Georgia Coastal Health District
TABLE OF CONTENTS FOR
NURSE PROTOCOLS
THIS PAGE INTENTIONALLY LEFT BLANK
DIVISION OF PUBLIC HEALTH
NURSE PROTOCOLS FOR REGISTERED PROFESSIONAL NURSES
for 2008
| |
|TABLE OF CONTENTS |
TAB/Page Number
|INTRODUCTION |1 |
|THE NURSE PROTOCOL PROCESS |2 |
|Mechanism for Development, Review and Revision |2.1 |
|General Time-Line for Annual Review and Update of Nurse Protocols |2.3 |
|Tool for Reviewing Nurse Protocols |2.4 |
|Standard Format for Nurse Protocols |2.5 |
|Word Processing for Nurse Protocols |2.6 |
|Certified Nurse Protocol Review Form |2.8 |
|Acknowledgments |2.9 |
|1. Nurse Protocol Committee |2.9 |
|2. Physician Consultants |2.11 |
|GUIDELINES FOR NURSE PROTOCOLS |3 |
|A. |Purpose |3.1 |
|B. |Definitions |3.1 |
|C. |Drugs to be Covered by Nurse Protocol |3.2 |
|D. |Drugs to be Covered by either Nurse Protocol or Policy/ Procedure |3.3 |
|E. |Requirements for a PHN Who Uses a Nurse Protocol |3.4 |
|F. |Licensed Practical Nurses |3.4 |
|G. |Requirements for Nurse Protocols |3.4 |
|H. |Delegated Authority for Ordering Dangerous Drugs |3.5 |
|I. |Dispensing Dangerous Drugs |3.5 |
|J. |Accountability |3.7 |
|K. |Signing Nurse Protocol Agreements |3.7 |
|L. |Retention of Nurse Protocols |3.10 |
|M. |Nurse Protocol Agreement Formats for Advanced Practice Registered Nurses |3.10 |
|Appendix 1 |Example for Women’s Health |3.14 |
|Appendix 2 |Example for HIV |3.16 |
|Appendix 3 |Example Drug Formulary for Advanced Practice Registered Nurses |3.19 |
|Appendix 4 |Texts/References Used/Recommended for Advanced Practice Registered Nurses |3.23 |
TAB/Page Number
|DRUG DISPENSING PROCEDURE |4 |
|The Drug Dispensing Procedure Signature Page |4.1 |
|A. |Definitions |4.2 |
|B. |General Requirements |4.4 |
|C. |Drug Storage and Record Keeping |4.4 |
|D. |Outdated, Deteriorated, Returned and Recalled Drugs |4.6 |
|E. |Inventory |4.7 |
|F. |Labeling and Appropriate Containers |4.8 |
|G. |Client Counseling Components |4.8 |
|H. |Additional Information |4.11 |
|ORIENTATION, TRAINING AND QUALITY ASSURANCE FOR NURSE PROTOCOLS |5 |
|A. |Initial Orientation and Training |5.1 |
|B. |Continuing Education/Training |5.1 |
|C. |Documentation of Training |5.1 |
|NURSE PROTOCOLS FOR SPECIFIC DISEASES AND CONDITIONS | |
|HYPERTENSION |6 |
|Primary Hypertension in Adults |6.1 |
|TABLE A: |SHAPP Program Drug Treatment Recommendations |6.15 |
|FIGURE 1: |Algorithm for the Treatment of Hypertension |6.16 |
|TABLE B: |SHAPP Antihypertensive Medications Drug Interactions/Pregnancy Category |6.17 |
|TABLE C: |Antihypertensive Medications Drug Interactions/Pregnancy Category |6.18 |
|DIABETES |7 |
|Diabetes Mellitus in Adults |7.1 |
| |Appendix A: |Continuum of Care Visits |7.13 |
| |Appendix B: |Summary of Recommendations |7.15 |
| |Appendix C: |Oral Hypoglycemic Agent and Oral Agent Adjustment Guidelines |7.17 |
| |Appendix D: |Oral Agents for Treatment of Type 2 Diabetes |7.18 |
| |Appendix E: |FDA Approved Indications for Combination Therapy |7.23 |
| |Appendix F: |Insulin Products Available in the United States |7.24 |
| |Appendix G: |Insulin Adjustment Guidelines |7.26 |
| |Appendix H: |Treatment Algorithm of Type 2 Diabetes |7.28 |
TAB/Page Number
|TUBERCULOSIS |8 |
|Uncomplicated Pulmonary TB (TB) (Age 18 And Over) |8.1 |
|Table 1: Regimen Options - Treatment Of Patients With Drug-Susceptible TB |8.4 |
|Table 2: First-Line TB Drugs |8.5 |
|Table 3: Drug Interactions |8.6 |
|Table 4: Treatment of TB - Drug Interactions |8.12 |
|Table 5: Drug Interactions - Rifampin |8.13 |
|Table 6: Drug Interactions - Isoniazid |8.15 |
|Latent TB Infection (LTBI) |8.17 |
|Table A: Treatment of Latent Tuberculosis Infection (LTBI) – First-Line Drug And Regimen Options |8.24 |
|Table B: Treatment of LTBI – Recommended Drug Regimens For Adults |8.25 |
|Table C: Treatment of LTBI – Drug Adverse Reactions And Monitoring |8.26 |
|Table D: Treatment of LTBI – Drug Interactions (Format 1) |8.27 |
|Table E: Treatment of LTBI – Drug Interactions (Format 2) |8.28 |
|Table F: Drug Interactions – Isoniazid |8.30 |
|Table G: Pediatric Dosage – Daily Dosage Of Isoniazid In Children and Adolescents |8.31 |
|SEXUALLY TRANSMITTED DISEASES (STD) |9 |
|Bacterial Vaginosis |9.1 |
|Chlamydia |9.4 |
|Epididymitis |9.8 |
|Genital Herpes |9.12 |
|Genital Ulcer, Possible Primary Syphilis |9.19 |
|Genital & Perianal Warts |9.23 |
|Gonorrhea |9.28 |
|Lymphogranuloma Venereum |9.37 |
|Mucopurulent Cervicitis |9.42 |
|Nongonococcal Urethritis |9.45 |
|Pediculosis Pubis |9.48 |
|Pelvic Inflammatory Disease |9.51 |
|Scabies |9.56 |
|Syphilis, Early Symptomatic |9.60 |
|Syphilis, Latent |9.67 |
|Trichomoniasis |9.76 |
|Vulvovaginal Candidiasis |9.79 |
TAB/Page Number
|CHILD HEALTH |10 |
|Acne, Mild |10.1 |
|Allergic Reactions/Anaphylaxis |10.5 |
|Allergic Rhinitis |10.6 |
|Animal Bites |10.13 |
|Asthma |10.16 |
|Burns, Minor—Pediatric/Adult |10.27 |
|Cerumen/Earwax, Impacted |10.33 |
|Chicken Pox (Varicella) |10.35 |
|Colic (Irritable Baby Syndrome) |10.39 |
|Conjunctivitis |10.42 |
|Constipation |10.47 |
|Cradle Cap |10.53 |
|Cutaneous Larva Migrans |10.55 |
|Dermatitis, Atopic (Eczema) |10.58 |
|Dermatitis, Contact |10.63 |
|Dermatitis, Diaper (Diaper Rash) |10.67 |
|Enuresis |10.70 |
|Epistaxis |10.74 |
|Erythema Infectiosum (Fifth Disease) |10.77 |
|Fever |10.79 |
| Acetaminophen & Ibuprofen Dosage Charts |10.81 |
|Gastroenteritis |10.85 |
|Giardiasis |10.94 |
|Human Bites |10.98 |
|Impetigo |10.101 |
|Influenza |10.106 |
|Intestinal Parasitic Worms: Roundworms, Whipworms, Hookworms |10.110 |
|Iron Deficiency Anemia in Children |10.113 |
|Labial Adhesions |10.120 |
|Nasolacrimal Duct Obstruction |10.122 |
|Nasolacrimal Duct Infection (Dacryocysitis) |10.124 |
|Otitis Externa |10.125 |
|Otitis Media |10.128 |
|Pediculosis Capitis (Head Lice) |10.137 |
|Pharyngitis |10.142 |
|Pinworms |10.149 |
|Pityriasis Rosea |10.152 |
|Ringworm: Non-hairy Skin (Tinea Corporis) |10.155 |
|Ringworm: Scalp (Tinea Capitis) |10.157 |
|Roseola (Exanthema Subitum) |10.160 |
|Rubella |10.162 |
|Rubeola/Measles |10.165 |
TAB/Page Number
|Rubral/Heat Rash |10.169 |
|Scabies |10.172 |
|Stye (Hordeolum) |10.177 |
|Teething |10.179 |
|Thrush (Oral Candidiasis) |10.181 |
|Tinea Pedis |10.184 |
|Upper Respiratory Infection (URI) Common Cold |10.187 |
|Vomiting |10.190 |
|WOMEN’S HEALTH |11 |
|World Health Organization Medical Eligibility Criteria for Contraceptive Use |11.1 |
|Combined Oral Contraceptives |11.11 |
|Abnormal Lipid Tests While Taking Oral Contraceptives |11.16 |
|Hypertension While Taking Oral Contraceptives |11.19 |
|Spotting or Breakthrough Bleeding While Taking Oral Contraceptives |11.22 |
|Progestin-Only Pill |11.25 |
|Emergency Contraceptive Pills |11.30 |
|Implanon: Insertion |11.35 |
|Implanon: Removal |11.39 |
|IUD Insertion: Copper T380A |11.42 |
|IUD Insertion: Mirena LNG IUD |11.47 |
|IUD-Related Dysmenorrhea |11.52 |
|Lost IUD Strings |11.55 |
|IUD-Related Menorrhagia |11.57 |
|Pregnancy With IUD In Place |11.60 |
|IUD Removal |11.62 |
|IUD Complications and Actions |11.65 |
|Medroxyprogesterone Acetate Injectable Contraceptive |11.67 |
|Ortho Evra Patch |11.74 |
|NuvaRing |11.79 |
|Diaphragm |11.84 |
|Norplant Removal |11.87 |
|Amenorrhea (Primary and Secondary) |11.90 |
|Bacterial Cystitis |11.94 |
|Dysmenorrhea |11.99 |
|Ectopic Pregnancy |11.102 |
|Nurse Protocol for Prophylactic Therapy with Folic Acid for Reproductive-Age Women | |
| |11.104 |
|Iron Deficiency Anemia In Non-Pregnant and Non-Lactating Women 18 and Over | |
| |11.108 |
|Osteoporosis in Women |11.112 |
|Sexual Abstinence Counseling |11.118 |
|Local Estrogen Therapy |11.121 |
TAB/Page Number
|HIV/AIDS-RELATED |12 |
| Recommendations for Use of The HIV/AIDS Related Nurse Protocols |12.1 |
| Continuation of Antiretroviral Therapy |12.3 |
| Diarrhea, New Onset (Acute) |12.8 |
| Diarrhea, Persistent (Chronic) |12.14 |
| DMAC Prophylaxis |12.21 |
| Herpes Zoster (Shingles) |12.26 |
| Oral Candidiasis |12.31 |
| Orolabial Herpes Simplex |12.36 |
| PCP Prophylaxis |12.40 |
| Seborrheic Dermatitis |12.45 |
| Toxoplasmosis Prophylaxis |12.49 |
|OTHER INFECTIOUS DISEASES |13 |
| |Amebiasis |13.1 |
| |Haemophilus Influenzae Meningitis, Preventive Treatment of Contacts |13.5 |
| |Invasive Meningococcal Disease, Including Meningitis, Preventive Treatment of Contacts |13.10 |
| |Pertussis, Preventive Treatment of Contacts |13.15 |
| |Presumptive Pertussis Cases, Identification and Treatment of |13.19 |
| |Drug Interactions |13.24 |
| |Rheumatic Fever – Prophylactic Antibiotic Therapy |13.26 |
| |Rifampin - Pediatric Drug Chart |13.29 |
|EMERGENCY PROTOCOLS AND PROCEDURES |14 |
| |Guidelines for Emergency Kits/Crash Carts |14.1 |
| |Vasovagal Syncope (Fainting) |14.4 |
| |Allergic Reactions including Acute Anaphylaxis, in Adults, Infants and Children |14.6 |
| |Allergic Reaction/Anaphylaxis Record |14.12 |
| |Policy for Reviewing Emergency Protocols/Procedures |14.14 |
| |Emergency Checklist |14.15 |
| |Evaluation Tool for Practice Drill |14.16 |
|APPENDICES: LEGAL REFERENCES |15 |
| |Appendices Index |15.1 |
|A. |Nurse Protocol Legislation, O.C.G.A. § 43-34-26.1. |15.3 |
|B. |Rules of Georgia Board of Nursing – Chapter 410-13: Regulation of Protocol Use by Registered Nurses |15.8 |
|C. |Rules of Georgia State Board of Pharmacy – Chapter 480-30: Dispensing of Drugs Under Authority of Job Description or Nurse|15.10 |
| |Protocol | |
|D. |Health Services Protocols, American Red Cross, August 2006 |15.13 |
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