Ortho in Primary Care: Hacks for New Nurse Practitioners

Ortho has to be the one of the main subjects new NPs stress about. Experienced NPs, too.

If you’re feeling like you don’t know enough, and still have to see patients with ortho complaints (especially in telemedicine)– here are the “hacks” of primary care ortho management.

You’ll learn:

  • The main 4 steps to managing almost all ortho complaints in primary care
  • The top red flags overarching most ortho complaints
  • How to triage ortho complaints
  • When to send to ortho (and what to do first)

Check it out here 👇

(FYI: to slow down the audio speed, hit the gear symbol in the bottom right corner and change it to .75x or .5x. Closed captions are also located at the bottom R hand corner of the video.)

Once you’ve watched, I’d love to hear from you.

Leave me a comment with any other questions you have.

Thanks so much for watching. Hang in there, and I’ll see you soon.

Liz

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15 thoughts on “Ortho in Primary Care: Hacks for New Nurse Practitioners”

  1. I would love to see specific ortho complaint videos (wrist, shoulder, knee, etc.). Thanks for the videos! They are always helpful.

  2. In your top suggestions – NSAIDS, PT, ortho referral, and surgery, what are your thoughts about chiropractors? I know this can be a touchy subject, but I’m curious where/if you’d place them in the line.

    Also, for chronic pain, what are your thoughts about the rampant CBD (with and without THC) usage? — legal dosages of course

    1. Great question! I personally see a really awesome chiropractor and I think they have their place in holistic care but I have definitely found wide variation between practitioners. The one I see uses a tool for very small adjustments compared to manual manipulations “neck snapping,” which feels a lot safer to me and he agrees with. I think my struggle with recommending it to patients is that the medical research, RCTs, meta-analyses don’t show enough evidence, so it’s not a first line recommendation for me– it depends on the patient. And I only recommend this for mild pain without any alarm signs, radiculopathy, etc. And the other thing about it is that you can adjust bones, but if you don’t do release/support/strengthening of tight muscles/fascia, the adjustments will just slide back into place, so it’s usually in conjunction with physical therapy or a chiropractor that also does soft tissue work.

    2. Oh and CBD! Lots and lots of that. I think the evidence for it is building, and people seems to have a great response to it anecdotally so far, although most are without THC. It’s legal in Massachusetts where I practice, and overall I still screen for drug dependence (since even though it’s not a tolerance/physical addiction it can be a behavioral addiction/self-treatment for underlying mental health issues). I don’t necessarily recommend it myself but have discussions with patients about its use.

  3. Great presentation. I usually only x-ray with traumatic injuries. I order naproxen 250-500 mg po bid with food, a topical pain patch daily x 7 days, ROM exercises and sometimes a muscle relaxent, but only for 14 days at bedtime.

  4. Alessandra Henderson

    Hi I was wondering if you could make a video on medication adjust for hypothyroidism relegated time labs, when to go up or down on patients medications based on lab results.
    And when patients are on levothyroxine, I feel like it’s even harder to adjust the dose.
    Am I the only one feeling this way!
    I started a job in internal medicine and I’m worried!
    Thanks a lot

  5. Hi, I have a question about differentiating gout and an infected joint. I see a lot of gout complaints in my current job setting and I know that a gout flare can develop acutely. I know that it is important to distinguish between gout and an infected joint, especially when prescribing steroids. Any advice?
    Thank you!

    1. SUCH a great question. As soon as I posted this video I realized I left out gout. I’ll have to do a video about gout but this is a tough DDX. If you’re concerned about infection and/or gout, it’s totally a good idea to do a CBC with diff and uric acid the day of the visit — considering that it can still be gout even if the uric acid isn’t elevated, but it helps rule it in if it’s high. To be honest, I’ve never had a septic joint in primary care, as patients tend to present more sick, febrile and self-triage to the ED or urgent care, but having a diff is helpful. I think they are also more likely to present with an effusion, fluid that can be “milked” around the knee. Hopefully that helps!

  6. Hi,
    I was watching the Clinical Pearls for the New Grad with you and Kim Ellis. You mentioned that you would look on Up to Date as you’re in the room listening to patients chief complaint….. THANK You! I always felt like I was the only one that did this! You have NO idea how much better I feel knowing I am not the only one who doesn’t know it all.
    I made the mistake of working in Oncology right out of school, that was a no no… Oncologist are not wonderful at teaching, so I failed pretty badly. I then went into hospice bc of a non compete clause and no I am somewhat bored. But I keep doing CEU’s and staying informed and will wait for the perfect position before I decide to leave hospice. But I do worry that I am getting behind or not getting the clinical experience that will Not allow be to be marketable in the future.. we will see.

    Thanks for this website, I appreciate it and you for knowing how important it was give back!
    Jenn

    1. YES! So, so normal to be constantly looking things up. I’m sorry to hear it hasn’t been great for you so far, hoping for you to find your dream job! Definitely check out Amanda at The Resume Rx if you’re looking for job resources ❤

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