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Primary Care Nursing Education Guide


This section of this website acts as an educational guide for Primary Care Nurses. You will notice a number of Lippincott resources listed throughout that may require access through the product.  Alternative resources have been listed at free institutions where applicable. APCNA continues to advocate provincially for access to these resources to provide the best primary care in Alberta.

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Found

2SLGBTQI+

Required Reading

  • Introduction  

    • Lesbian, gay, and bisexual are identities based on their sexual orientation, where transgender is based on gender identity. Approximately 7% of young adults identify as LGBTQ. People that identify in the LBGTQ demographic are at higher risk of mental health illness and this should be taken into consideration during all medical appointments and when gathering medical history.  

      • Sexual orientation indicates to whom one is attracted  

      • Gender identity indicates which gender one identifies 

      • Sexual behavior and orientation can evolve over time 

      • Sexual behavior does not necessarily indicate sexual identity; for example, men who have sex with men may identify as heterosexual

    • Gender identity is the sense of having your own gender: male, female, or neither. This may be the same or different than a person's physical gender or sex. Physical sex is determined by a person's anatomy, chromosomes, and hormones. It is assigned at birth and is based on anatomy. Gender identity is something someone's develop over time and does not decide to whom you are sexually attracted. This means your gender identity does not determine if you are straight, gay, or bisexual.

    • Transgender is a person whose physical sex does not match their gender identity. Gender-queer individuals are people do not fully relate to either the male or female gender or may relate to both of them.  

 

Further Reading and Resources

Adult Physical Assessment

Putting together the Appointment:

  • Conduct appropriate measurements including, but not limited to, height, weight, blood pressure, and pulse 

  • Assess vision, as required 

  • Review past medical history (PMHx) and best possible medication history (BPMH) 

  • Review any patient concerns or questions 

  • Conduct preventative health screening, including but not limited to, general health and well-being, cognition, sleep habits, stress, diet, exercise, contraception/STI, safety measures, living conditions, social support, substance use, and intimate partner abuse. 

  • Conduct any other assessment and/or screening, including but not limited to, preparing requisitions, as appropriate using ASaP Maneuvers, Choosing Wisely Recommendations, Canadian Task Force on Preventive Health Care, and Canadian Council of Motor Transport Administrators

  • Vaccination counseling, including, but not limited to HPV and Pneumococcal. 

  • Clinic and Physician dependent – conduct all or some portions of review of systems and head-to-toe assessment 

  • Discuss any required follow-up based on information gathered in visit. 

Required Reading:

Assessment

 

 

Further Reading:

 

Advanced Care Planning

Required Reading:

Note: The universal location for storing greensleeves is on top of the patient's own refridgerator. It can also be helpful to encourage patient's to store a list of their current medical conditions, medications and emergency contacts along with their greensleeve.

Further Reading

Clinic Specific Factors:

  • Who is responsible for ordering Greensleeves for the clinic?

Arthritis

Putting Together the Appointment:

  • Focused history and pain assessment  

  • Assessment of impact on AADL such as HAQ-11 

  • Discussing Chronic Pain- see below 

  • Screening for comorbid conditions (including mental health) 

  • Nutritional counseling (obesity avoidance, calcium, vitamin D) 

  • Exercise such as GLA:D 

  • Community OT/PT Kinesiologist  referral for home safety or mobility aid 

  • Preoperative assessment and postoperative self-care 

  • Systemic anti-inflammatory medication injection with patient teaching 

  • Advocate and follow Musculoskeletal clinical pathways for shoulder and soft tissue knee spine assessment from AHS 

Required Reading:

 

Osteoarthritis Toolkit:

 

Further Reading:

 

Pharmacology:

 

Laboratory Tests

Asthma

Putting Together the Appointment:

  • Focused assessment with review of recent history of exacerbations and impacts on ADL 

  • Confirm severity with a validated tool (MRC scale, CTS Asthma Class and severity) 

  • Inhaler usage education 

  • Discuss trigger avoidance 

  • Review preventative actions (vaccination, smoking cessation, hand hygiene, breathing techniques, allergies) 

  • Review or initiate COPD/Asthma action plan 

  • Screen for comorbid conditions including mental health 

  • Spirometry or peak flow coordination 

  • Refer to specialist link pathway COPD 

  • Encourage Pulmonary Rehab where appropriate 

Required Reading:

General Knowledge

Guidelines

Pharmacology

Action Plan

Smoking Cessation

Spirometry

 

General Knowledge

Cardiovascular

 

Required Reading:

Putting Together the Appointment:

  • Conduct Framingham risk score 

  •  Review diagnostics and update according to protocol such as electrocardiogram and blood panel on netcare

  •  Discuss dietary interventions 

  •  Discuss healthy activity levels 

  •  Medication teaching where appropriate 

  •  Discuss smoking cessation 

 Dyslipidemia

Putting Together the Appointment: 

Hypertension 

  • Conduct automated office blood pressure (AOBP)  

  • Review home bloop pressure log 

  • Review diagnostics (last electrocardiogram, chemistry and electrolytes, urinalysis, lipid profile and blood glucose; prep requisitions if due) 

  • Assess for comorbid conditions including mental health (stress) 

  • Discuss dietary interventions (including ETOH consumption) 

  • Discuss healthy activity levels 

  • Medication teaching where appropriate 

  • Discuss smoking cessation 

Hypertension

Putting Together the Appointment:

  • Focused assessment with review of recent history of exacerbations and impacts on ADL 

  • Review daily weights 

  • Review diagnostics (Blood panel, Chest X Ray, Echocardiogram, Electrocardiogram) 

  • Assess for comorbid conditions including mental health and sleep disturbances 

  • Discuss dietary interventions (including alcohol consumption, salt, and fluid consumption) 

  • Discuss healthy activity levels 

  • Medication teaching where appropriate 

  • Discuss smoking cessation  

  • Review heart failure action plan and prescriptions

Heart Failure

Further Reading:

Cardiovascular Disease:

Cerumen Impaction Removal

Putting Together the Appointment:

  • Assess ear canals for cerumen impaction 

  • Discuss hearing changes and/or pain due to cerumen impaction 

  • Irrigate using warm water and check often if cerumen not removing easily 

  • Once cleared, assess ear canals and tympanic membranes 

  • Post-procedure assessment including, but not limited to, dizziness, changes to hearing, and/or pain. 

  • Provide post-procedure teaching, including but not limited to, relieving water in ear canal, when to return to clinic, and what to do if cerumen not removed at that visit. 

Required Reading:

Clinic Specific Factors:

  • What equipment is used in your clinic? How is it cleaned and who is responsible for cleaning it?

Cognitive Screening

Putting the Appointment Together:

  • Complete Functional Assessment, as required, including, but not limited to. Edmonton Frailty Scale. 

  • Review ADL and self- or assisted-medication administration 

  • Cognitive screening, as appropriate (RUDAS, SLUMS, etc.) 

  • Discuss home care and/or other community supports, as appropriate 

  • GOC discussion 

Required Reading:

Clinic Specific Factors:

  • What are the preferred screening tools in your clinic?

Coagulation & Anti-Coagulation

Putting the Appointment Together:

  • Patient education on common drug and diet interactions and activity safety 

  • Patient education lab work frequency and follow up 

  • Collaborate with physician or pharmacist on maintenance dosing or adjustment algorithm 

  • Optimization of medication adherence emphasizing the need for same time dosing (ex bubble packs) 

  • Patient education about missed dose 

  • Document and update patient warfarin record sheet 

  • Educate and assess for signs and symptoms of bleeding 

Required Reading: 

INR: 

Thromobtic Disorders: 

Further Reading:

INR: 

Coagulation Disorders: 

Thrombotic Disorders: 

Medications: 

MyHealth Alberta: Anticoagulants (watch the videos)

Chronic Pain

Putting the Appointment Together:

  • Uses a trauma-informed and functional approach to care 

  •  Focused pain assessment assessing for impact on ADL (Brief Pain Inventory) 

  • Assess for comorbid conditions including mental health and sleep disturbances  

  • Discuss non-pharmacological therapies to manage pain 

  • Initiate multidisciplinary referrals for patient 

  • Educate on risks of opioid therapy (opioid risk tool) facilitate informed consent prior to initiation 

  • Establish realistic and patient centered smart goals 

  • Naloxone and opioid safety teaching 

  • Ongoing assessment of potential side effects (cognitive decline, falls ct). 

  •  Recommend appropriate physical activity (example GLAD hip and knee) 

Required Reading:

General Knowledge

Guidelines

Assessment

Treatment

Further Reading:

Clinic Specific Factors: 

  • Is your clinic agreeable to initiating OAT?

  • Does your clinic have a Naloxone kit on site?

Contraceptive Counselling

Putting the Appointment Together:

  • Can be done with all patients, of any gender 

  • Review patient’s contraceptive goals 

  • Review emergency, hormonal, non-hormonal, and natural options 

  • Review sexual behaviors and support and/or provide STI screening, as appropriate 

Required Reading:

SexandU

Emergency Contraception

 Hormonal

Non-Hormonal

Further Reading:

 

Clinic Specific Factors:

  • Does the clinic have equipment that can be used for demonstrative purposes to support patient education?

Cryotherapy

Putting the Appointment Together: 

  • After assessment and diagnosis by Physician, Primary Care Nurse can initiate treatment 

  • Primary Care Nurses cannot conduct cryotherapy on genitalia and mucous membranes 

  • Perform steps of cryotherapy, including pre- and post-care 

  • Complete patient teaching, including, but not limited to frequency and timing of follow-up treatments 

Required Reading:

Clinic Specific Factors:

  • What equipment is used in your clinic? How is it cleaned and who is responsible for cleaning it?

  • How often should the patient be reassessed by their physician?

COPD

​Putting the Appointment Together:

  • Focused assessment with review of recent history of exacerbations and impacts on ADL 

  • Confirm severity with a validated tool (MRC scale, CTS Asthma Class and severity) 

  • Inhaler usage education 

  • Discuss trigger avoidance 

  • Review preventative actions (vaccination, smoking cessation, hand hygiene, breathing techniques, allergies) 

  • Review or initiate COPD/Asthma action plan 

  • Screen for comorbid conditions including mental health 

  • Spirometry or peak flow coordination 

  • Refer to specialist link pathway COPD 

  • Encourage Pulmonary Rehab where appropriate 

Required Reading:

Guidelines

  • Pages 87-102

Pharmacology

Action Plan

Smoking Cessation

Further Reading

Pulmonary Rehab

Smoking Cessation

Diabetes, Basics (1/6)

Putting the Appointment Together:

  • Discuss acceptance of disease diagnosis, including, but not limited to GAD and PHQ-9, as appropriate 

  • Discuss diabetes as a chronic and progressive disease that needs ongoing and increased treatment over time  

  • Discuss aspects of vascular health and reasons why ABCDE’s of diabetes are important for prevention of diabetic complications 

  • Review smoking cessation and Framingham risk score, as appropriate 

  • Review blood work results, as available 

  • Review of SMBG, if applicable 

  • Review medication, including insulin or medication adherence and adjustment, as well as proper insulin injection and site rotation techniques 

  • Teaching regarding nutritional intake, physical activity, safe driving, hypoglycemia, sick day protocols and emergency situations, and insulin adjustment 

  • Complete diabetic foot exam, as due, and provide foot care teaching 

Required Reading:

Pathophysiology and Diagnosis

Establishing and Organizing Care

Case Study

Further Reading:

Pathophysiology and Diagnosis

Establishing and Organizing Care

Special Populations

Other

Diabetes, Glycemic Management (2/6)

Required Reading:

Targets for Glycemic Control

Monitoring for Glycemic Control

Hypoglycemia

Hyperglycemia

Safe Driving

Case Studies:

Further Reading:

Targets for Glycemic Control

Monitoring for Glycemic Control

Hypoglycemia

Hyperglycemia

Safe Driving

Other

Diabetes, Nutrition Therapy (4/6)

Required Reading:

Further Reading:

Other

Diabetes, Managing Complications (5/6)

Complications

Foot Care

Cardiovascular Protection

Dyslipidemia

Hypertension

Acute Coronary Syndromes

Heart Failure

Mental Health

Chronic Kidney Disease

Retinopathy

Neuropathy

Sexual Dysfunction and Hypogonadism

Case Study

Further Reading:

Complications

Foot Care

Cardiovascular Protection

Dyslipidemia

 Hypertension

Acute Coronary Syndromes

Heart Failure

Mental Health

Chronic Kidney Disease

Retinopathy

Neuropathy

Sexual Dysfunction and Hypogonadism

Other

Diabetes, Pharmacology (6/6)

Required Reading:

Non-Insulin

Insulin

Medication Management

SADMANS

Case Study

Further Reading:

Non-Insulin

Insulin

Medication Management

SADMANS

Travel

Other

Driver’s Medical

Required Reading:

  • Alberta Health: Information for Aging Drivers

  • Vision Screening

  • Canadian Council of Motor Transportation Administrators: Standard 6. Part 2: Medical Standards for Drivers 

    • Chapter 3: Cardiovascular disease and disorders 

      • 3.1 About cardiovascular disease

      • 3.4 Effect on functional ability to drive

    • Chapter 4: Cerebrovascular disease 

      • 4.1 About cerebrovascular disease

      • 4.4 Effect on functional ability to drive

    • Chapter 5: Chronic renal disease 

      • 5.1 About chronic renal disease

      • 5.4 Effect on functional ability to drive

    • Chapter 6: Cognitive impairment including dementia 

      • 6.1 About cognitive impariment and dementia

      • 6.4 Effect on functional ability to drive

    • Chapter 7: Hypoglycemia 

      • 7.1 About diabetes and hypoglycemia

      • 7.4 Effect on functional ability to drive

    • Chapter 8: General debility and lack of stamina 

      • 8.1 About general debility and lack of stamina

      • 8.4 Effect on functional ability to drive

    • Chapter 9: Hearing loss 

      • 9.1 About hearing loss

      • 9.4 Effect on functional ability to drive

    • Chapter 10: Intracranial tumours 

      • 10.1 About intracranial tumours

      • 10.4 Effect on functional ability to drive

    • Chapter 11: Musculoskeletal conditions 

      • 11.1 About musculoskeletal conditions

      • 11.4 Effect on functional ability to drive

    • Chapter 12: Neurological disorders

      • 12.1 About neruological disorders

      • 12.4 Effect on functional ability to drive

    • Chapter 13: Peripheral vascular diseases 

      • 13.1 About peripheral vascular diseases

      • 13.4 Effect on functional ability to drive

    • Chapter 14: Psychiatric disorders 

      • 14.1 About psychiatric disorders

      • 14.4 Effect on functional ability to drive

    • Chapter 15: Drugs, alcohol and driving 

      • 15.1 About drugs, alcohol and driving

      • 15.4 Effect on functional ability to drive

    • Chapter 16: Respiratory diseases 

      • 16.1 About respiratory diseases

      • 16.4 Effect on functional ability to drive

    • Chapter 17: Seizures and epilepsy 

      • 17.1 About seizures and epilepsy

      • 17.4 Effect on functional ability to drive

    • Chapter 18: Sleep disorders 

      • 18.1 About sleep disorders

      • 18.4 Effect on functional ability to drive

    • Chapter 19: Syncope 

      • 19.1 About syncope

      • 19.4 Effect on functional ability to drive

    • Chapter 20: Traumatic brain injury 

      • 20.1 About traumatic brain injury

      • 20.4 Effect on functional ability to drive

    • Chapter 21: Vestibular disorders 

      • 21.1 About vestibular disorders

      • 21.4 Effect on functional ability to drive

    • Chapter 22: Vision impairment 

      • 22.1 About vision impairment

      • 22.4 Effect on functional ability to drive

    • Note: these sections are required reading for the primary care nurse's baseline knowledge. The remaining sections can be referenced as needed.

  • SIMARD MD Background

  • SIMARD MD Information Video

  • Trail Making Test Part A & B

Clinic Specific Factors:

  • What are the preferred screening tools in your clinic?

Functional Assessment

Required Reading:

Further Reading:

Clinic Specific Factors:

  • What are the preferred screening tools in your clinic?

Immunizations

Required Reading:

Further Reading:

Clinic Specific Factors:

  • Who is responsible for uploading immunizations to the IDSM?

  • Who is responsible for monitoring the vaccination fridge and ordering vaccines?

Injections

Putting the Appointment Together:

  • Obtain order from physician on injectable, including but not limited to medication/vaccine, reason, dose, route, timing/frequency. 

  • Types of injections include, but are not limited to 

  • Antineoplastics 

  • Antipsychotics 

  • Depot contraceptives 

  • Immunotherapy (allergy shots) 

  • Immunizations 

  • Iron 

  • Testosterone 

  • Vitamin B12 

  • Appropriate teaching including, but not limited to, pre-injection, common side effects, adverse reactions, post-injection, self-injection, and any relevant teaching if medications are listed as known or potentially hazardous. 

Required Reading:

Technique

Allergy Injections

Common injectable medications in Primary Care

Handling Hazardous Medication

Clinic Specific Factors:

  • Is there appropriate PPE for cytotoxic or hazardous medication?

Menopause

Putting Together the Appointment:

  • Assess for factors related to the cause of menopause, including, but not limited to increased cardiovascular risk, increased osteoporosis risk, insomnia, psychological stress, body structure and function changes, atrophic vaginitis, and urinary or other pelvic floor concerns. 

  • Discuss conservative management techniques. 

  • Discuss pharmacological treatment, as appropriate. 

  • Refer to other healthcare providers, as needed. 

Required Reading:

Further Reading and Resources:

Mental Health

Putting Together the Appointment:

  • Conduct appropriate mental health screening, as appropriate, including, but not limited to screening for ABBAS ( A- ADHD, B- Bipolar, B- Borderline Personality Disorder, A-Anxiety S- Substance abuse) 

  • Assess for imminent harm and/or danger to self and/or others 

  • Discuss changes in mood, sleep pattern, nutrition, physical activity and assess for barriers 

  • Screen for signs and symptoms of abuse, trauma, and substance misuse 

  • Use Cognitive Behavioral Therapy, and other clinical tools, as appropriate 

  • Discuss healthy coping strategies 

  • Prepare medication refills 

  • Review goals of care (GOC), as appropriate 

  • Refer to interdisciplinary team members, as appropriate 

  • Navigation of community resources, as necessary 

Required Reading:

  • Mental Health Visit Recommendations:

    • Mental health diagnoses often do not exist alone, which makes it important to approach all mental health appointments with a variety of screening tools to ensure an additional diagnosis isn’t missed.

    • When a patient presents with emotional dysregulation remember the Acronym ABBAS for screening A- ADHD, B- Bipolar, B- Borderline Personality Disorder, A-Anxiety S- Substance abuse.

    • Abuse, trauma, and substance misuse are intertwined with mental health visits. Please see the related comptency pathways.

Further Reading and Resources:

Prenatal Care

Putting the Appointment Together:

  • Discuss any questions or concerns 

  • Nutritional counseling 

  • Exercise counseling 

  • Provide information on genetic screening available – public and private paid options 

  • Measure fundal height, as appropriate 

  • Auscultate fetal heart rate, as appropriate 

  • Discuss other appropriate teaching [trimester dependent] including, but not limited to, expected physiological changes, diagnostic imaging, routine bloodwork, labour and birth, postpartum recovery. 

  • Discuss plan of care including, but not limited to, referral, continued visit, appointment schedule 

Required Reading:

Further Reading and Resources:

  1. If not done already, create an online ordering portal. Contact Canadian Client Success Managers at intl-csm@invitae.com

  2. When placing the order through the online ordering portal, choose the “Ship a kit option” after entering the patient’s address (regardless of whether a kit is needed or not)

  3. Once the option is selected, please click “EDIT” to see the option to ship a blood kit and arrange a blood draw OR arrange a blood draw only (when providing patient a kit in advance)

  4. The client services team will process your request to mail the patient a kit and blood draw request within 24 business hours.

  5. Once the request has been processed by the client services team, the blood kit will arrive to the patient within 5 to 7 days and a mobile phlebotomist from ExamOne will call the patient within 3 business days to set up an appointment.

Additional Patient Prenatal Resources:

Postpartum Care

Putting the Appointment Together:

  • Discuss spouse/family/friend supports and transition to motherhood 

  • Assess lochia, vaginal or cesarean incision healing (birth-dependent) and breast/nipple health 

  • Return to physical and sexual activity counseling, as appropriate with postpartum healing 

  • Discuss psychological well-being and assess/screen for postpartum depression, anxiety, and psychosis, as appropriate 

  • Refer to Pelvic Health Physiotherapist and/or Psychologist, and other community resources, as appropriate 

Required Reading:

Further Reading

Sleep Disturbances

Required Reading:

Further Reading:

Clinic Specific Factors:

  • What are the preferred screening tools in your clinic?

Substance Misuse

Putting the Appointment Together:

  •  Obtain emergency contact information 

  •  Review past and current misuse – both licit and illicit, with mode of use (ex. Injection, oral) with a trauma informed lens 

  • Use appropriate screening tools (CAGE, POMI, ACE’s) 

  • Motivational interviewing with harm reduction focus 

  • Utilize appropriate treatment pathways, as needed (Connect MD) 

  • Overdose education (ensure naloxone kit education done) 

  • Advocate and educate on protentional pharmacotherapy treatment 

  • Counsel and supervise induction of OAT, as appropriate 

  • Educate on community resources for addiction therapy (Access 24/7) 

Required Reading:

Further Reading:

Clinic Specific Factors:

  • What are the preferred screening tools in your clinic?

  • How often should the patient be reassessed by their physician?

Wound Care

Required Reading:

Further Reading: 

Clinic Specific Factors:

  • What equipment is used in your clinic? How is it cleaned and who is responsible for cleaning it?

  • How often should the patient be reassessed by their physician?

Sexually Transmitted Infection (STI) Screening

Required Reading:

Further Reading:

Clinic Specific Factors

  • What equipment is used in your clinic? How is it cleaned and who is responsible for cleaning it?

  • How often should the patient be reassessed by their physician?

  • Who is responsible for ordering supplies for the clinic?

Well Child

Required Reading:

Further Reading and Resources:

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