November, 2010

Volume X, Issue XI

Fitzgerald Health

Education Associates, Inc

FHEA News

Click Here to See the Complete 2011 Schedule

10% off Physical

Assessment &

Health History of

the Child Cue

Cards, 7th Edition

Excerpt from the Nurse Practitioner Certification Examination and Practice

Preparation Margaret A. Fitzgerald

DNP, FNP-BC, NP-C, FAANP, CSP

11/11/2010 Dallas, TX

12/01/2010 Sacramento, CA

12/04/2010 Huntsville, AL

12/06/2010 Denver, CO

2011 Schedule

2010 Schedule

Inside this issue:

Take advantage of informa-tion and discounts available only to FHEA Facebook fans!

Upcoming Family and Adult NP Certification Exam Review

Courses GNP Certification

Alternative Criteria per

ANCC

2

Breastfed Infants are less

likely to Experience Fever

after Immunizations by

Marie L. Bosco

3

Need a Speaker? 3

Weight Loss Supplement

Recalled, by Emily Paquin 3

Administering Influenza

Vaccine in Egg Allergy Per-

sons, by Christy Yates, MSN, FNP-BC, NP-C, AE-C

4

Fitzgerald Health Education

Associates Company

Milestones

5

What our Customers Say... 5

The NP is In

by Jaclyn Fitzgerald 7

Advanced Pathophysiology

for NPs and Advanced

Practice Clinicians

9

Clinical Pharmacology for

NPs and Advanced Practice

Clinicians

10

Question and Answer, with

Margaret A. Fitzgerald DNP, FNP-BC, NP-C,

FAANP, CSP

11

Margaret Fitzgerald’s

Upcoming Speaking

Engagements

12

Offer of the Month

01/04/2011 North Andover, MA

01/07/2011 Baltimore, MD

01/07/2011 Oakbrook, IL

01/12/2011 Atlanta, GA

01/14/2011 Oakland, CA

01/21/2011 Cleveland, OH

02/01/2011 Manhattan, NY

02/26/2011 Minneapolis, MN

03/11/2011 Charlotte, NC

03/17/2011 Philadelphia, PA

03/23/2011 San Diego, CA

04/15/2011 Charleston, WV

04/20/2011 Atlanta, GA

04/29/2011 Greensville, SC

05/04/2011 Oakbrook, IL (Also Acute Care)

05/05/2011 Columbus, OH

05/06/2011 Newark, NJ

05/10/2011 Salt Lake City, NJ

05/13/2011 New Haven, CT

05/13/2011 Tampa, FL

05/16/2011 Boston, MA (Acute Care and Pediatric)

05/18/2011 Boston, MA (Also Women’s Health)

The following is an excerpt from Dr. Fitzgerald’s book, The Nurse Practitioner Certification Examina-tion and Practice Preparation. Based on the second edition which was an AJN Book of the Year award winner, the third edition features even more ques-

tions and content.

How would you answer these sample questions from the section on iron deficiency anemia?

1. Which of the following is most consistent with iron-deficiency anemia?

A. Low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH)

B. Low MCV, low MCH

C. Low MCV elevated MCH

D. Normal MCV, normal MCH

2. One of the earliest laboratory markers in iron-deficiency anemia is:

A. An increase in RBC distribution width (RDW)

B. A reduced hemoglobin level.

C. A low MCH level.

D. An increased platelet count.

(Answers and rationals on page 6)

Gerontological Nurse Practitioner Alternative Eligibility Ends December 31, 2010

Nurse practitioners who wish to apply for ANCC Gerontological Nurse Practitioner certification using alternate eligibility must submit an application by De-cember 31, 2010. Applications seeking certification through alternate eligibility that are received after December 31, 2010 will not be processed. Fitzgerald Health offers a gerontology package which provides 77.3 contact hours to meet the ANCC re-quirements. In addition, certified gerontologic nurse practitioners can use these as CE for recertification

(see details on next page).

Page 2 FHEA News

The ANCC has announced a certification test to enable licensed Adult, Family, and Acute Care Nurse Practitioners who treat older adults to use alternative eligibility criteria to qualify to sit for ANCC’s Gerontological Nurse Practitioner certification exam. Visit www.nursecredentialing.org for details. FHEA provides 77.3 contact hours to meet the ANCC requirements in the follow-ing three programs:

GNP Certification Alternative Criteria per ANCC

Comprehensive Gerontological Update Earn 35 contact hours* by taking FHEA’s Comprehensive Geron-tological Update designed specifically to help meet the eligibility re-quirements.

Aging Demographics

Health Assessment

Clinical Management of Acute and Chronic Illnesses: Skin, Car-diac, Respiratory, Gastrointestinal, Genitourinary, Gynecologic, Musculoskeletal (common arthritis problems), Neurologic, Endo-crine/Metabolic, Immunologic, Multisystem Disorders, Psycho-Social

Pharmacologic Issues in Older Adults (including Polypharmacy)

Geriatric Syndromes: Constipation, Dementia/Delirium, Anxiety/Depression, Falls, Failure to Thrive, Functional Loss, Inconti-nence, Sensory Loss, Sleep Disorders, Pain Management•

Palliative Care

Ethics

Advanced Directives

Elder Abuse/Neglect

The Nurse Practitioner/Patient/Family Relationship

Professional Role and Policy

Research Utilization

5 day live seminar $699. Also available on-line.

The Gerontological Pharmacology Package Earn an Additional 24.8 contact hours* from these lectures:

Antibiotic Update: A Focus on Treatment Options in Community-acquired Pneumonia.

Drug-drug & Drug-nutrient Interactions: A Focus on Common Problems.

Principles of Safe Prescribing: Pharmacokinetics, Pharmacodynam-ics, Pharmacogenomics, Drug Interactions.

Pharmacogenomics: Exploring Genetic Variation in Drug Metabo-lism.

Prescribing in the Elder.

The Golden Years: Understanding and Treating Skin in the Older Adult.

Refining Laboratory Assessment Skills in Drug Monitoring.

Evaluation of Renal Function.

Now available on-line for $109 or CD set for $160

Nurse Practitioner Advanced Practice Update—Gerontological Track

Review gerontological essentials to earn 17.5 contact hours* net of test preparation content. 2 day live seminar (or recorded) with additional 2 hours on-line. Available on-line for $260 or CD set for $381.

Preparing for Exam and Test Taking Strategies

Primary Prevention: Health Promotion and Immunization Secondary Prevention Geriatric Demographics Theoretical Foundations of Advanced Gerontological Nurs-

ing Practice Scope and Standards of Advanced Gerontological Nursing

Practice Wellness Assessment of the Gerontological Patient Age-related Physiologic Changes Illness Assessment of the Gerontological Patient Pharmacology Considerations in the Gerontological Patient Blepharitis, Macular Degeneration, Cataracts Hypertension, Coronary Artery Disease, Peripheral Arterial

Disease Pneumonia, Asthma, Pulmonary Embolus Constipation, Diarrhea, GERD, Diverticulitis, Abdominal

Pain UTI, BPH, Atrophic Vaginitis Arthritis, Gout, Osteoporosis Dementia, Delirium, Depression, Movement Disorders, TIA Diabetes, Thyroid Disorders, Anemias Skin Ulcers, Lesions, Decubitus Ulcers Select Ethical, Legal, Cultural, Epidemiologic and Profes-

sional Practice Issues (delivered via FHEA’s NPexpert on-line learning portal)

Now available on-line for $260, on CD set for $381 and live from $381 to $452.

* Post-tests included in fee for these programs.

For more information about these products visit

www.fhea.com

Need a Speaker?

If you are interested in having Dr. Fitzgerald or one of our other talented associates speak at your school, local, regional or national conference, please e-mail: services@fhea.com for more information. Conference

administrative services are also available.

Page 3

Study with a Master

Dr. Margaret A. Fitzgerald's Speaker School Fitzgerald Health Education Associates Conference Center

85 Flagship Dr, North Andover, MA 01845 March 3–4, 2011

Earn 14 Contact Hours!

If you have ever wanted to share your practice ex-pertise by speaking to other providers, or if you just want to improve your "platform skills," this is the seminar for you! This two-day intensive workshop will be led by Dr. Margaret Fitzgerald, one of the most experienced, well-known, and skilled NP speakers in the country. With more than one thou-sand presentations to her credit, she has been rec-

ognized by the NP community for her dynamic speaking abilities. Dr. Margaret Fitzgerald also earned the coveted Certified Speaking Pro-fessional (CSP) designation from the National Speakers Association. Dr. Margaret A. Fitzgerald's Speaker School will make extensive use of recorded practice presentations prepared by participants, re-corded in the FHEA studio, and critiqued by instructors and peers. Hands-on presentation preparation and slide development tech-niques will be covered. Also learn how to improve your "speaking voice." The workshop is limited to twenty participants. A personal laptop equipped with Microsoft PowerPoint will be required.

Click here for more information

FHEA News

Breastfed Infants are less likely to Experience Fever after Immunizations

by Marie L. Bosco, BSN, RNC, IBCLC

The American Academy of Pediatrics (AAP) has identified breastfeeding as the first immunization for newborns. It not only provides antibodies to protect against infection, but also helps immunizations to work better (AAP). Breastmilk boosts the newborns immune system allowing for a stronger response to the immunizations. New research pub-lished in Pediatrics in June 2010 showed that breastfeeding reduced the risk for fever after immunizations. Fever is one of the most common side-effects of infant immunizations. Of 460 infants included in this study, 25% of the infants who were exclusively breastfed developed a fever, 31% of par-tially breastfed infants developed fever, and 53% of exclu-sively formula fed infants developed fever after receiving their first or second dose of hexavalent combination vaccine (diphtheria, tetanus, acellular pertussis, hepatitis B, inactive polio virus, and Haemophilus influenzae type b). Mothers were taught how to measure and record their infant’s tem-perature the evening of the immunization along with the next 3 days. The information was recalled by phone on the third day after the vaccine. Why are breastfed infants less likely to be febrile? It may be the proinflammatory cytokines produced in response to the vaccine acting as pyrogens and the antimicrobial and anti-inflammatory components of breastmilk help to minimize febrile response by causing a decrease in the production of interleukin or of Toll-like receptor; this in turn affects ther-moregulation in the hypothalamus. In addition, breastfeed-ing likely provides comfort and emotional support to the infant. Breastfed infants also have higher caloric intake after immunization than infants that are not breastfed. The re-duced intake by formula fed infants may increase serum leptin and proinflammatory interleukin 1B leading to fever. Although further research is needed to replicate these re-sults, healthcare providers should support and encourage mothers to continue to breastfeed. Breastfeeding is best for both mothers and their infants. Breastfeeding after immuni-zation can be therapeutic and comforting to young infant.

References: American Academy of Pediatrics. Breastfeeding: Baby’s First Immunization, available at http://www.aap.org/breastfeeding/curriculum/documents/pdf/BFIZPoster.pdf, accessed October 15, 2010. Dinarello CA. Infection, fever, and exogenous and endogenout pyrogens: some concepts have changed. J Endotoxin Res. 2004; 10(4):201-222. Pisacane, A, Continisio P, Palma, O, Cataldo, S, De Michele F, Vairo, U. Breastfeeding and Risk for Fever After Immunization. Pediatrics Vol. 125 No.6 June 2010, ppe1448-e1452.

Weight Loss Supplement Recalled

by Emily Paquin

The obesity drug sibutramine (Meridia), manufactured by Abbott Laboratories, was recently recalled by the US Food and Drug Administration (FDA). Sibutramine is a prescription-only product and is not intended for use in over-the-counter diet pills. In a recent study, sibutramine was found to in-crease the risk for stroke, myocardial infarction risks, and caused a 16% increase in nonfatal heart attacks. Sibutra-mine can be found in other products including an over-the-counter drug called Slimming Beauty Bitter Orange Slimming Capsules. The FDA has advised healthcare professionals to discontinue the prescription of these drugs until further no-tice. In place of sibutramine, healthcare providers are being encouraged to prescribe other FDA approved weight loss supplements such as an over-the-counter supplement called Alli, or Xenical which is available by prescription. Orlistat (the generic form of Alli and Xenical) is also recommended. Read more

Fitzgerald Health Education

Associates Catalog Available On-line!

Page 4 FHEA News

Browse through FHEA products and seminars in this convenient on-line format

The 2010-2011 Influenza recommendations by the Cen-ter for Disease Control’s Advisory Committee on Immu-nization Practices (ACIP) include routine vaccination of all persons aged 6 months and older. The universal rec-ommendation emphasizes the importance of preventing influenza among all age groups and is supported by evidence that the vaccine is safe and effective. In addi-tion, removing the age and risk indications reduces bar-riers to vaccination. In general, anaphylactic reactions to vaccines are rare. There are approximately 235 million doses of vaccines administered in the United States each year, and ana-phylactic reactions are estimated to occur at a rate of approximately one per million doses. The 2010-2011 CDC guidelines recommend avoidance in persons with an anaphylactic hypersensitivity to eggs or to other com-ponents of the influenza vaccine unless they have been desensitized. A review of reports to the Vaccine Event Reporting System (VAERS) over a 15-year period from 1990 to 2005, during which 747 million doses of influ-enza vaccine were administered in the US, revealed four reports of death shortly after influenza vaccination that identified anaphylaxis as the cause. No information on egg allergy was provided nor was any evaluation performed to determine whether these were allergic reactions. Since influenza vaccines are grown in chick extraembry-onic fluid and contain micrograms of egg protein, there has been a concern for the potential risk of an allergic reaction when administering the influenza vaccine to an egg allergic person. To provide a comparison, the mea-sles, mumps, and rubella (MMR) vaccine contains pico-grams to nanograms of egg protein, which are clinically insignificant amounts. In the past, influenza manufactur-ers did not state the egg protein content of the vaccines; independent research laboratories found some egg pro-tein levels to be as high as 42 mcg/ml. Currently, most manufacturers provide this information in the package insert. The protein content also varies in any given years’ vaccine and between manufacturers. The 2009-2010 seasonal and H1N1 influenza vaccines manufac-tured by CSL Biotherapeutics, Inc., GlaxoSmithKline, MedImmune, LLC, and Novartis Vaccines and Diagnos-tics, Inc. all were reported to contain <1 mcg per dose. The lowest reported threshold for anaphylaxis during oral egg challenges is 130 mcg of egg protein (Taylor, S. et. al.). The safe administration of influenza vaccine containing up to 1.2 mcg of egg protein/ml has been reported in multicenter trials in egg allergic persons.

Administering Influenza Vaccine in Egg Allergy Persons: Are We Needlessly Avoiding Vaccinations? by Christy Yates, MSN, FNP-BC, NP-C, AE-C

Family Allergy & Asthma, Family Health Centers, Inc., Louisville, KY

Senior Lecturer, Fitzgerald Health Education Associates, Inc.

Editor’s Note: Christy Yates would like to thank Stephen Pollard, MD, for his input and support with this article.

A report in The Journal of Allergy and Clinical Immunology (Gagnon, et.al,2010) revealed the safe vaccination of 830 confirmed egg-allergic patients (approximately 90% less than 12 years of age) with a monovalent adjuvanted A/H1N1 pandemic vaccine manufactured in Canada by Glaxo-Smith-Kline. Among the 830 confirmed egg-allergic patients, 9% required two divided doses due to a history of respiratory or cardiovascular reactions after egg ingestion and 91% were vaccinated in a single dose since they had other egg-induced allergic reactions that were lower risk. No patient receiving the vaccine had an anaphylactic reac-tion. Further vaccination of more than 3,600 other children with egg allergy caused no anaphylaxis. The authors con-cluded that vaccination of patients with egg allergy with an adjuvanted monovalent A/H1N1 influenza vaccine resulted in no anaphylaxis and on that basis appears to be safe. However, these results cannot be generalized to all sea-sonal influenza vaccines, since the content of ovalbumin in the delivered vaccine was <0.015 mcg/ml, lower than in some seasonal influenza vaccines. Until recently, there were no parameters to guide health-care providers according to the egg protein level in the influenza vaccines and the patients’ risk for allergic reac-tion. Therefore, many healthcare providers withheld influ-enza immunizations for any reported egg allergy. This unfortunately left many individuals susceptible to influenza and the associated morbidities and mortality. The recent worldwide concern about H1N1 influenza and the known substantial benefit from H1N1 and seasonal influenza vac-cination has accelerated efforts over the last few years to reduce another barrier to receiving influenza vaccines: possible needless avoidance of immunization due to egg allergy. (Continued on page 8)

Page 5 FHEA News

What our Customers Say… I took the certification exam yesterday and passed! I just wanted to express my gratitude to you for your FNP certification exam prep course. I haven’t taken the exam in 10 years. I stalled on applying for the exam because I couldn’t imagine how I’d study. I took the FNP/ANP review course in Oak Brook, IL in early January. The class, on-line materials and study guides and other items I purchased made all the difference. Thanks for your instruction and for the very professional way it was deliv-ered. The on-line modules were represented on the exam (cultural sensitivity, cultural competence, and prenatal care). I feel more knowledgeable and mindful of the importance of keeping current with primary care to do my job better.

—Patricia K. Musto DNP

Fitzgerald Health Education Associates Company Milestones

FHEA Announces New Team Member

Fitzgerald Health Education Associates, Inc. is pleased to announce that Kimberly Dempster-Gonzalez, MAOM, has joined their staff in the newly created position of Director of Academic, Corporate and Government Marketing. Mrs. Dempster-Gonzalez will lead FHEA’s marketing and sales ef-forts as they expand their business presence in the academic (university), corporate and government sectors both nationally and internationally. Mrs. Dempster-Gonzalez has a master’s degree in organizational management and brings to FHEA extensive professional experience working with cor-porate, pharmaceutical, academic and association relations, communications and development. For the last 12 years, Mrs. Dempster-Gonzalez held the position of Director of Development and Operations for the American Academy of Nurse Practitioners Foundation (AANP Foundation), the first national foundation working to support and benefit nurse practitioners of all specialties which began opera-tions in 1998. This previous experience makes her uniquely qualified to undertake new FHEA business endeavors and activities. The daughter of a nurse practitioner, Mrs. Dempster-Gonzalez has been ad-vocating for NPs both personally and professionally for almost four decades. ―We are very excited to have Kimberly join our team,‖ states FHEA Founder, President and Princi-pal Lecturer Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP. ―She has a rich professional background and innovative ideas that we know will compliment and facilitate FHEA’s growth and con-tinued national and international leadership in NP education and development.‖ FHEA Weddings in the Dominican Republic FHEA employee Jeff Turner married Rosana Padilla on October 3, 2010 in Cotui, Dominican Republic. FHEA employee Johanna Cabrera married Joseph Walker on October 9, 2010 at the Barcelo Resort in Puerto Plata, Dominican Republic. Best wishes to the newlyweds!

Notice of System Maintenance for Testing and Learning Site

Routine maintenance is scheduled for November 20, 2010. FHEA is committed to providing our customers maximum uptime, reli-ability, and security for our On-line Testing and Learning Site. Regular system maintenance is critical to achieving this goal.

System maintenance is normally performed the third Saturday of each month.

Page 6 FHEA News

(Nurse Practitioner Excerpt: Continued from Page 1)

2. Correct answer—B

3. Correct answer—A

Worldwide, iron deficiency is the most common reason for anemia. Because an estimated 8 years of poor iron intake is needed in adults before iron-deficiency anemia occurs, diet is rarely its origin. Rather, chronic blood loss causing a wasting of the RBCs’ recyclable iron, the body’s most important iron source, is the most common cause. Occult gastrointestinal blood loss, such as from an oozing gastritis or gastrointestinal malignancy, is a common reason, as is excessive menstrual flow. Men and postmenopausal women require 1 mg of iron each day. During reproductive years, women require 1.5 to 3 mg/day of iron, in part because of the monthly loss of RBCs with the menses. In all these circumstances, these iron requirements are achievable with a well-balanced diet. One milliliter of packed RBCs contains 1 mg of iron, so even losses of 2 to 3 mL of blood per day through chronic, low gastrointestinal bleeding or re-peated phlebotomy can lead to iron deficiency. The laboratory diagnosis of iron-deficiency anemia is supported by the following findings (Table 11-3 Identify-ing Commons Anemias).

● Early disease: low to normal hg, low hct, and low total RBC count; normocytic, possible hypochromic; RDW > 15%

● Later disease: microcytic, hypochromic anemia with low RBC count and elevated RDW > 15%

● Low serum iron level: reflecting iron concentration in circulation. Serum iron is reflective of iron intake during the past 24-48 hours and can be falsely ele-vated because of recent high levels of dietary iron ingestion or self- prescribed oral iron supplementa-tion.

● Elevated total iron-binding capacity (TIBC): a meas-ure of transferrin, a plasma protein that easily com-bines with iron; when more of transferrin is available for binding, the TIBC level increases, reflecting iron deficiency.

● Iron saturation less than 15%: calculated by dividing the serum iron level by the TIBC.

● Low serum ferritin level: the body’s major iron stor-age protein

● Absence of iron from bone marrow, if aspiration is done

Therefore, a decrease in hemoglobin or RBC indices is a late rather than an early marker of disease. Therapy for patients with iron-deficiency anemia involves not only iron replacement but also treatment of the underlying cause.

TABLE 11–5

DRUG INTERACTIONS WITH ORAL IRON THERAPY

Drug Effect Comment

Antacids Decreased iron absorption

Separate use by ≥2 hr

Caffeine Decreased iron absorption

Separate use by ≥2 hr

Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, others)

Decreased fluoro-quinolone effect

Avoid concurrent use or separate doses by at least 6 hours

Levodopa Decreased levodopa and iron effect

Separate medications by as much time as possible; in-crease levodopa dose as needed

Select antihyper-tensives (ACE inhibitor, methyl-dopa)

Decreased anti-hypertensive effect

Separate medications by ≥2 hr, monitor BP. Additional effect with IV iron: when ACE inhibitors are given concur-rently, increased risk of sys-temic reaction to iron (fever, arthralgia, hypotension); concurrent use should be avoided

Tetracyclines including doxycy-cline

Decreased tetracy-cline and iron effect

Do not use concurrently, or separate by ≥3–4 hr

Thyroid hor-mones

Decreased thyrox-ine effect

Take thyroid hormones ≥2 hr before or 4 hr after iron dose

Histamine 2 re-ceptor antago-nists

Decreased iron absorption

Minor interaction

Drug Digest: Drug Interactions, available at http://www.drugdigest.org/wps/portal/ddigest, accessed 10.26.10.

ACE, angiotensin-converting enzyme; BP, blood pressure; IV, intrave-nous.

Click here for more information

A unique presentation condenses a vast amount of information into an effective review. Questions, answers, case examples, in-depth discussions and references help develop your understanding of disorders and show you how to apply what you've learned to practice. Based on the AJN Book of the Year second edition, this updated edition features even more ques-tions, more content, and all-new full-color photo-graphs online-to ensure your success.

Nurse Practitioner Certification Examination and

Practice Preparation, 3rd

Edition

FHEA News Page 7

Upcoming Suturing Conference

The Art of Wound Repair— Suturing for NPs and PAs

Instructor: Robert M. Blumm, MA, PA-C Location: New York, NY Date: February 2, 2011

Class hours: 8:30AM - 4:30PM

Wound repair is a necessary skill for all NPs and PAs. It is usually placed into their aca-demic curriculum with the knowledge that there will be an extensive period of practical application as they continue their studies and move forward into rotations. However, many NPs and PAs graduate from their programs

and pass their boards without acquiring this useful and billable skill. This workshop will be a full-day course with the utiliza-tion of a pig's foot, anesthesia tips, 4-0 nylon suture, and a disposable stapler. Dermabond and other newer prod-ucts about to come on the market will be covered, as an introduction to the use of a bio-adhesive in the care of

lacerations.

Click here for more information

Never lose track of your certification, professional li-cense and contact hour data again!

Thousands of your colleagues have already discovered this time saving tool. Contact Hour Tracker is a no-cost internet service available on

Fitzgerald Health Education Associates’ NP Expert website.

Store all your certification and license documentation dates and CE requirements.

Keep track of all your continuing education hours as they occur.

Contact Hour Tracker logs FHEA earned contact hours automati-

cally.

Enter contact hours from any CE provider.

Monitor deadlines and CE requirements for multiple agencies.

Track your progress toward contact hour goals.

Set up electronic ―alarm clocks‖ to receive automatic e-mail remind-

ers for all upcoming license and certification renewal dates.

Print contact hour summaries by category and source to help com-plete certification and license renewal paperwork.

Go to www.npexpert.com to register.

Contact Hour Tracker

for NPs in all states needs to be expanded so that they can practice more independently and continue to increase the quality of healthcare that they provide. With the number of people in need of primary care projected to rise exponen-tially over the next few years, now is the time to make these changes. The healthcare reform bill enacted by the Obama administration will result in 32 million newly insured young people and 15 million new Medicare applicants by 2014, according to a study released this year by the Association of American Medical Colleges (AAMC). In accordance with the Affordable Care Act, the U.S. Department of Health and Hu-man Services announced in September that $320 million in grants would be used to aid primary care clinics and expand nursing programs at colleges and universities in an attempt to offset the anticipated demand for healthcare. NPs will continue to serve a vital role in the healthcare industry now and when the full impact of the reform is witnessed. References: Nurse Practitioner Facts, American Academy of Nurse Practitioners, Ac-cessed 10.18.10 from: http://www.aanp.org/NR/rdonlyres/54B71B02-D4DB-4A53-9FA6-23DDA0EDD6FC/0/NPFacts2010.pdf Nurses' Push For Bigger Role Gets Powerful Ally, Kaiser Health News, Accessed on 10.18.10 from: http://www.kaiserhealthnews.org/stories/2010/october/05/iom-report-on-nurses.aspx Pay Growing Faster for Nurse Practitioners Than Physicians, MedScape, Accessed on 10.18.10 from: http://www.medscape.com/viewarticle/727497 Physician Shortages to Worsen Without Increases in Residency Training, Association of American Medical Colleges, Accessed 10.18.10 from: http://www.aamc.org/newsroom/presskits/mdShortage1.pdf The Doctor Can't See You Now – But the Nurse Can, AARP, Accessed on 10.18.10 from: http://www.aarp.org/health/doctors-hospitals/info-10-2010/doctor_cant_see_you_but_nurse_can.1.html

The NP is In

by Jaclyn Fitzgerald

With the need for primary care increasing in the United States, many healthcare professionals and patients have noticed that nurse practitioners are at the forefront of their industry. With more than 8,000 NPs graduating annually, a noticeable trend in the healthcare field is that the NP is nearly always ―in‖ when patients are in need of care. According to a 2002 British Medical Journal report, many patients feel that they receive the same quality of care from NPs as they do from physicians. Patients also feel that they receive more indi-vidualized care when seeing an NP, because NPs often have greater availability and can often devote more time to patients. It’s not just the demand for NPs that has grown recently; it’s their salaries as well. A report released by the Medical Group Management Association (MGMA) last month indi-cated that in the past five years NPs have seen a 21.9% increase in their pay. In contrast, primary care physicians have seen an average increase of 13.9% whereas compen-sation for specialty physicians rose 2.9%. These pay in-creases are indicative of how vital the role of the NP is in an industry where physicians are few and far between. The MGMA report recommended that all states should re-evaluate the regulations in their Nurse Practice Act. Many healthcare professionals believe that the scope of practice

Page 8 FHEA News

Practice Parameter Summary Statement Comment

Mild local reactions and constitutional symptoms after vaccinations are common and do not contrain-dicate future doses.

Local, injection site reactions (swelling, redness, and/or soreness) are com-mon and do not warrant withholding future vaccinations. Delayed hypersensi-tivity contact dermatitis reactions at the injection site are also not contraindi-cations to future vaccinations.

All serious events occurring after vaccine administra-tion should be reported to the Vaccine Adverse Event Reporting System (VAERS), even if it is not certain that the vaccine was causal.

The Vaccine Adverse Event Reporting System (VAERS) relies on reporting from healthcare professionals, parents, and patients so all events can be evaluated for strength of potential causality.

All suspected anaphylactic reactions to vaccines should ideally be evaluated by an allergist in an at-tempt to determine the culprit allergen.

Before labeling the patient ―allergic‖ to the vaccine and leaving the patient inadequately immunized, refer to an allergist to determine if the patient is allergic and if it is to the immunizing agent itself or to a constituent in the vac-cine. Not knowing this may pose a risk with future vaccinations that contain the same ingredient and/or prevent the patient from receiving needed immuni-zations. The recommended protocol for skin testing (i.e. egg and influenza vaccine) in the parameter is being utilized by allergists across the country. The office visit takes approximately 2 hours, which includes the history, exam and skin testing. If the skin test is negative, the patient is given the full dose of the influenza vaccine. If the skin test is positive, the influenza vaccine may still be administered, if necessary, in graded doses under close observation.

IgE-mediated reactions to vaccines are more often caused by vaccine components rather than the im-munizing agent itself (i.e. egg protein in influenza vaccines).

Measles and mumps vaccines are grown in chick embryo fibroblast cultures and contain negligible or no protein. They can be administered safely to egg allergic persons. Egg protein is present, however, in higher amounts in influ-enza vaccines and may cause reactions in egg allergic patients. Administra-tion of influenza vaccine containing 1.2 mcg/ml of egg protein or less has been safely administered to egg allergic patients. The vaccine is newly made each year and there are variable amounts of egg protein present in any given years’ vaccine (as high as 42 ug/ml of egg protein). Whether this is sufficient to cause a reaction in an egg allergic person is not known but may pose a risk. The trigger point for reactions above 1.2 mcg/ml egg protein is not known and varies among individuals.

In patients with histories and skin test results consis-tent with an IgE-mediated reaction to the influenza vaccine, consideration can be given to administering the vaccine in graded doses under observation by an allergist.

Patients needing influenza vaccination who are at higher risk for systemic reactions, with either a strong positive history or a positive skin test, should receive graded dosing of the influenza vaccination under close medical obser-vation by an allergist. Emergency treatment should be readily available should an anaphylactic reaction occur. The procedure lasts approximately 2 hours.

References Centers for Disease Control and Prevention. Recommendations for using TIV and LAIV during the 2010-11 Influenza Season. http://www.cdc.gov/flu/professionals/acip/recommendations.htm. Accessed 10/9/10 Centers for Disease Control and Prevention. 2010-11 Influenza prevention and control recommendations: persons who should not be vaccinated. http://www.cdc.gov/flu/professionals/acip/shouldnot.htm. Ac-cessed 10/9/10 Gagnon, R., et.al. Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine. J Allergy Clin Immu-nol. 2010;126:317-323. Kelso, J., et.al. Adverse reactions to vaccines: a practice pa-rameter. Ann Allergy. 2009;103:S1-S12. Taylor, S. et.al. Factors affecting the determination of threshold doses for allergenic foods: How much is too much? J Allergy Clin Immunol. 2002;109:24-30.

(Administering the Influenza Vaccine: Continued from page 4) The publication of Adverse Reactions to Vaccines pro-vides an evidence-based approach to the evaluation of the person at risk for allergic reactions to vaccines, including the influenza vaccines. It was developed by the Joint Task Force on Practice Parameters (JTF), representing the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI) and the Joint Council of Allergy, Asthma and Immunology (Ann Allergy Asthma Immunol. 2009 Oct;103 [4 Suppl 2]:S1-14; www.allergyparameters.org). There are two key points of the practice parameter; first, the evidence shows that most people with a history of egg allergy or a history of previous reaction to an influenza vaccine can be immunized safely after allergy testing. Second, patients with suspected al-lergy to vaccines or vaccine components should be evalu-ated by an allergist/immunologist. The summary of the practice parameter in the table below will primarily focus on influenza vaccines and egg allergy.

Adverse Reactions to Vaccines Practice Parameter 10/09: Influenza Vaccines and Egg Allergy

FHEA News

Unit XI - Pathophysiology of Renal Disease I. Anatomy and physiology of the nephron. II. Regulation of blood pressure, calcium, and

erythropoietin. III. Regulation of renal function; tubuglomerular

feedback. IV. Cortical and medullary flow. V. Acute renal failure. VI. Chronic kidney disease. VII. Electrolyte imbalance. VIII. Regulation of acid/base balance. Unit XII - Pathophysiology of Digestive System Disease I. Anatomy and musculature of the gastrointes-

tinal track. II. Neural control systems. III. Chemical control systems. IV. Myogenic control systems. V. Oropharyngeal/esophageal motility. VI. Gastric motility and control. VII. Gastric acid secretion. VIII. Selected disease states. Topics Presented by Margaret A. Fitzgerald Unit VII - Pathophysiology in Reproduction I. Factors influencing impaired female fertility. II. Factors influencing impaired male infertility. III. Pathophysiologic problems encountered in

pregnancy: Recurrent pregnancy loss, preg-nancy induced hypertension, placental disor-ders, others.

Unit VIII Pathophysiology of the Cardiovas-cular System I. Cardiac action potential. II. Contractile tissue. III. Non-contractile tissue. IV. Cardiac conduction. V. Contractile fibers and the sarcomere. VI. Electromechanical coupling. VII. Cardiac muscle tasks. VIII. Selected disorders. IX. Lipid synthesis and transport. X. Selected dyslipidemias. Unit IX Pathophysiology of Endocrine Dis-ease I. Types of hormones. II. Hormone receptors. III. Feedback mechanisms of secretion. IV. Maintenance of plasma glucose con-

centration. V. Maintenance of thyroid hormone con-

centration. VI. Maintenance of adrenal cortex/

medullary hormone concentration. VII. Selected disorders. Unit X Pathophysiology of Pulmonary Dis-ease I. Anatomy and physiology of airways. II. Vascular and lymphatic anatomy. III. Autonomic nervous system regulation. IV. Compliance and recoil. V. Airflow and resistance. VI. Ventilation and perfusion. VII. Selected obstructive/restrictive dis-

eases.

Topics Presented by Sally K. Miller Unit I Cellular Pathophysiology I. Cell structure and function. II. Mechanisms of cellular transport. III. Membrane and action potentials. Unit III Mechanisms of Cell Trauma I. Reversible injury. II. Irreversible injury. III. Hypoxia. IV. Physical trauma. V. Infectious trauma. VI. Chemical trauma. Unit IV Cellular Response to Injury I. Adaptation. II. Inflammation. Unit V Pathophysiology of the Hema-tologic System I. Hematopoiesis. II. Microcytic anemias. III. Macrocytic anemias. IV. Hemoglobinopathies. V. Primary hemostasis. VI. Secondary hemostasis. Unit VI Pathophysiology of the Nerv-ous System I. Synaptic transmission. II. Neurotransmitter. III. Post-synaptic processes. IV. Selected disorders.

Presented by highly acclaimed clinician-educators who currently maintain clinical practice, thus bringing clinical relevance to the classroom in addition to their knowledge and teaching skills in pathophysiology.

FHEA instructors consistently rank at the top of speaker ratings at national conferences.

Both the course material and testing material are kept up-to-date on subject matter. The electronic components of this program are updated as needed to reflect the current state of practice.

Test items are professionally developed and are subject to rigorous validity and reliability review.

Meets the needs of a geographically dispersed student population using on-line lectures with full audio-visual content.

On-line version allows students to proceed at their own pace and earn contact hours as they complete each module.

5 ¾ Day Advanced Pathophysiology for NPs and Advanced Practice Clinicians

Manhattan, NY

July 18-23, 2011

More Information Here

Click here for more information about this course

Earn 45 Contact Hours!

Presented by: Sally K. Miller, PhD, ACNP-BC, ANP-BC, FNP-BC, GNP-BC, CNE, FAANP

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP

Page 9

This course addresses the growing need for a thorough course in the principles of pharmacotherapeutics. Prescrib-ing has become a major part of the role of advanced prac-tice nurses while at the same time, prescribing has become more complex and polypharmacy is more prevalent with the possibility of adverse interactions. Thus, a course of this caliber is critical to the preparation of advanced practice nurses.

The course is taught in an intensive format by two of the nation’s most respected NP educators. In addition, recorded lectures of this course form the basis for other university NP pharmacology courses including Pennsylvania State, Pace University, Neumann College, Georgia College and State University. The material constitutes the equivalent of a three credit university course in pharmacology. Pharmacology contact hours: 45.0** Code: PCON — standard $799; advance: $7501; early bird: $6992 Note 1: Registrations received or postmarked between two months and two weeks prior to the start of the course qualify for this rate. Note 2: Registrations received or postmarked more than two months prior to the start date of the course qualify for this rate. Upon receipt of your enrollment and full payment, you will receive a confirmation of registration and directions to the course. A fee of $50.00 will be charged for cancellation. No refunds will be granted within two weeks of the starting date. All cancellations and changes must be received in writing. * Contact hours differ from the live course. See www.fhea.biz for details. **Because states’ requirements vary, it is important that you contact your Board for details regarding educational requirements for prescriptive authority.

5 ¾ Day Clinical Pharmacology for NPs and Advanced Practice Clinicians

Presented by:

Presented live in the following cities:

Manhattan, NY—February 14 to 19, 2011

Dallas, TX— October 25 to 30, 2011

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP and

Sally K. Miller, PhD, ACNP-BC, ANP-BC, FNP-BC, GNP-BC, CNE, FAANP

Can’t attend a live course? This program is also available on-line*

Click here for more information

National legal and practice issues.

Principles of safe prescribing: Pharmacokinetics, pharmacodynamics, pharmacogenomics, drug in-teractions.

Prescribing in special populations: Pregnancy, lac-tation, children, older adults.

Hormonal contraception and post menopausal hor-mone therapy.

Pharmacologic management in type 1 and type 2 DM: Oral agents, insulin and non-insulin prepara-tions.

Principles of antimicrobial therapy: Intervention in bacterial infection.

Drugs that affect the respiratory system: Beta2 agonists, methylxanthines, anticholinergics, mast cell stabilizers, inhaled and systemic corticoster-oids, leukotriene modifiers, over-the-counter cough and cold medications.

Evaluation and intervention in common thyroid dis-orders.

Assessment and intervention in common anemias.

Drugs that affect the cardiovascular systems: Anti-hypertensives, antianginals, dysrhythmics, medica-tions used in the management of heart failure.

Pharmacologic treatment of lipid abnormalities and drugs that affect clotting.

Drugs that affect the GI system: H2 receptor an-tagonists, proton pump inhibitors, antacids, proki-netics, antidiarrheals, including over-the-counter medications.

Management of viral, fungal and protozoal infec-tion.

Management of pain; opioids, NSAIDs and others including over-the-counter medications.

Management of eye, ear, and skin disorders.

For more information visit: www.fhea.biz

Topics covered in this course:

FHEA News Page 10

Educational Travel Upcoming Course Location

Sheraton Maui Resort and Spa, Lahaina, HI

March 15 and 16, 2011 Presented by:

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP

Due to the overwhelming success of the Pharma-cology Update in Maui in March of this year, FHEA is offering the 2011 version of this seminar on Maui’s Ka’anapali beach at the Sheraton Maui Resort & Spa. Be sure to book your air and hotel reservations early as this is a very busy season in Hawaii!

Featuring:

The latest in treatment options

In-depth pharmacologic information on clinical conditions you encounter in practice

Click here for more

information

Want to read more articles like this? Click here for more question and answer

sessions with Dr. Fitzgerald

FHEA News Page 11

Question and Answer with Margaret A. Fitzgerald

DNP, FNP-BC, NP-C, FAANP, CSP

Question: I will be graduating in 26 days and I'm terrified at the thought of going from an "expert" nurse with 20 years of experience to a "novice." I realize that I am so green, I probably glow in the dark. Do you have any ad-vice? Response: Please remember, you know much more than you realize! Your years of nursing practice, bolstered by successful completion of graduate study, have clearly provided you with the ability to provide thoughtful evalua-tions. This is a mark of a highly skilled clinician. How about thinking of yourself as a person who has provided healthcare for more than two decades and has success-fully completed graduate school and is ready to embark on a new career challenge?

Contents:

Dermatology DDxDeck, Book

These cards are linked together at one corner,

much like a collection of color samples, allow-

ing you to compare potential diagnoses visu-

ally, side by side, without the need to flip back

and forth between different pages. Each card

includes a full color image and information

about a particular diagnosis, as well as cross

references (DDx-refs) to other potential diag-

noses. Small enough to fit in your pocket, this

is the perfect reference for those on the front

line of dermatological diagnosis.

Dermatology Across the Lifespan, Audio CD Set This package contains 4 CDs and includes on-line

access to all images associated with the lectures.

Topics covered:

● A Primer in Dermatology: In-

creasing skills to enhance clini-

cal competence

● Is this Skin Cancer? Identifying

and treating malignant cutane-

ous neoplasms

● The Golden Years: Understand-

ing and treating skin in the older adult

● Help My Child: Topics, diagnosis and treatment of

common pediatric dermatologic conditions

Common Dermatologic Procedures, DVD

Learn to identify and treat a variety of

skin lesions and strategies for lesion

management including shave and punch

biopsies, cryotherapy, elliptical excision

biopsy.

Dermatologic diagnosis can be daunting.

These resources will help refine diagnostic

skills as well as teach simple dermatologic

procedures appropriate to perform in the pri-

mary care setting.

Special Offer: Dermatology Package

Click here for more information

Save

$71!

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North Andover, MA

01845-6154

Phone: 978.794.8366

Fax: 978.794.2455

E-mail: cs@fhea.com

Providing Education to

the Healthcare

Community

Fitzgerald Health

Education Associates, Inc.

Interested in advertis-

ing in this newsletter?

Email june@fhea.com

Editorial Staff

Managing Editor:

Marc Comstock

Editor:

Emily Paquin

Assistant Editors:

June Kuznicki

Jaclyn Fitzgerald

Technical Assistant:

Bernice Flete

Contributors

Margaret A. Fitzgerald

DNP, FNP-BC, NP-C,

FAANP, CSP

Marie L. Bosco, BSN, RNC,

IBCLC

Open Forum

FHEA welcomes articles,

news, comments and ideas

from its readers!

Please e-mail

emily@fhea.com

If you would like to contact

customer service please e-

mail cs@fhea.com

We have sent this e-mail

newsletter in the hope that

you will find it useful. If you

prefer not to receive future

issues, please e-mail:

stopnews@fhea.com Please

include "Stop" as the subject

of your e-mail and your full

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If you received a copy of this

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can subscribe by sending an

e-mail to:

newsletter@fhea.com. Be sure to include your full

name, mailing address and

daytime phone number so

that we can confirm and au-

thenticate your subscription.

Dr. Margaret Fitzgerald’s Upcoming Speaking Engagements

FHEA News

Date Location Topics

November 11, 2010

Nurse Practitioner Certification Exam

Review and Advanced Practice Update

InterContinental Dallas

15201 Dallas Parkway

Addison, TX

Click here for more information

December 1, 2010

Nurse Practitioner Certification Exam

Review and Advanced Practice Update

Courtyard Sacramento Midtown

4422 Y Street

Sacramento, CA 95817

Click here for more information

January 12, 2011

Nurse Practitioner Certification Exam

Review and Advanced Practice Update

DoubleTree Atlanta Buckhead

3342 Peachtree Rd, NE

Atlanta, GA 30326

Click here for more information

February 1, 2011

Nurse Practitioner Certification Exam

Review and Advanced Practice Update

Manhattan, NY

Click here for more information

February 14, 2011

Clinical Pharmacology for NPs &

Advanced Practice Clinicians

Manhattan, NY

Click here for more information