder show signs of agitation, clinicians should stop, pause, and readjust their care accordingly, Burkhart said. Enlisting the help of the patient’s caregiver for recommendations on how to keep the patient calm or reevaluating whether you truly need information from examinations that they might find triggering or uncomfortable (eg, taking temperature or measuring height). The speaker ended with a summary of how to understand and prevent escalation of behaviors.
The session Acute Coronary Syndrome: Diagnosis and Management of the New Myocardial Infarction by Kathy Noyes, DNP, APRN, FNP-BC, ACNP-BC, received phenomenal reviews and ratings. Dr Noyes presented evidence demonstrating how the diagnosis of myocardial infarction has evolved and the spectrum of symptom presentation, diagnostic markers, and evidence-based management. This unique spectrum now identified as acute coronary syndrome (ACS) is important for all clinicians to understand. Dr Noyes covered practical knowledge of pathophysiology for the clinical spectrum of ACS along with drug therapy options used in the management of this syndrome. The speaker also provided a review of the ACC/AHA Updated Guidelines for the medical management of ACS. The practical nature of the “can’t be missed diagnosis” made this presentation a favorite pick for relevance in NP practice.
Case Studies in Orthopedics
In the excellent presentation on orthopedics, Case Studies in Orthopedic Management: An Expert Approach. Zachary A. Lerner, APRN, DNP, FNP, and Karen Myrick, DNP, APRN, ONP, FNP-BC, reviewed 5 case studies, 2 of which involved possible drug seeking or drug diversion, to help providers increase their comfort levels in managing orthopedic patients in both a specialty and nonspecialty settings.
The first case is a 37-year-old man who rolled his ankle walking down steps. The patient describes feeling a pop. The patient is prescribed ibuprofen, naproxen, meloxicam, celecoxib, and acetaminophen. The patient prefers oxycodone and is already taking buprenorphine/naloxone for opioid use disorder. What should the provider do? Check the prescription drug monitoring program (PDMP), contact the prescriber of the buprenorphine/naloxone, and be honest with the patient, the presenters said.
The second case involved a 12-year-old girl who broke her wrist (distal radius fracture) during cheer practice. The fracture occurred from a fall on outstretched hand (FOOSH) injury. The patient was treated and prescribed ibuprofen and acetaminophen/codeine for severe pain. The mom called requesting something stronger “such as oxycodone.” What should the provider do? Check the PDMP for the daughter as this might indicate parental opioid diversion (frequent opioid fills from multiple providers) and contact the patient’s pediatrician to assess the patient’s situation.
The last 3 cases involved a 54-year-old woman with right hip pain, 56-year-old woman with shoulder pain, and 16-year-old boy with right knee pain. The presenters described orthopedic case evaluation, appropriate examination techniques, differential diagnosis, and treatment strategies. They ended with a matching game for common orthopedic presentations. Whether you are practicing in primary care or orthopedics, these case studies provided an important background when implementing care in everyday practice.
Antiviral Therapy Review
To wrap up our top picks for this year’s conference sessions, we chose a review of antiviral therapy for health care providers. Antiviral therapy has garnered special interest during the COVID-19 pandemic. In the case-based presentation Antiviral Medications: A Pharmacological Review, Jeffrey Kwong, DNP, ANP-BC, FAANP, FAAN, provided an overview of the mechanism of action of common antiviral medications used for respiratory infections, herpes infections, human papillomavirus (HPV), and viral hepatitis. Dosing considerations, common side effects, and evidence-based recommendations were reviewed. A review of contraindications for commonly used antivirals was included.
Visit Clinical Advisor’s meetings section for complete coverage of AANP 2022.
American Association of Nurse Practitioners. 2022 AANP National Conference session spotlight: kicking off a week of learning. News release. June 23, 2022. Accessed July 14, 2022. https://www.aanp.org/news-feed/2022-aanp-national-conference-session-spotlight-kicking-off-a-week-of-learning