Melissa DeCapua, DNP, PMHNP-BC

Chronic sinusitis is inflammation of the nasal passages that results in symptoms of drainage, facial pain, and decreased sense of smell and can greatly affect overall quality of life. This is a review, of and update on, assessing, diagnosing, and treating chronic sinusitis.

Chronic sinusitis, also called chronic rhinosinusitis, is inflammation of the nasal passages and paranasal sinuses that results in persistent symptoms. Specifically, the American Academy of Otolaryngology—Head and Neck Surgery defines chronic sinusitis as (1) more than 12 weeks of 2 or more symptoms of anterior or posterior mucopurulent drainage, nasal obstruction, facial pain, and decreased sense of smell and (2) evidence of inflammation, documented by either radiographic evidence, swelling in the middle meatus or ethmoid region, or observation of polyps in the nasal cavity.

From 60% to 67% of chronic rhinosinusitis cases occur in women, and the prevalence increases with age, leveling off after 60 years

Chronic rhinosinusitis is one of the most common reasons for ambulatory care visits, with a prevalence of 5% to 15% in the United States.

Twenty-nine million individuals are diagnosed each year, resulting in significant health care expenditures, lost workdays, and antibiotic use.

Factors that likely increase the risk of chronic rhinosinusitis include the following

Chemical and particulate air pollutants such as nitrogen dioxide, ozone, and sulphur dioxide

Impaired mucociliary clearance, such as due to

Innate immunodeficiencies, such as cystic fibrosis

The etiology of chronic rhinosinusitis is not well understood but generally accepted as involving many factors, including a genetic predisposition, environmental factors, and infectious agents that, when combined, cause chronic inflammation of the upper airway.

Patients with chronic rhinosinusitis will likely present with persistent symptoms—lasting more than 12 weeks&mdash;of nasal congestion, facial pressure, nasal blockage, anterior or posterior rhinorrhea, and a reduced sense of smell.

They might also report ear pain, bad breath, and sleep difficulties.

Warning signs of a more serious condition warranting immediate intervention include a severe headache and stiff neck (suggesting meningitis), intracranial or epidural abscess, or cavernous sinus thrombosis.

Any ocular symptoms, such as pain, swelling, or visual changes, suggest orbital cellulitis or cavernous sinus thrombosis and should be investigated further.

A medical history should be conducted to ask the patient about allergies, asthma, aspirin sensitivity, nasal trauma, and exposure to tobacco

smoke, as well as any previous treatments for rhinosinusitis.

The practitioner should also assess for an immunocompromised state, a history of cystic fibrosis, and a personal or family history of Kartagener syndrome.

An anterior rhinoscopy might reveal nasal mucosal erythema, nasal discharge from the middle meatal area, and nasal polyposis.

It might also show an anatomic abnormality such as a septal deviation or evidence of prior surgery. Sinonasal inflammation should be assessed using either a rigid or flexible endoscope.

This nasal endoscopy will give a detailed view of the sinus pathways and any polyposis, edema, mucosal obstruction, or purulent discharge.

Practitioners should consider using the Lund-Kennedy endoscopic scoring system, which helps assess the pathologic states of the sinuses by quantifying symptoms such as polyps, discharge, edema, scarring, adhesions, and crusting.

Scores range from zero to 20, from least to greatest severity, with separate scores for each side of the nasal cavity.

A diagnosis of chronic rhinosinusitis can be considered if 2 or more of the following symptoms have been present for at least 12 weeks

• Nasal blockage, obstruction, or congestion

Articles

This is a review, of and update on, assessing, diagnosing, and treating chronic sinusitis.

Chronic Sinusitis: A Review and Update

Psoriasis is a chronic inflammatory disease that affects primarily the skin and joints.

The condition is triggered and worsened by some medications, infections, skin trauma, obesity, and stress, and those suffering from psoriasis are at higher risk for both cardiovascular disease and depression.

Below is a review and update on the assessment, diagnosis, and treatment of psoriasis.

There are 5 types of psoriasis, and patients may present with more than 1 type.

Those are plaque psoriasis, intertriginous psoriasis, erythrodermic psoriasis, pustular psoriasis, and guttate psoriasis.

Plaque psoriasis, which presents as well-defined, sharply demarcated erythematous plaques, affects 80% to 90% of patients with psoriasis. Of those affected by plaque psoriasis, 80% have a mild presentation, whereas 20% have a moderate-to-severe presentation, meaning that it affects crucial body regions, including the hands, feet, face, or genitals.

Intertriginous psoriasis, also commonly referred to as inverse psychosis or flexural psoriasis, presents as erythematous plaques, with minimal scale and lesions within the skin fold.

Erythrodermic psoriasis, which is considered a life-threatening emergency, refers to generalized erythema, covering almost the entire surface area of the patient’s body. It is sometimes associated with electrolyte imbal- ances, high-output cardiac failure, hypoalbuminemia, and hypothermia.

Pustular psoriasis appears as monomorphic sterile pustules on painfully inflamed skin. It often covers the patient’s soles and palms, and it may or may not accompany palmoplantar psoriasis. Pustular psoriasis includes von Zumbusch psoriasis, which includes widespread pustules resulting from fever and toxicity.

Guttate psoriasis affects fewer than 2% of those suffering from psoriasis and appears as dew-drop-like salmon-colored papules with a very fine scale. This type of psoriasis often follows a group A streptococcal pharyngitis infection and is more common in children and adolescents than in adults.

Psoriasis typically presents before age 40 and affects males and females equally.

About 2% of the US population is afflicted, with an incidence in adults of about 14 per 10,000.

Without a family history of psoriasis, the risk of developing it is about 4%. However, the risk increases to 28% and 65%if 1 or both parents, respectively, are affected.

Risk factors for developing psoriasis include taking medications, weight gain, smoking, and infection. In addition, alcohol abuse, cold weather, stress, HIV, and postpartum hormonal changes can trigger or exacerbate psoriasis.

Medications that most commonly induce or worsen psoriasis include beta-blockers, lithium, indomethacin, tetracyclines, and synthetic anti-malarials.

Other medications that have some evidence suggesting that they may induce or worsen psoriasis include doxycycline, amoxicillin, ampicillin, penicillin, amiodarone, clonidine, digoxin, quinidine, fluoxetine, olanzapine, and benzodiazepine.

Other conditions associated with psoriasis include psoriatic arthritis, which occurs in 25% of patients with psoriasis and typically affects the hands and feet.

Furthermore, psoriasis increases a patient’s risk for a variety of mental health conditions including depression, anxiety, and suicidal ideation.

Research suggests that nearly 60% of patients with psoriasis also suffer from depression.

Psoriasis also increases a patient’s risk for metabolic syndrome, Crohn’s disease, ulcerative colitis, lymphoma, diabetes, cardiovascular disease, kidney disease, and chronic obstructive pulmonary disease.

Patients typically have skin lesions that are erythematous, scaly patches, papules, or plaques on the extensor surfaces of their hands, feet, scalp, trunk, and/or buttocks.

These skin lesions may or may not be itchy and painful.

The presentation for psoriasis is typically chronic, though it may have a waxing and waning course.

Sometimes lesions can occur after trauma, which is called the Koebner phenomenon.

The clinician should ask about recent medication use as well as recent group A streptococcal upper respiratory infection, which often proceeds guttate psoriasis.

In addition, assess for alcohol and tobacco use as well as a family history of psoriasis.

During the physical assessment, focus on the skin and head, eyes, ears, nose, and throat (HEENT). The general physical should look for toxic signs such as fever, hypothermia, and/or dehydration.

The HEENT assessment should look for facial lesions, though these are uncommon, except on the scalp and forehead.

Oral symptoms might be found on the tongue.

The skin assessment should focus on the extensor surfaces of the elbows and knees, buttocks, trunk, and scalp.

Other sites that may have lesions include the genitals, the palms and soles, and skin folds.

Also look for sebopsoriasis, greasy scales found on the nasolabial folds and eyebrows as well as Woronoff ring, a circle of pale skin surrounding a psoriatic plaque.

The common physical findings for each type of psoriasis are as follows

Plaque psoriasis presents as well-demarcated round to oval-shaped lesions that vary in size from 1 to several centimeters. The smaller plaques often merge to form larger lesions on the trunk and legs. Plaque psoriasis appears symmetrical on the scalp, trunk, buttocks, and limbs as well as the extensor surfaces of the knees, elbows, and genitals. The scale appears dry, thin, and silvery white. Pinpoint bleed, called the Auspitz sign, happens when the scale is removed. The patient often reports painful fissuring over joints.

Intertriginous psoriasis presents as erythematous plaques, with much less scaling than plaque psoriasis. Inverse psoriasis is found in the axillary, genital, perineal, and inframammary skin folds.

Erythrodermic psoriasis, as mentioned above, presents as generalized erythema that covers almost the entire body with varying amounts of scaling.

Pustular psoriasis appears on the soles and palms, with small sterile pustules.

Guttate psoriasis appears as dew-drop-shaped, salmon-colored papules with fine scale. They are most often located on the trunk and proximal extremities.

Diagnosis is made based on the clinical appearance (table 1).

Typically, the severity of psoriasis is measured by the amount of body surface area affected. Mild-to-moderate psoriasis affects less than 5% of the patient’s body surface area and does not affect their hands, feet, face, and genitals. Moderate-to-severe psoriasis affects greater than 5% of the patient’s body surface area or affects their hands, feet, face, and genitals. A biopsy is rarely needed for confir- mation of the diagnosis.

For plaque psoriasis, the differential diagnosis should include atopic dermatitis (history of hay fever or asthma), contact dermatitis (no silvery scale), lichen planus (involves the wrist and ankles with less scale), seborrheic dermatitis (greasy scale), onychomycosis, tinea corporis (thinner scale with positive potassium hydroxide preparation), pityriasis rosea, and mycosis fungoide (less distinct lesion borders).

For guttate psoriasis, the differential diagnosis should include sec- ondary syphilis, which presents with red-brown lesions on the palms of the patient’s hands and the soles of the patient’s feet.

For erythrodermic psoriasis, the differential diagnosis should include drug rash with eosinophilia and systemic symptoms and Stevens-Johnson syndrome.

Finally, with pregnant women, evaluate for impetigo herpetiformis, also called pustular psoriasis of pregnancy.

Patient preferences and the ability to adhere to treatment (table 2) are important when choosing therapy. Psoriasis treatment for pregnant women includes topical steroids, followed by phototherapy if necessary. Specific treatment options for each type of psoriasis are listed below.

Plaque psoriasis is typically treated with either topical medications or phototherapy. Emollient should be encouraged for all patients to restore the cutaneous barrier function. Effective topicals include corticosteroids, vitamin D analogs, tazarotene, dithranol, and coal bars. Phototherapy, specifically ultraviolet B radiation, is ideal for treating plaque psoriasis that affects greater than 10% of the body’s surface.

Intertriginous psoriasis should be treated with a low-to-mid—potency topical steroid for less than 4 weeks. Long-term treatment might include calcipotriol, topical immunomodulators, or antimicro- bial therapy.

Erythrodermic psoriasis should be treated systemically with cyclosporine, infliximab, acitretin, or methotrexate.

Pustular psoriasis should be treated with acitretin, though this is contraindicated in women of childbearing potential. Other treatments for pustular psoriasis include cyclosporine, methotrexate,and infliximab.

Guttate psoriasis should be treated with phototherapy or a tonsillectomy.

As mentioned above, depression is often comorbid with psoriasis. It is important to both recognize and treat the depression, as well, because this can lead to poor adherence to treatment regimens and a lower overall quality of life. Consider referring these patients to mental health counseling in addition to treating their psoriasis.

L40.5 arthropathic psoriasis—use also                                                                                                                                                                                                                                                 o M07.0 distal interphalangeal psoriatic arthropathy.                                                                                                                                                                                                                              o M07.1 arthritis mutilans o M07.2 psoriatic spondylitis                                                                                                                                                                                                                       o M07.3 other psoriatic arthropathies                                                                                                                                                                                                                                                         o M09.0 juvenile arthritis in psoriasis

L41 parapsoriasis                                                                                                                                                                                                                                                                                   o L41.0 pityriasis lichenoides et varioliformis acuta                                                                                                                                                                                                                           o L41.1 pityriasis lichenoides chronica                                                                                                                                                                                                                                                   o L41.2 lymphomatoid papulosis                                                                                                                                                                                                                                                          o L41.3 small plaque parapsoriasis                                                                                                                                                                                                                                                      o L41.4 large plaque parapsoriasis                                                                                                                                                                                                                                                                o L41.5 retiform parapsoriasis                                                                                                                                                                                                                                                               o L41.8 other parapsoriasis                                                                                                                                                                                                                                                                     o L41.9 parapsoriasis, unspecified

, is a psychiatric nurse practitioner with a clinical background in psychosomatic medicine. She now works as a design researcher in

the technology industry, guiding product development by combining her clinical expertise and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Dr. DeCapua, visit her website at melissadecapua.com and follow her on Twitter @melissadecapua.

Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics.

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Boehncke WH, Schön MP. Psoriasis. Lancet. 2015;386(9997):983-94. doi: 10.1016/S0140-6736(14)61909-7.

Huerta C, Rivero E, Rodríguez LA. Incidence and risk factors for psoriasis in the general population.

. 2007;143(12):1559-1565. doi: 10.1001/archderm.143.12.1559.

4. Swanbeck G, Inerot A, Martinsson T, et al. Genetic counselling in psoriasis: empirical data on psoriasis among first-degree relatives of 3095 psoriatic probands. Br J Dermatol. 1997;137(6):939-942.

Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.

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Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis.

. 2010;49(12):1351-1361. doi: 10.1111/j.1365-4632.2010.04570.x.

Kupetsky EA, Keller M. Psoriasis vulgaris: an evidence-based guide for primary care.

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Canadian Psoriasis Guidelines Committee. Canadian guidelines for management of plaque psoriasis. http://dermatology.ca/wp-content/uploads/2012/01/cdnpsoriasisguidelines.pdf. Published June 2009. Accessed July 11, 2017.

Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy.

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Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies.

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Psoriasis: Diagnosis and Treatment Review

Understanding the most effective management strategy for obesity—including diet, activity, counseling, technology, acupuncture, and economic incentives&mdash;can improve clinical skills and the patient—provider relationship. This article reviews and summarizes up-to-date information on the treatment of obesity while focusing on communication and counseling techniques.

In 2013, the worldwide prevalence of obesity was 36.9% in men and 38% in women. This prevalence is significantly higher in developed countries than in developing countries and increased dramatically between 1980 and 2013.

Obesity is associated with myriad complications including an overall poorer health-related quality of life.

Obesity is defined as a body mass index (BMI) of greater than or equal to 30. BMI is a measure of body fat based on height and weight. A healthy adult should have a BMI between 18.5 and 24.9. Overweight adults have a BMI between 25 and 29.9. Obesity is divided into 3 classes.

Obesity results in an increased risk of overall mortality and lifetime impact of disability and morbidity.

It is associated with a greater risk of cardiovascular disease, specifically coronary heart disease, stroke, heart failure, atrial fibrillation, and venous thromboembolism.

Obesity during pregnancy increases the risk for complications that accompany other conditions, such as pregnancy-induced hypertension, antepartum venous thromboembolism, labor induction, cesarean delivery and wound infection, and fetal and neonatal mortality.

Furthermore, obesity and lack of exercise increase a person’s risk for type 2 diabetes as well as many types of cancers in both men and women.

Obesity in middle and late life is also associated with an increased risk for dementia, gastrointestinal disease, and liver disease.

The primary treatment for obesity is weight loss through diet and exercise. Weight loss of 5% to 15% greatly reduces complications in obese persons.

Other strategies include behavioral and cognitive behavioral therapy.

Acupuncture and medication have also demonstrated some efficacy in treating obesity.

When counseling obese patients, explain that their caloric expenditure must exceed caloric intake for any diet to effectively result in weight loss. Specifically, an adult can lose 1 to 2 pounds per week if they consume 500 to 1000 fewer calories per day. In general, diets that consist of low-carbohydrate and high-protein foods are associated with more weight loss than other diets.

Patients increasing their vegetable and fruit intake can help contribute to weight loss as well.

In addition, reducing the amount of dietary sugar consumed can result in significant weight loss.

Other effective ways to lose weight include following a Mediterranean diet.

Encouraging patients to use portion control can also be effective.

Finally, research suggests that drinking 500 mL of water before meals results in increased weight loss in obese and overweight adults.

The American College of Sports Medicine recommends exercise and diet to treat obesity in adults. This combination is more likely to reduce weight than either intervention alone.

Moderate intensity exercise, such as a brisk walk or a gentle swim for greater than 150 minutes per week, can result in sustained weight loss.

Although prolonged resistance training is not effective for weight loss, it can improve the patient’s cholesterol profile, insulin resistance, and blood pressure.

Furthermore, some study results suggest that lifestyle physical activity (ie, raking leaves, using stairs instead of the elevator, and brisk walking) can be as effective as a structured exercise program in promoting weight loss over 2 years.

A 2006 study mailed surveys to US residents and asked about their successful and unsuccessful weight-loss strategies. With 6207 responses, the study results showed that the most successful strategies reported by participants included

Using fewer nonprescription diet products

Similarly, research suggests that regular self-weighing improves weight loss without increased adverse psychological outcomes.

Providing individual obesity-management education and counseling in the primary care setting can result in modest weight loss, and research demonstrates that this is actually more effective than medication.

Counseling in the primary care setting often involves brief monthly visits that include measuring the patient’s BMI and providing diet and activity education. Advice can increase the patient’s awareness of the health risks of obesity and motivate patients to continue pursuing their weight-loss goals.

Over the past decade, numerous computer-based weight-loss programs and nutritional applications have been developed. A 2012 systematic review evaluated the efficacy of computer-based interventions for weight loss in 2537 adults. The study found that computer interventions have a modest benefit compared with no intervention; however, they are not as effective as in-person counseling from the patient’s primary care provider.

Another recent 2016 study analyzed the main features of 13 nutrition-related mobile phone apps and compared their strategies for dietary assessment and user feedback.

This study found that a majority of apps offered a food diary, portion size selection, physical activity tracking, and motivational coaching. One app called Fat Secret connected patients with their health care provider, and another called S Health provided a unique nutrient balance score. Although research suggests that patients who use apps are not more or less likely to lose weight than those who do not, other study results reveal that combining apps with weight-loss groups leads to significant sustained weight loss.

A newer approach to weight loss includes economics incentives. A 2013 randomized trial published in the

compared a control group with individuals who received $100 per month for meeting weight-loss goals and groups who split $500 per month for meeting weight-loss goals.

The study found that group-based financial incentives increased weight loss more than individual-based incentives or none at all.

Although often forgotten, acupuncture can help patients achieve their weight-loss goals as well. A systematic review published in 2009 found that acupuncture was associated with significant weight loss in obese patients compared with conventional treatments alone.

In the study, acupuncture resulted in the loss of an additional 4.2 pounds. Self-applied acupressure, on the other hand, is not as effective as acupuncture and is not a recommended treatment for obesity.

For patients with weight-loss goals, follow-up is essential. Monthly appointments offer primary care providers the opportunity to reassess vital signs, weight circumference, and BMI and reinforce health education.

Here are the ICD-10 codes related to obesity. ICD-10 is a medical classification list by the World Health Organization:

Z71.3 dietary counseling and surveillance

E66.2 extreme obesity with alveolar hypoventilation

E66.8 other obesity (use for morbid obesity)

Melissa DeCapua, DNP, PMHNP-BC, is a psychiatric nurse practitioner with a clinical background in psychosomatic medicine. She now works as a design researcher in the technology industry, guiding product development by combining her clinical expertise and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Dr. DeCapua, visit her website at melissadecapua.com and follow her on Twitter @melissadecapua.

Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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Yancy WS Jr, Olsen MK, Westman EC, Bosworth HB, Edelman D. Relationship between obesity and health-related quality of life in men. Obes Res. 2002;10(10):1057-1067.

Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.

. 2016;388(10046):776-786. doi: 10.1016/S0140-6736(16)30175-1.

Visscher TL, Rissanen A, Seidell JC, et al. Obesity and unhealthy life-years in adult Finns: an empirical approach.

Murphy NF, MacIntyre K, Stewart S, Hart CL, Hole D, McMurray JJ. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15,000 middle-aged men and women (the Renfrew-Paisley study).

Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity.

Cloostermans L, Wendel-Vos W, Doornbos G, Howard B, et al. Independent and combined effects of physical activity and body mass index on the development of type 2 diabetes - a meta-analysis of 9 prospective cohort studies.

. 2015;12:147. doi: 10.1186/s12966-015-0304-3.

Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.

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Loef M, Walach H. Midlife obesity and dementia: meta-analysis and adjusted forecast of dementia prevalence in the United States and China.

. 2013;21(1):E5-5. doi: 10.1002/oby.20037.

Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications.

Hart CL, Morrison DS, Batty GD, Mitchell RJ, Davey Smith G. Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies.

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2014;31(6):643-653. doi: 10.1093/fampra/cmu064.

Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2009;33(2):183-196. doi: 10.1038/ijo.2008.269.

Krieger JW, Sitren HS, Daniels MJ, Langkamp-Henken B. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1.

Svendsen M, Blomhoff R, Holme I, Tonstad S. The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders.

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. 2012;346:e7492. doi: 10.1136/bmj.e7492.

Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and weight loss: meta-analysis of randomized controlled trials.

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Pedersen SD, Kang J, Kline GA. Portion control plate for weight loss in obese patients with type 2 diabetes mellitus: a controlled clinical trial.

Understanding the most effective management strategy for obesityâ€”including diet, activity, counseling, technology, acupuncture, and economic incentivesâ€”can improve clinical skills and the patient-provider relationship. 

Managing Obesity

Is your nurse practitioner (NP) certification expiring soon? If you’re like most other NPs, the recertification process can feel overwhelming and anxiety-ridden. At least that’s how I felt a few months ago when I received the e-mail from the American Nurses Credentialing Center (ANCC) alerting me that I had 1 year (and counting!) until my psychiatry credential expired.

I feverishly jumped on my computer. “How does a nurse practitioner recertify,” I typed into the search engine. This spiraled into a long afternoon of investigation, checklists, printouts, and calendar reminders. As is often the case with the Internet abyss, I learned way more than I needed; therefore, to save the rest of my fellow nurse practitioners the trouble, I decided to write this simple guide to the recertification process. So, never fear! You’ll know what to do in no time.

In the United States, 4 different national boards award and maintain nurse practitioner certifications. You must seek recertification through the board that initially certified you following graduation from NP school. These organizations differ in the specialties they certify and in their renewal cycles, costs, and requirements. They include:

American Nurses Credentialing Center (ANCC)

Pediatric Nursing Certi cation Board (PNCB)

American Academy of Nurse Practitioners Certification Program (AANPCP)

includes which specialties each board certifies and its corresponding renewal cycle. The table also notes which specialties are retired, which means they can only be renewed by meeting professional development and practice-hour requirements. Retesting is not an option.

NURSE PRACTITIONER NATIONAL CERTIFICATION BOARDS

Adult psychiatric-mental health (retired)

Pediatric Nursing Certification Board (PNCB)

Adult, gerontological, adult-gerontology primary care, emergency, and family NPs can earn their certification through either the ANCC or AANPCP.  Remember, you must stick with the same board throughout your entire career. If you cannot remember which board you used, check your credential. Those nurse practitioners with ANP-BC, FNP-BC, AGPCNP-BC, or AGACNP-BC credentials were certified through the ANCC, and those with NP-C credentials were certified through the AANPCP.

The requirements for recertification vary by board. Typically, you have the option to combine professional development (ie, continuing medical education) with practice hours (ie, clinical work). All boards require NPs to provide proof of an active registered nurse (RN) license.

When reviewing your requirements, pay attention to the details, and get started early. In the words of author Olin Miller, “If you want to make an easy job seem mighty hard, just keep putting off doing it.”

summarizes the high-level requirements for each board.

A nurse practitioner may choose to renew by combining professional development with

Regardless of which route you take, you must complete 75 hours of continuing education (25 of which are related to pharmacology) and one or more of these categories:

â—      Category 1: Continuing education hours (an additional 75 hours)

â—      Category 2: Academic credits (5 semesters of academic courses)

â—      Category 3: Presentations (1 or more presentations totaling 5 hours)

â—      Category 4: Publication or research (1 article published in peer-reviewed journal, a PhD thesis, or a doctor of nursing practice final project)

â—      Category 5: Preceptor hours (120 hours as a preceptor for a nurse practitioner, physician assistant, pharmacy, or medical student)

â—      Category 6: Professional service (2 or more years of volunteer service)

Document at least 15 hours of continuing education each year leading up to recertification. At least 15 hours every 7 years must be related to pediatric pharmacology.

Complete required online modules called “PNCB Pediatric Updates” every 7 years. You must choose 2 primary care or acute care modules (depending on your specialty) and 2 modules of your choice. These are accessed by logging onto the PNBC website.

Complete a “specialty assessment” through the NCC website. This can be accessed by logging into your NCC account, navigating to the green Continuing Competency Specialty Assessment section, and selecting “Take the assessment.”

Create and finish a personalized education plan, which defines the amount of continuing education you need to earn to recertify. This varies by individual but is usually between 10 and 50 hours.

A nurse practitioner can choose to either retake the certification exam

document 1000 hours of clinical practice and earn 100 hours of continuing education (with 25 of these related to pharmacology).

The cost of recertification encompasses the fee to the board, the price of continuing education, and for some, the cost of the exam. Fees vary by board and can change, so you should check each website for the most updated information; however, typically these fees are less than $400. Often, boards offer discounts for members of the American Nurses Association and the American Association of Nurse Practitioners.

Is your nurse practitioner certification expiring soon? 

Melissa DeCapua, DNP, PMHNP-BC

Articles

Chronic Sinusitis: A Review and Update

Psoriasis: Diagnosis and Treatment Review

Managing Obesity

The Nurse Practitioner's Guide to Recertification