Lhop Protocols Ellyn Stecker

Things non-medical persons can do

  1. Blood pressures (give card with blood pressure and goals written on it)
  2. Give info re: other resources
  3. Assist with vaccinations by providing info, triage
  4. Monitor flow of patients/staff/outside persons such as press, police, public

Things to be done by a nurse or medical assistant or under their direct supervision

  1. Glucose testing (give card with glucose level and goals)
  2. Blood pressures (see info sheet re: goals)
  3. Triage

Common conditions

(?licensing; Suggestions must be followed by admonition to seek medical care if not improving or if worse)

Runny nose with sneezing

Suggest the following over-the-counter meds

  • Nasal decongestant spray or nasal saline
  • Loratadine (generic for Claritin… there are many names): does not make sleepy or keep awake
  • Other allergy meds like Benadryl (diphenhydramine) can make drowsy, Sudafed (pseudoephedrine or-D in combo meds) and phenylnephrine (PE in meds) can keep awake. There have their place
  • Combo over-counter meds like DayQuil and Nyquil are popular and help some a lot

Reasons to go to the clinic or to see the doc/NP

  • Not improving after 2 weeks
  • Gettting worse after 1 week on non-prescription meds and herbs
  • Temperature over 100.5 for more than 72 hours, or
  • Short of breath

Cough

Suggest

  • Cough drops
  • Dextromephoran (in cold meds that say "cough suppressant") for symptoms; there are many brands.
  • Benadryl (diphenhydramine) 25 mg helps stuffiness, itching, and is a mild cough suppressant also.

Reasons to go to the clinic or to see the doc/NP

  • Cough worse after 1 week, or
  • If wheezing or shortness of breath is present.

Itchy eyes with NO redness, no pus, no other symptoms of a viral cold, and swelling that is all round the eye: probably allergic

Suggest

  • Loratadine 10 mg 1x/day, plus
  • Cold compresses,
  • Benadryl 25 mg for an adult at night (can make drowsy), or
  • Over the counter eye allergy drops.

See a doc or NP if pus in eye, if not improving after 2 days, or if vision stays blurry, or if there is increasing pain.

Athlete's Foot. This is caused by a fungus.

  • Use any of the over the counter anti-fungal creams (miconazole, clotrimazole, lamisil) after washing well with soap and water twice a day
  • Change socks daily and wash all flip flops weekly. Can use 1 part household bleach to 9 parts of water to soak the feet every few days AND to flood the inside of the shoes 1 x a week for 15 minutes til condition is gone

Sore throat

  • Salt gargle (1/4 tsp table salt in 1/4 cup water); pain meds like naproxen 1 or 2 tabs every 8 hours or Tylenol 1-2 tabs every 6 hours; throat lozenges

Epigastric, i.e., upper stomach, pain

  • If not sick, just sore and pain is mild, try over counter stomach acid relievers like Prilosec (omeprazole), Zantac (ranitidine), Axid (nizatidine), Tagamet, or antacids.

See a doc or NP if vomiting 2 times or more, vomiting blood (more than a tiny spot or two), passing black stools (peptobismol, iron, blueberries cause black stools too) frequently, or feeling very weak.

Wheezing

  • Should see a doc, sooner if temp over 100 and short of breath; can go less urgently if only slightly bothersome.

Cuts and scrapes

  • Wash with saline or water, soap if you have it; advise to keep covered. If red and very painful after 24 hours, try warm compresses 15 minutes for 24 hours; then if not improving or at any time there is severe swelling and pain, see a doc that day

Leg pain

  • For general aches and pains, any of ibuprofen, naproxen, acetaminophen (Tylenol) or aspirin

Tooth ache

  • Salt water mouth rinses (1/4 tsp salt in 1/4 cup water) 4 times a day; pain meds as for leg pain; if not improving after 48 hours or if temp over 100.5 or severe face swelling see a doc

Mouth sores

  • Salt water mouth rinses as above or peroxide. If very painful or if they don't clear in a few days, see a doc/NP

Authors

Ellyn Stecker, MD
Jennifer
Gina
Eve
Bruin

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