March, 2010

Volume X, Issue III

Fitzgerald Health Education Associates, Inc

Inside this issue:

Breastfeeding Everywhere, by Marie Bosco

2

Live On-line Review Course 2

Pre-sale!: 3rd Edition of the Nurse Practitioner Certifica-tion Exam Book, by Margaret Fitzgerald

3

Educational Cruises and Travel 3

Advanced Directives: Question and Answer with Sally Miller

4

FHEA DVDs Now Available in On-line Format

4

Six-Day Advanced Pathophysi-ology Course

5

Nurse Practitioners Report Salary Growth, by Emily Paquin

6

France Payne Bolton School of Nursing’s Graduates

8

Physician Assistant Fellowship in Hospital Internal Medicine

8

Five Day Comprehensive Gerontological Update

8

Contact Hour Tracker 9

Growth Charts for Children 9

Clinical Update 10

H1N1: “Phased-in” Approach 10

Need a Speaker? 10

Six-Day Clinical

Pharmacology Course

11

Margaret Fitzgerald's Upcoming Speaking Engagements

13

FHEA News

Upcoming NP Certification Exam Review Courses

03/12/2010 Charlotte, NC

03/26/2010 San Diego, CA

03/28/2010 Philadelphia, PA

03/29/2010 Live On-line Course (Adult, Family and Acute Care Tracks)

04/09/2010 Seattle, WA

04/16/2010 Ann Arbor, MI

04/21/2010 Atlanta, GA

04/21/2010 Charlestown, WV

04/25/2010 Covington, KY

04/30/2010 Greenville, SC

05/03/2010 Lisle, IL (Gerontology)

05/05/2010 Newark, NJ

05/05/2010 Lisle, IL (Also Acute Care)

05/06/2010 Columbus, OH

05/10/2010 Burlington, MA (Pediatric and Acute Care)

05/11/2010 Burlington, MA (Also Women’s Health)

05/11/2010 Salt Lake City, UT

05/14/2010 New Haven, CT

05/14/2010 Tampa, FL

05/21/2010 Dallas, TX

05/21/2010 Evansville, IN

05/21/2010 Miami, FL

05/25/2010 Omaha, NE (Also Acute Care)

06/02/2010 Manhattan, NY (Also Acute Care)

06/04/2010 Phoenix, AZ

06/04/2010 Richmond, VA

06/07/2010 Los Angeles, CA (Also Acute Care)

06/11/2010 Pittsburgh, PA

06/11/2010 Raleigh, NC

FHEA Offer of the Month Physical Assessment & Health History of the Adult Examination, Sixth Edition

Browse through FHEA products and seminars in this convenient on-line format. Click here to visit the on-line catalog.

2010 Fitzgerald Health Education Associates Catalog Now Available On-line!

Mumps: The Return of a Seldom-Seen Illness

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

In 1968, the year the vaccine against mumps was first licensed, mumps affected at least 90 out of 100,000 people in the United States. Within 10 years of widely available pediatric immunization against the disease, this rate was reduced to about one per 100,000. Given this public health triumph, we are left with a situation where many clinicians currently in practice have never seen a patient with mumps. This article focuses on the current state of mumps dis-ease and prevention in the United States. The Centers for Disease Control and Prevention (CDC) recently reported on the current outbreak of mumps striking the greater New York City area. The outbreak began during the summer of 2009; as of January 29, 2010, a total of 1,521 cases had been reported. The index case occurred in June 2009 with an 11 year-old boy who had returned home from a trip to the United Kingdom where more than 7,400 reports of laboratory-confirmed mumps occurred in 2009. The New York City outbreak has remained confined primarily to the tradition-observant Jewish community; nearly ⅔ of these cases have occurred among children ages 7 to 18 years with about ¾ of the patients being male. This distribution is likely due to transmission of the illness among attendees of select activities such as religiously affiliated summer camps and schools. In addition to New York, in-stances of mumps have been reported in New Jer-sey. In the 44 cases diagnosed in children outside of this religious community (less than 3% of the total cases reported), nearly all children had regular con-tact with those in the affected group. (Continued on page 7)

Acute Care NP Certifica-tion Review & Advanced Practice Update Live on-line with Dr. Sally K. Miller Sessions 1 and 2: March 29-30, 2010 Sessions 3 and 4: April 5-6, 2010 Sessions 4 and 5: April 12-13, 2010 Sessions 5 and 6: April 19-20, 2010 Sessions 6 and 7: April 26-27, 2010

Must attend all sessions to complete full course. Course time: 8:30pm-10:30pm EST

Family and Adult NP Certification Review & Advanced Practice Update Live on-line with Dr. Margaret A. Fitzgerald Sessions 1 and 2: March 29-30, 2010 Sessions 3 and 4: April 5-6, 2010 Sessions 4 and 5: April 12-13, 2010 Sessions 5 and 6: April 19-20, 2010 Sessions 6 and 7: April 26-27, 2010 (FNP only)

Must attend all sessions to complete full course. Course time: 8:00pm-10:00pm EST.

Page 2 FHEA News

This program allows you to: • Register for Family, Adult and Acute Care tracks

• Listen to the live presentation watching slides in real time

• Ask the instructor your own questions and hear the answer

• Hear other attendee’s questions and hear the answer

• Attend a convenient schedule spread over two evenings per week over a five-week period

• Once you have enrolled for this live on-line pro-gram, you will be sent instructions on how to pre-pare your computer in order to participate in the review.

This program includes: • A course workbook

• Hundreds of sample questions

• An on-line review of questions for content rein-forcement

Breastfeeding Everywhere By Marie L. Bosco, BSN, RNC, IBCLC

Live On-line Review Course Schedule

Live course prices apply, including early bird pricing. Click here for more information and to register.

Want to read other articles like this one? Click here to see archived articles on lactation.

Attend Margaret Fitzgerald’s Certification Exam Review Course Live in Your Own Home Via NPExpert® Interactive On-line Technology!

See a Demo Here!

In the United States breastfeeding in public can cause controversy and discomfort for some people. Fortu-nately, these views are not shared worldwide. There are numerous countries where breastfeeding is not only widely accepted, but often expected. Countries that ac-cept breastfeeding in public as natural and necessary include Peru, Chile, Argentina, Kenya, Pakistan, Austra-lia, Venezuela, Sweden, and others. In these countries mothers may breastfeed anywhere. Formula use in these locations is used mainly for adopted children or by mothers for whom breastfeeding is inadvisable. In many ways, the United States falls short in recogniz-ing the importance of breastfeeding. Despite the fact that breastfeeding in public is legal in the U.S. (forty-three states have explicit laws regarding the practice) it is of-ten perceived negatively. Breastfeeding is legal any-where that a woman is allowed to be with a baby; how-ever, many are unaware of this common law. Some even consider breastfeeding a form of indecent expo-sure. Ironically, one will likely see more skin watching a Victoria’s Secret commercial than observing the typical woman who breastfeeds in public. Perhaps the issues

surrounding breastfeeding have less to do with skin ex-posure and more to do with cultural beliefs. An intimate relationship between a mother and child begins during pregnancy and continues during breastfeeding. It is pos-sible that, either consciously or subconsciously, people confuse the closeness between a mother and child as a sexual act instead of functional act which demands re-spect and privacy. As positive breastfeeding statistics continue to rise in United States, so too should the acceptance of breast-feeding. The benefits of breastfeeding can improve not only the health of the mother and child, but of the coun-try as a whole. Cultural taboos which pigeonhole breast-feeding as a sexual act are not only unfortunate, but naïve. The new mother, who is likely feeling uncomfort-able nursing in front of others, needs to be comforted and supported in her choice. Breastfeeding is a natural, nutritional, and necessary practice to supporting healthy children, healthy mothers, and a healthy community.

In 2010 and 2011, our pharmacology update courses will be land-based rather than cruise-based. Over the past ten years we have offered one week and ten day cruises for Alaska, Mexico, the Caribbean and Medi-terranean and we have decided that it’s time to try

something new. On March 15-16, 2010, we will be holding a phar-macology update on Ka’anapali beach, Maui, Hawaii. Ka’anapali is the premier resort area of Maui with miles of beautiful beaches, many wonderful restaurants, snorkeling, scuba diving and whale watching. Margaret and I have enjoyed this outstanding part of Hawaii for a number of years and want to share it with our friends.

Earn 9 pharmacology related contact hours!* Instructor: Margaret Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP Topics covered in this course:

• Pharmacokinetics, Pharmacodynamics: Getting Back to Basics in Choosing and Prescribing Medications

• Drug Update: New Products, New Uses, New Warnings

• Antibiotic Update: A Focus on Urinary Tract Infection

• Emerging Infectious Disease Threats: Community-acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA), Avian and Pandemic Flu, and Pertussis

• Dangerous Liaisons: Drug-Drug, Drug-Nutrient Interactions

• Commonly Used Herbal Remedies, Vitamin and Mineral Therapies: Issues of Efficacy and Safety

Seminar Pricing: Standard $295; advance: $2691; early bird: $2492

Call 1-800-927-5380 for hotel information 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 that two months prior to the start date of the course qualify for this rate.

*Because states’ requirements vary, it is important that you contact your Board for details regarding educational requirements for prescriptive authority.

Educational Cruises and Travel Update on Events for 2010 and 2011

By Marc W. Comstock, CEO Fitzgerald Health Education Associates, Inc.

In spring 2011 we will be holding a pharmacology update again in Lahaina, Hawaii. Hotel information and seminar topics will be announced later in the year.

- Marc W. Comstock

Sheraton Maui Resort and Spa, Lahaina, HI

Additional Upcoming Course Locations

Lahaina, Hawaii

Nurse Practitioner Certification Examination and Practice Preparation, 3rd Edition

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

Click here for more information

Page 3 FHEA News

What's New?

● Nearly 1,400 questions in all, 200 more than the previous edition, representing every major clini-cal condition.

● 75 full-color photographs on-line to be used as part of the assessment data

● New chapter on the older adult

● Updated coverage of test-taking techniques.

● Update-to-date information on clinical preven-tative services and intervention

● More than 160 quick-look tables

Key Features

• Clinical pointers offering practice pearls and words of advice.

• In-depth discussions of disorders and their diag-nosis and treatment, with questions and answers to test your knowledge base

• Emphasis on analysis and synthesis of knowl-edge to enhance diagnostic and treatment rea-soning skills.

• Index of Disorders on end pages.

A unique presentation condenses a vast amount of infor-mation into an effective review. Questions, answers, case examples, in-depth discussions and references help de-velop 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 questions, more content, and all-new full-color photographs on-line—to ensure your success.

Pre-publication Sale!

Fitzgerald Health Education DVDs Now Available in On-line Format!

• Watch and listen to these presentations as Fitz-

gerald’s renowned faculty share their expertise gained over years of clinical practice.

• Presentations are broken down into convenient sessions of approximately 20-25 minutes each.

• Pause and replay each session as needed while attending the seminar.

• Follow along with the downloadable handout. (Instructions for access to PDF included with the course)

• Order the optional on-line post-test for contact hour credit.

• FHEA contact hour credits are automatically posted to your Contact Hour Tracker account, a free service of FHEA.

Beyond the Basics in 12-Lead ECG Interpretation

12-Lead ECG Interpretation: A Primary Care Perspective

Chest X-ray Interpretation: A Primary Care Approach

Expert Exam: Abdomen

Expert Exam: Cervical, Thoracic and Lumbar Spine

Expert Exam: ENT Skills for Primary and Acute Care Practitioners

Expert Exam: Physical Examination of the Adult

Increase your clinical skills and you will in-crease your earning power by billing more

complex and higher level procedures.

Expert Exam: Practical Orthopedics - Knee

Expert Exam: Practical Orthopedics - Shoulder

Expert Exam: Primary Care Neurologic Exam

For more information on these and other FHEA products visit: www.fhea.biz

Advanced Directives: Question and Answer with Sally K. Miller, PhD, ACNP-BC, ANP-BC, FNP-BC, GNP-BC, CNE, FAANP

Question: I am studying for the gerontological NP certifica-tion examination and have a question about advanced direc-tives. Is this a legal binding document? I have researched that the advanced directive is binding if it is has been appro-priately written according to the state in which a person lives. Could you please clarify this for me so I will know how to answer this type of question if it appears on the exam?

Response: Thank you for raising this question because it is an issue that can use some clarity. The terminology is am-biguous, and basically, the answer is not clear cut. "Advanced directive" is a term that is used to represent a wide variety of mechanisms by which people direct care in the event that they become incapacitated. The terminology from the American Bar Association (ABA ) is as follows: "If the directive is constructed according to the outlines pro-vided by pertinent state legislation, they can be considered legally binding.” In legalese, "can be" is not an absolute— it means "may be;" if it said "shall be," then that would be the absolute. So, "if" the advanced directive is constructed ac-cording to state legislation is an important "if." A durable power of attorney is considered a legally binding form of an advanced directive and it is a legally executed document. On the other hand, a living will that someone

downloads from the internet, signs, and then gives to a healthcare provider is not considered a legally executed document. Similarly, a generic living will that someone uses to check off boxes and signs when admitted to the hospital is not a legal document; this may only become an issue if there is a dispute between family members and providers. If you have a situation in which one person or group wants aggres-sive treatment and you choose to follow the advanced direc-tive, you want to be sure that it is a legally binding document. And don't forget— once you get past the important "if" you want to remember that the terminology from the ABA says that an advanced directive "can be" legally binding. In other words, "if" the document is written according to state legisla-tion, it "can be" legally binding. None of this language as-sures legality.

Ultimately, you do not want to assume that all advanced di-rectives are legally binding. If there is any question or dis-pute, you want to be sure that it has been properly con-structed in accordance with state legislation, if it has, re-member that even then it may be contestable. Investigate the possible issues that may be raised about circumstances under which the document was signed, such as mental du-ress, drug-induced impaired judgment, lack of comprehen-sion of implications, and other similar situations.

Page 4 FHEA News

Page 5 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.

Six-Day Advanced Pathophysiology for NPs and Advanced Practice Clinicians Chicago Area, IL

August 23rd–28th, 2010

New Program!

Click here for more information about this course

Earn 45 Contact Hours!

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

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

FHEA News Page 6

22nd Regional Conference Toward Excellence in Advanced

Practice Nursing Northern Kentucky Convention Center

Covington, Kentucky April 21-24, 2010

Earn up to 22.5 ANCC Approved Contact Hours!*

This conference is designed to teach the healthcare practi-tioner how to provide clinical excellence and quality care. This conference will allow the attendee to:

• Examine pharmacologic therapies and methods of treatment

• Develop assessment and clinical management skills

• Work closely with specialists in acute and primary care spheres

• Focus on issues regarding Adult, Women’s, Acute and Pediatric healthcare

*Credit for pending approval from the AANP and NAPNAP for 22.5 contact hours. Kentucky Board of Nursing (KBN), Conference attendees may obtain a maximum of 26.8 continuing education credits (19.29 pharmacology related). Click here for more information about this conference

The effects of the country’s recession have reached nearly every occupation in the United States. From 2007 to 2009 the national unemployment rates rose to 10.2% leaving 5.6 million people jobless in the United States. In a recent arti-cle, Advance for Nurse Practitioners surveyed 6,000 NPs to determine salary growth rates for 2009. Unlike the many professions which suffered significant job decreases, the healthcare industry actually added 600,000 new jobs. Even with the overall depressed economy, the average annual salary for nurse practitioners increased by 10%. In 2007 the average overall salary for an NP was $81,397; in 2009 it rose to $89,579. But despite the growth in their profession, NPs have not completely escaped the effects of the reces-sion. When asked whether they were better off financially than they were two years ago, 64% of NPs said “yes,” but 26% said they were “about the same” and 10% said that they were “worse off.”

Nurse Practitioners Report Salary Growth in a Strained Economy by Emily Paquin, BFA

Note: Emily Paquin is currently pursuing a Master of Fine Arts degree in writing at Emerson College in Boston, Massachusetts. She is also the editor of FHEA News.

The growth in the NP occupation has caused a noticeable shift in salary distribution throughout the profession. For the first time in 10 years, NP practice and hospital settings were removed from the top five highest paying positions and were replaced by mental healthcare settings. This change can be attributed to several factors including an increase in patients seeking mental health and a shortage of psychiatric provid-ers, particularly those with prescriptive authority. Other than mental healthcare settings, the four most lucrative positions for NPs include aesthetics/skin care, emergency depart-ments, house calls, and neonatal units. But even though these settings provide the highest pay, they only employ about 5% of NPs.

Across all settings, NPs who own their own practice (about 3% of those surveyed) have larger salaries than those who do not; however, the various costs associated with opening and running a business can impact a practice owner’s gross income. The dominant NP practice owners include those who own a family practice, followed by those in mental health settings. For practice owners, even though the salary is significantly higher than NPs who do not own their own business, there are many variables which influence take home salary. Some of these factors include geographical location, debts associated with starting and maintaining a business, and marketing ability. Another determination of NP salary has to do with gender. When compared to male NPs, female NPs make about 13% less. Despite the high number of females versus males in the NP profession, the gender disparity relates to the overall societal norm where women take home approximately 78% of men’s wages within the same vocation. Another factor which influences salary relates to the large number of men in the higher paying sectors of the healthcare industry. Gen-erally, men represent only about 8% of NPs, but they work in some of the highest paying positions including emergency departments (about 25%), mental health settings (about 12%) and private practice owners (about 19%). As is the case in most professions, more education leads to higher pay. In the NP world, for example, a nurse with a doc-toral degree earns about $10,000 more than a colleague with a master’s degree. Though NPs who have a DNP only ac-count for 2% of the NP profession, this will likely change in 2015 when the degree becomes essential for entrance into advanced practice. (Continued on page 9)

“In 2007 the average overall salary for a nurse practitioner was $81,397; in 2009 it rose to $89,579.”

Page 7 FHEA News

(Mumps: Continued from page 1) Mumps is a viral illness caused by a paramyxovirus. In out-break, the mumps strain has been identified as genotype G —not an unusual or rare genotype and one that has been circu-lating globally for many decades. Transmission of the mumps virus occurs with direct contact with infected saliva, respiratory droplets or contaminated fomites. As a result, the disease can be transmitted through sneezing, coughing, laughing, or with any activity that involves close physical proximity. The virus can also be spread through direct contact, such as picking up tissues or using drinking glasses that have been used by an infected person. Thus, it is not surprising that the current outbreak is largely seen among males who spend extended periods of time in study performing activities associated with their religious community. The mumps incubation period can range from 12 to 25 days from the time of exposure to the onset of symptoms; the incubation period is generally 16 to 18 days. The virus has been isolated in saliva 2 to 7 days before symptom onset and until 9 days after onset of symp-toms. The mumps virus causes an acute illness that typically in-volves fever, headache, muscle aches, fatigue, and loss of appetite. This is often, but not always, followed by unilateral or bilateral swelling of the parotid or other salivary glands. The illness usually lasts 7 to 10 days. Though mumps is not usually a serious disease, complications of mumps infection include deafness, mastitis, pancreatitis, and meningitis or

encephalitis. About 25% of pregnant women in the first tri-mester who contract mumps will have a spontaneous abor-tion. Orchitis occurs in about ⅓ of post-puberty males and is usually unilateral. Oophoritis occurs in up to ⅓ of all fe-males over the age of 15 who contract mumps and can pre-sent as pelvic inflammatory disease. Subsequent sterility or infertility resulting from reproductive associated mumps

complication is uncommon. With the exception of deafness, these complications are more common among adults than children. There is no medication or specific treatment for mumps. For the majority of people who contract mumps, symptomatic treatment and bed-rest will suffice. Orchitis is usually treated with an ice pack and elevation as a comfort measure. The need for more intensive intervention is di-rected by the severity of the illness. Although the majority of the children who developed mumps in the New York City outbreak had evidence of immuniza-tion, the best protection against mumps is still the mumps vaccine. This is most often provided by the measles, mumps and rubella (MMR) vaccine. Infants should be vac-cinated with the first dose of MMR as close to the first birth-day as possible. By age 4 to 6 years, children should re-ceive two doses, according to the Advisory Committee on Immunization Practices (ACIP). Two doses are preferred because data has shown that MMR is approximately 80% effective against mumps after one dose and approximately 90% effective after two doses. Post-high school and col-lege-age people should receive a second dose if this has not been previously administered. The mumps vaccine has not been shown to be an effective preventative measure after people have been exposed to the virus. Indeed, the vaccine should not be considered fully effective until the vaccinated person has waited an interval of 2 to 4 weeks after receiving the vaccine. This, and the fact that the incu-bation period for mumps is 12 to 25 days, means that dur-ing an outbreak, newly vaccinated people may develop mumps as long as a month after they are vaccinated. While the current outbreak is certainly a cause for concern, it is important to note that only 4% of the potentially mumps-exposed youth who attended an overnight summer camp developed the illness. A person born before 1957 is widely accepted as having immunity against mumps because of the high likelihood that the individual had the disease in childhood. The CDC ad-vises that, in the presence of an outbreak, adults born prior (Continued on page 12)

“The mumps virus causes an acute illness that typically involves fever, headache, mus-cle aches, fatigue, and loss of appetite. This is often followed by unilateral or bilateral swell-ing of the parotid, or other salivary glands.”

Click here for more information about this course

FHEA’s Comprehensive Gerontological Update is specifically designed to help meet the eligibility re-quirements for previously 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. For details visit http://www.nursecredentialing.org

Five Day Comprehensive Gerontological Update June 14th–18th, 2010

Fitzgerald Health Education Associates 85 Flagship Drive

North Andover, MA

New Program!

• Aging Demographics • Health Assessment • Clinical Management of Acute and Chronic Illnesses: Skin, Car-

diac, Respiratory, Gastrointestinal, Genitourinary, Gynecologic, Musculoskeletal (common arthritis problems), Neurologic, En-docrine/Metabolic, Immunologic, Multisystem Disorders, Psy-cho-Social

• Pharmacologic Issues in Older Adults (including Polypharmacy) • Ethics

• Geriatric Syndromes: Constipation, Dementia/Delirium, Anxi-ety/Depression, Falls, Failure to Thrive, Functional Loss, In-continence, Sensory Loss, Sleep Disorders, Pain Management

• Palliative Care • Advanced Directives • Elder Abuse/Neglect • The Nurse Practitioner/Patient/Family Relationship • Professional Role and Policy • Research Utilization

Topics Covered:

Earn 35 Contact Hours!

The picture below features graduates of the Case Western Reserve University, France Payne Bolton School of Nurs-ing’s Doctor of Nursing Practice program. All women are fel-lows of the American Academy of Nurse Practitioners (FAANP), an award given in recognition of nurse practitio-ners who serve as leaders and contributors to the healthcare industry through clinical practice, research, education, or policy.

From Left: Jean Aertker, DNP ’06, Carol Lynn Sarin, DNP ’01, Evelyn Duffy, DNP ’04, Margaret “Peg” Fitzgerald, DNP ’06, Peggy P. Francis, DNP ’08.

France Payne Bolton School of Nursing’s Doctor of Nursing Practice Graduates

The Mayo School of Health Sciences is offering a 12-month post-graduate Physician Assistant Fellowship in hospital internal medicine. The fellowship, which runs from October 1st through September 30th, will be awarded to one applicant. The fellow will complete several medical speciality rotations which last 2 to 4 weeks. The program allows the fellow to develop a range of skills necessary to treating hospitalized patients. Some of the program goals include allowing the fellow to develop a broad knowledge-base in understanding pathophysiology, and disease prognosis. The Physician Assistant Fellowship is accred-ited through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and is also recognized by the Association of Postgraduate Phy-sician Assistant Programs (APPAP).

Physician Assistant Fellowship in Hospital Internal Medicine

Click here for more information about this fellowship

Presented by: Terry Mahan Buttaro, MS, ANP-BC, GNP-BC

Page 8 FHEA News

Notice of System Maintenance for Testing & Learning Site

Routine maintenance is scheduled for March 20th, 2010. FHEA is committed to providing our customers maxi-mum uptime, reliability, 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 3rd Saturday of each month.

Never lose track of your certification, professional license 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 Associ-ates’ NPExpert 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

automatically. • 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 reminders for all upcoming license and certifica-tion renewal dates.

• Print contact hour summaries by category and source to help complete certification and license renewal pa-perwork. Go to www.npexpert.com to register.

Page 9

Contact Hour Tracker

FHEA News

Growth Charts for Children There are many factors which determine a child’s weight, height and head circumference. Click here to view growth charts which provide data for children from China, Southeast Asia, Thailand and Vietnam. The ages represented range from 0 months to 20 years. Click here for more information

(Nurse practitioners report salary growth: continued from page 6)

Finally, a factor which effects NP salary is geography. As is the case in many professions, an NP’s salary varies based on location. From the top five highest paying states (California, Arizona, Alaska, New Jersey and Nevada) to the lowest (South Dakota, Alabama, and Nebraska) an NP can make anywhere from $106,481 to $77,192. But, be-cause the cost of living varies from state to state, in the end a nurse practitioner from California may not have as much take home income as an NP from a state with a lower cost of living. Ultimately, NP salary can fluctuate for many reasons. But unlike many professions which are decreasing and down-sizing, the NP profession continues to grow. Though NPs may not unanimously admit to being better off than they were two years ago, one thing is for sure, they are likely better off than many others in the country. Source: Rollet, J. (2010, January 6). 2009 Salary & Workplace Survey: Good News in a Troubled Economy. Retrieved Febru-ary 5, 2010, from Advance for Nurse Practitioners:

http://nursepractitioners.advanceweb.com/Editorial/Content/Editorial.aspx?CC=213354

This course is designed to meet the continuing education needs of advance practice nurses. There will be an intense review and update of new pharmacological agents. Discus-sion of drugs and treatment of modalities relating to specific illnesses will be reviewed at length. This program features: ● A pre-conference meeting: Dessert and Debate

(May 13th, 2010) ● Workshops taught by acclaimed educators, including

Fitzgerald Health Education Associates Faculty members Wendy L. Wright and Kismet D. Rasmusson

Topics covered in this seminar include: ● New Drugs in Primary Care 2010 ● Emerging Infection in Disease Trends ● Pearls of Practice in Prescribing Cardiovascular Drugs ● Many More…

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17th Annual Pharmacology Conference Sponsored by the Utah Nurse Practitioners

May 14-15, 2010 Sheraton City Centre Hotel

150 West 500 South Salt Lake City, Utah

Earn 12 Contact Hours!

Need a Speaker? If you are interested in having Margaret or one of our other talented associates speak at your school, local, regional or national conference, please e-mail: services@fhea.com for more infor-mation. Conference administrative services are also available.

Evaluation of Dizziness, Syncope and Vertigo (1.5 Contact Hours) This session offers a systematic approach to the patient complaining of 'dizziness'. Vertigo, ataxia, and near-syncope are all clinical occurrences typically referred to as 'dizziness' by the patient. Appropriate classifica-tion of 'dizziness' and the evaluation of common differentials for ver-tigo, ataxia, and near-syncope are presented. Sally K. Miller, PhD, ACNP-BC, ANP-BC, FNP-BC, GNP-BC, CNE, FAANP Controlled Substances: A Focus on Prescribing (3 RX Contact Hours) The purpose of this program is to provide prescribers of controlled sub-stances with core knowledge to facilitate the most effective and safe prescribing of scheduled drugs (opioids, benzodiazepines, weight loss medications, stimulants, anabolic steroids, others). Following an intro-duction to the Controlled Substance Act, each of the five schedules will be presented with an analysis of the pharmacodynamics by therapeutic category and a discussion of clinical application and utility. Sally K. Miller, PhD, ACNP-BC, ANP-BC, FNP-BC, GNP-BC, CNE, FAANP Drug Update: New Products, New Uses, New Warnings (1.5 RX Con-tact Hours) What is the latest in drug therapy? What are the latest new uses and cautions for use of established medications? What products have re-cently gone generic? Learn the answers to these and other questions in this informative session. Margaret Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP

Click here for more information about this course

Earn 6 Contact Hours

4.5 contact hours are pharmacology related (3 contact hours are specific to Controlled Substance Prescribing)

Topics:

New Program!

Clinical Update May 13th, 2010

Marriott Burlington Burlington, MA 01803

Presented by: 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

Earn Controlled Substance Prescribing Contact Hours!

FHEA News Page 10

H1N1: Advisory Committee on Immunization Practices Recommends a “Phased-in” Approach to Vaccination

In the past year, the threat of the H1N1 influenza has been at the forefront of healthcare discussion. But despite the best efforts of the healthcare com-munity there remains a continued threat of circula-tion of pandemic influenza. Recently, the Advisory Committee on Immunization Practices (ACIP) discussed the need to provide universal influenza vaccination to the entire U.S. adult population (those 19 to 49 years of age). Last year, approxi-mately 50% of adults had indication which war-ranted vaccination. The committee discussed a new “phased-in” approach which would provide vaccination for all adults and offer the most com-prehensive option for patients and healthcare pro-viders. It is predicted that the new approach will not only simplify the current recommendations for adults, it will also prevent wasted vaccine doses. In addition to changing the recommendations for vaccination of adults, the committee approved a motion to endorse a measure carried out by the Food and Drug Administration (FDA) advisory panel meeting. On February 22, the FDA ap-proved immediate implementation of the 2010-2011 seasonal flu vaccine, which will include the H1N1 strain. The FDA’s Vaccines and Related Biological Products Advisory Committee unani-mously recommended replacing the current influ-enza vaccine’s A/Brisbane/59/2007 (H1N1)-like virus with the pandemic A/California/7/2009 (H1N1)-like virus strain for the 2010-2011 season. Sources: Foster, M. (2010, February 25). ACIP recommends universal flu vaccine. Retrieved March 1, 2010, from Pediatric Supersite: http://www.pediatricsupersite.com/view.aspx?rid=61297

Foster, M. (2010, February 22). FDA advisory commit-tee recommends including pandemic H1N1 strain in next season’s influenza vaccine. Retrieved March 1, 2010, from Pediatric Supersite: http://www.pediatricsupersite.com/view.aspx?rid=61178

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 be-come 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. The instructors have taught this curriculum at several universities most recently at Pennsylvania State, Lasalle, and Samford Uni-versities. In addition, recorded lectures of this course form the basis for other university NP pharmacology courses. 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. An adminis-trative 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.

Six Day Clinical Pharmacology for NPs and Advanced Practice Clinicians

Presented by:

Oakbrook, IL, July 12-17, 2010 Atlanta, GA, October 27-November 1, 2010

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

Presented live in the following cities:

• 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 infection • 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 11

Want to read other articles like this? Click here to see archived articles by Margaret Fitzgerald.

(Mumps: Continued from page 7) to 1957 consider receiving a single MMR dose to ensure immunity. Healthcare workers are especially at risk of ac-quiring mumps and transmitting it to patients—they should receive two doses of MMR vaccine or provide proof of im-munity. Apart from the above-mentioned immunization strategies, the CDC’s recommendations for controlling an outbreak of mumps include the following:

• Increase surveillance for mumps among people suffer-ing from parotitis or other salivary gland inflammation. Continue the observation for 50 days (two times the maximum incubation period) after the date of illness onset in the last identified case. Approved case defini-tions and case classifications for mumps as defined by the Council of State and Territorial Epidemiologists (CSTE) are available at: http://www.cdc.gov/nip/diseases/mumps/case-def.htm.

∗ Clinical case definition An illness with acute onset of unilateral or bilateral ten-der, self-limited swelling of the parotid or other salivary gland, lasting 2 or more days, and without other appar-ent cause.

∗ Laboratory criteria for diagnosis Positive serologic test for mumps immunoglobulin M (IgM) antibody, or significant rise between acute- and convalescent-phase titers in serum mumps immu-noglobulin G (IgG) antibody level by any standard sero-logic assay, or isolation of mumps virus from clinical specimen, or detection of viral antigen by reverse tran-scription polymerase chain reaction (RT-PCR)

∗ Case classification

° Probable: A case that meets the clinical case definition, has noncontributory or no serologic or virologic testing, and is not epidemiologically linked to a confirmed or probable case.

° Confirmed: A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologi-cally linked to a confirmed or probable case. A labora-tory-confirmed case does not need to meet the clinical case definition. False-positive IgM results by im-munofluorescent antibody assays have been reported.

● Immediately test and report to local health officials any-one who is suspected of having mumps. You can find information on collection and testing of clinical speci-mens for mumps at http://www.cdc.gov/mumps/clinical/qa-case-reporting.html (accessed 2.25.10). Testing is essential because not all cases of parotitis are mumps, although mumps is the only known cause of epidemic parotitis.

FHEA News Page 12

● Home isolation is recommended for patients suspected of having mumps 9 days after the onset of symptoms. In healthcare settings, healthcare providers are advised to use respiratory precautions.

● Consider excluding unvaccinated individuals from insti-tutions such as schools and colleges that are affected by a mumps outbreak and even from institutions that are not directly affected by an outbreak but that are judged by local public health authorities to be at risk for transmission of disease. Unvaccinated people should be excluded for at least 25 days after the onset of the virus in the last person with mumps in the affected insti-tution.

You can find the latest information on mumps and prevent-ing and controlling mumps outbreaks, including vaccination, on the Center for Disease Control and Prevention website at: http://www.cdc.gov/mumps/clinical/index.html (accessed 2.25.10).

85 Flagship Drive, 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.

Editorial Staff Managing Editor: M. W. Comstock Editor: Emily L. Paquin Assistant Editor: June Kuznicki Technical Assistant: B. 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 name and the mail address you wish to cancel in the body. If you received a copy of this newsletter from a friend, you 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 authenticate your subscrip-tion.

Interested in advertis-ing in this newsletter? Email june@fhea.com

Margaret A. Fitzgerald’s Upcoming Speaking Engagements

03/15/2010

Pharmacology Update Sheraton Maui Resort & Spa 2605 Ka'anapali Parkway Lahaina, HI 96761

Topics: - Pharmacokinetics, Pharmacodynamics: Getting Back to Basics in Choosing and Prescribing Medications - Drug Update: New Products, New Uses, New Warnings - Antibiotic Update: A Focus on Urinary Tract Infec-tion Click here to see a complete list of topics

03/29/2010

NP Certification Exam Review and Advanced Practice Update Fitzgerald Health Education Associates, Inc Live On-line Course Course is held Monday and Tuesday nights for 5 weeks. (See page 2 for de-tails).

Topics: - Preparing for Exam and Test Taking Strategies - AANP vs ANCC: A Comparison of the Two Examinations - Primary Prevention: Health Promotion and Immunization Click here to see a complete list of topics

04/14/2010

36th Annual The National Organization of Nurse Practitioner Faculties Confer-ence Omni Shoreham Hotel 2500 Calvert Street NW Washington, DC

Topics: - Pharmacology Update: Topics TBA

04/21/2010

NP Certification Exam Review and Advanced Practice Update Fitzgerald Health Education Associates, Inc DoubleTree Atlanta Buckhead 3342 Peachtree Road NE Atlanta, GA 30326

Topics: - Preparing for Exam and Test Taking Strategies - AANP vs ANCC: A Comparison of the Two Examinations - Primary Prevention: Health Promotion and Immunization Click here to see a complete list of topics

05/05/2010

NP Certification Exam Review and Advanced Practice Update Fitzgerald Health Education Associates, Inc Hilton Lisle/Naperville 3003 Corporate West Dr Lisle, IL 60532

Topics: - Preparing for Exam and Test Taking Strategies - AANP vs ANCC: A Comparison of the Two Examinations - Primary Prevention: Health Promotion and Immunization Click here to see a complete list of topics

05/112010

NP Certification Exam Review and Advanced Practice Update Fitzgerald Health Education Associates, Inc Marriott Burlington 1 Mall Road Routes 128 & 3A Burlington, MA 01803

Topics: - Preparing for Exam and Test Taking Strategies - AANP vs ANCC: A Comparison of the Two Examinations - Primary Prevention: Health Promotion and Immunization Click here to see a complete list of topics

05/20/2010 The National Conference for NPs Hyatt Regency Chicago Chicago, Illinois

Topics: - In the Spotlight: Honing Your Speaking Skills (Together with Wendy Wright & Mimi Secor) - Analyzing Laboratory Data: A Case Study Approach - Max Rx Track: Dangerous Liaisons: Drug-Drug, Drug-Nutrient Interactions - New Products, New Uses, New Warnings - Pediatric Pharmacology: Update for Primary Care