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Th e new nurse practitioner and the practicing nurse practitioner in the ambulatory care setting must be prepared to perform an increasing array of skills competently to meet patient care needs. Th e inspiration for this book came when, on graduating from a nurse practitioner program, I found no procedural resources directed toward the needs of the nurse practitioner in ambulatory care. Th e need to perform many procedures—those not taught in my nurse practitioner program—was apparent. Th e physician I practiced with required a knowledge base in procedural skills greater than the one I possessed. Fortunately, this physician was willing to teach me the necessary procedures. Th is improved care to our patients and decreased the necessity to refer many patients for procedures easily performed in the ambulatory care (outpatient) setting. Th is text was developed to assist in the many demands on the newly graduated nurse practitioner and the nurse practitioner currently in practice. We believe the procedures outlined will improve the marketability of the nurse practitioner and serve as a good reference tool for family and/or adult nurse practitioners in an ambulatory care setting. Prerequisites for this book are basic anatomy and physiology, microbiology, pharmacology, principles of aseptic technique, and basic nursing skills. Th is book would be an appropriate text for incorporation of procedural techniques throughout a family or an adult nurse practitioner curriculum. It also would be appropriate for an elective on minor surgery and diagnostic procedures and interpretation. Another potential use for this book would be as part of the protocol/guidelines in the nurse practitioner ’ s practice. Many procedures performed by primary care physicians are not currently appropriate for the nurse practitioner to perform. Th e procedures in this book were chosen based on a comprehensive study of types of procedures currently used in the nurse practitioner ’ s practice. Many of the procedures can be used in any ambulatory setting. Some of the procedures need specialized equipment, and some use equipment commonly found in any offi ce. A few of the procedures—fl exible chest tube insertion, colposcopy, endometrial biopsy, IUD insertion and removal, sigmoidoscopy, and thrombosed hemorrhoid removal—require additional training. Th ey are included for reference only. Check with your state board of nursing if you are unsure whether or not a certain procedure may be performed by nurse practitioners in the state in which you practice. Th e major theme of this book is clinical application of knowledge and clinical skills. Th ere are seven sections in the book. Th ese sections are based on body systems for ease of classifi cation. Each major section begins with diagnostic procedures the nurse practitioner performs with the basis for their interpretation. Next in each section, listed in alphabetical order, are procedures performed in an ambulatory care setting. Each procedure contains seven parts. First, an Overview is presented, outlining causes, incidence, and other specifi c information intrinsic to each procedure. Th e Health Promotion/Prevention section gives tips to the nurse practitioner to pass on to the client to help promote health or prevent the need for the procedure in the future. Options lists one to four methods of performing the procedure and gives a choice of how to perform the procedure. Th e Rationale section gives reasons to perform the procedure. Indications tell the nurse practitioner when the procedure should be performed, and Contraindications tells the nurse practitioner when not to perform the procedure. Th e Procedure section lists the necessary equipment and gives step-by-step instructions for performing each procedure listed under Options . Client Instructions assist the nurse practitioner with postprocedure instructions, listing what the client must and must not do to have an optimal recovery period. At the end of each is a bibliography for further information gathering. We hope you will fi nd this text to be a good learning tool and a great resource in your practice.