Nikkie the NP’s Classroom

Write something

Common Concepts in Pharm is happening in 7 days

Pinned

Nikkie Miller

3h •

General discussion

Faculty Friday : Ask Me Anything!

It’s faculty Friday. Ask me anything. Questions about learning style, study tips, jobs, contracts, a topic that has you stumped? Ask away.

Pinned

Nikkie Miller

2d •

General discussion

Unfolding NP Case: “I’m Having Drainage From My Breast”

Instructions You are the NP seeing a 45-year-old woman in a primary care clinic for new breast drainage. Information will be provided as you ask questions. You will not receive the entire history upfront. The goal is to work through the patient organically. Use your interview skills to clarify the complaint, identify concerning findings, and develop a differential diagnosis before selecting diagnostic tests. Start with an open-ended question. Follow the patient’s answers with focused questions. Initial presentation Jamie Carter, age 45, presents with the following concern: “I noticed some drainage from my breast. That has never happened before, and I’m a little worried.” Vital signs: BP 124/78 mm Hg, HR 76 beats/min, RR 16 breaths/min, temperature 98.2°F, SpO₂ 99% on room air. Your first task: What would you ask Jamie next?

Pinned

Aug 12 •

👋 Welcome! If you’re an NP student overwhelmed by how much you’re expected to know, you’re in the right place. I’m Nikkie, an Acute Care NP and NP educator behind Nikkie the NP. My goal here is simple: Stop memorizing random crap. Start learning how to think like a provider. 🧠 This community focuses on mastering the 3Ps: Pathophysiology, Pharmacology, and Physical Assessment, with an emphasis on actually applying what you know and using diagnostic reasoning. Expect: 🧠 Simple breakdowns of complex concepts 💊 Pharm that actually makes sense 🩺 Clinical reasoning and application 📚 Study strategies and practice questions 🔥 A little tough love along the way This is a community, so ask questions, participate, and share your wins. 👇 Introduce yourself and tell us what you’re studying and what you struggle with most. Let’s get to work. 💪

New comment 12d ago

Nikkie Miller

1d •

General discussion

Breast Cancer Screening Cheat Sheet (See attached for nice version)

01 AVERAGE-RISK SCREENING USPSTF [1] Ages 40-74: mammography every 2 years. Age 75+: evidence is insufficient; individualize. 2D mammography or 3D tomosynthesis may be used. American Cancer Society [2] 40-44: option for annual mammograms. 45-54: annual mammograms. 55+: every 2 years or continue annually. Continue while in good health with a life expectancy of at least 10 years. Guidelines differ. Use shared decision-making; document the guideline, benefits, false positives, and overdiagnosis discussed. 02 IDENTIFY HIGHER RISK Ask about both maternal and paternal cancer history and ages at diagnosis; known pathogenic variants; prior chest radiation; personal breast cancer, atypia, or LCIS; and previous biopsies/imaging. ACS high risk [2]: annual MRI plus mammography, usually beginning at 30, for lifetime risk about 20%-25% or greater, BRCA1/2 variants, an untested first-degree relative of a carrier, or chest radiation before 30. Specialist plans may start earlier. Refer for formal risk assessment/genetic counseling when indicated. Prior cancer or high-risk lesions require an individualized surveillance plan. 03 DENSE BREASTS + EXAM Dense tissue raises risk and can obscure cancer. USPSTF finds insufficient evidence for routine supplemental ultrasound/MRI after a negative mammogram; assess overall risk. [1] Teach breast awareness. ACS does not recommend routine clinical breast exam for average-risk screening; symptoms still require a focused exam. [2] 04 ASK + EXAMINE Ask: onset, progression, focal vs diffuse pain, cyclicity, pregnancy/lactation, trauma, prior changes, and last imaging/results. For discharge: spontaneous or expressed, one or both breasts, single or multiple ducts, and color. Examine: symmetry, contour, skin and nipples; palpate both breasts and regional nodes. Document a mass by clock position, distance from nipple, size, borders, mobility, tenderness, and associated skin changes. 05 RED FLAGS: PROMPT WORKUP New dominant mass or focal thickening, especially hard, irregular, or fixed. Cancer may also be soft, mobile, or painful. [3]