Exert for CPT NU 607
Recognize need for referrals by collaborating and consulting with members of the health care
team
A) I feel that recognizing the need for referrals is a very important aspect of being a nurse
practitioner. I feel that a nurse practitioner needs to understand that they are not trained
to know everything, although the NP needs to be able to identify when they need help
and a referral is necessary. As a family nurse practitioner, there is a large variety of
patients that present to the clinic for various reasons and it is impossible to the NP to
address each need, they need the help of a surgeon, cardiologists, and various other
doctors. I believe that an NP doesn’t need to know everything, but they do need to know
when a referral is required.
B) Ex.1- 50 year old male presented to the clinic with dyspnea on exertion, cough, inability
to swallow solid foods, and trouble talking without having a cough attack. This patient
had been seen by Cotton O’Neil pulmonology, gastroenterology, and cardiology. Along
with Cotton O’Neil, he saw a doctor at the Mayo clinic. Along with all of these
physicians, he was seen on a regular basis at the VA hospital because was a Vietnam
Veteran. With all of these refers, the patient had no answers, and his condition was
continuing to get worse. When I was reviewing the notes from all of physicians, it
appeared as though there were positive findings, but no follow-up was provided by the
physicians. In previous clinical setting, I had a very similar patient that had severe
GERD and tracheal malagia that presented very similarly to this patient. The previous
patient was seen by Dr. Garnett at KU Med (Otolaryngologist) and he was able to provide
effective treatment for that patient. I was able to refer my patient to Dr. Garnett, and he
has an appointment scheduled.
Ex. 2- 80 year old patient presented to the clinic with periods of shortness of breath,
dyspnea on exertion, intermittent chest pressure, and diaphoresis with exertion. I was
able to identify the need to cardiac testing. While in the office, I did and EKG, drew
blood work, scheduled a stress test and echocardiogram for the next day. I always
scheduled for a cardiology referral when stress test was completed. After failing the
stress test at the Holton Hospital, she was sent to Stormont Vail where she got a heart
catheterization 2 days after being admitted.
C) To gain more knowledge in this topic, I feel that will need to continue to work with my
preceptor to understand what referrals are available, and how to use these resources. I
feel that experience is also going to a huge contributor to this topic. I also that as I
continue to learn in class, I will continue to contribute that knowledge into my practice.
D) My course work is detrimental to this topic, along with my nurse practitioner pal and
mobile device. All of these resources are very important, but discussing options with the
patient is still one of the most important ways to learn when referral is necessary.
E) 4
5/1/13
A. Ex. 3- 15 year old boy presented to the clinic with pain to the right wrist, and deformity.
The patient was playing basketball in gym class and tripped and fell and landed awkwardly on
the arm. The patient had 3+ pulses and poor grip strength to the right hand. The deformity was
noted at the distal portion of the right radius/ulna. My immediate diagnose as Colles fractures. I
referred the patient to get an X-ray at Holton Hospital where the ER doctor saw him and placed a
cast on the right arm.
Grade 4