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IDEAS FOR NEXTGEN MY PHRASES - COMMON ACUTE CARE ASSESSMENTS AND PLANS(Adapted from W. Chadwick, VHC Urgent Care Epic dot phrases)ABRASIONKeep wound clean and dry, change dressing twice daily.Apply topical antibiotics with dressing changes.See pediatrician if signs of infection (redness, warmth, drainage, fever)Handout provided.ABSCESSWarm compresses three times daily.Keep wound clean and dry, change dressing twice daily.See pediatrician if signs of worsening infection (increased swelling, redness, new sites of infection, fever)Hand washing to prevent spread of infection.Handout providedALLERGIC REACTIONAvoid inciting allergensBenadryl as needed for pruritus.EpiPen use reviewed.Call 911 for serious reaction (lip/tongue swelling, wheeze, dyspnea, and whenever EpiPen used)Handout providedALLERGIESShower / eye wash if exposed to environmental allergen.Take allergy medication as prescribed.See pediatrician if symptoms not controlled or worsening.Call 911 for serious reaction Handout providedAOMWill treat with antibiotics given history and exam findings.To complete entire antibiotic course.Provide Tylenol/ibuprofen as needed for fever / pain.See pediatrician if worsening or no improvement on antibiotics.ASTHMAAction plan and proper use of medications reviewed.See pediatrician for increasing work of breathing, worsening cough, or persistent fever.Handout provided.ATOPICDERMATITIS, ECZEMABath no more frequently than every other dayUse moisturizing soap onlyUse emollient BID (Vaseline, aquaphor, cetaphil)Apply topical steroid cream as prescribed.See pediatrician for worsening symptoms or signs of super-infection.Benadryl or atarax before bed if difficulty sleeping due to itchingHandout provided.BACKACHE, MUSCLESTRAINLikely musculoskeletal strain, benign exam - Ibuprofen every 6 hours x 2 days.Warm packs and massage as tolerated.See pediatrician if not improved in one week or worsening.Reviewed injury prevention with proper lifting techniques.Handout provided.BLEPHARITIS, STYE, CHALAZION, HORDEOLUMWarm compresses 2-3 times a day until resolved.Once resolved daily face washing with attention to eyelash line encouraged for prevention of recurrence.See pediatrician if worsens, or persists > 4 weeks (ophthalmology referral).Handout provided.BRONCHIOLITISLikely viral etiology and lack of effective medicinal therapy reviewed.Supportive care with nasal saline and suctioning, good hydration, warm showers/baths and humidifiers, acetaminophen as needed for fever See pediatrician or return to ED for increased work of breathing, poor intake, vomiting, decreased urine output, persistent fevers or any other concerns. Hand washing to prevent spread of infection.Handout provided.BURN- Apply silvadene cream to burn twice daily with dressing changes.- Ibuprofen and/or acetaminophen as needed for pain.- See pediatrician in 2 days for wound check. - See pediatrician sooner if fever, swelling, increased redness or pain not controlled on OTC analgesics. - Handout provided. COLIC, FUSSY, GASWell appearing infant, benign exam.- Suspect colic, possibly GERD or gas pain.- Soothing techniques (5S’s) discussed.- Increased risk for abuse reviewed along with parental coping techniques.- May try simethicone drops for gas pain.- Positional interventions for reflux and gas reviewed. - Return if fever (>100.4), poor feeding, persistent, projectile or bilious vomiting, or respiratory distress- Handout providedCONJUNCTIVITISExam consistent with conjunctivitis, favor *** etiology.- Antibiotic eye drops as prescribed.- Return to clinic if worsening symptoms, eye swelling, or change in vision.- Hand washing to prevent spread of infection.- Handout provided.CONSTIPATIONHistory consistent with constipation, exam benign.- Increase fiber, fluids, fruits, and vegetables in diet.- See pediatrician if no improvement in stooling.- Handout provided.DERMATITIS, RASH- Apply topical treatment as prescribed.- Take diphenhydramine as needed for itching. - Avoid inciting allergens and fragrant skin products.- See pediatrician if signs of infection or no improvement in 48 hours.- Handout provided.DIAPER RASH, CANDIDAL DIAPERRASHExam consistent with *** diaper rash.- Remove diapers and air-dry 3 x daily for 10-15 minutes.- Change diapers frequently. - Apply topical barrier cream with every diaper change.*** - Apply antifungal cream four times daily for candida diaper rash.- See pediatrician for signs of worsening infection or super infection. DIARRHEALikely self-resolving infection, exam benign.- Supportive care measures reviewed.- Maintain good hydration, frequent small amounts of oral rehydration solution.- Return for signs of dehydration, urinating less than 3 times in 24 hours. - Return if blood develops in stool or fever lasts longer than 5 days. - Hand washing to prevent spread of infection.- Handout provided. EARPAIN, OTALGIA- No evidence of acute otitis on exam or dental caries (referred pain).- Ibuprofen or acetaminophen and eardrops as prescribed for pain.- See pediatrician if not improved or worsening symptoms.FEBRILE SEIZUREHistory consistent with simple febrile seizure, no focal neurologic deficits on exam and at baseline mental status at time of discharge. - Typically benign nature of this seizure type and risks of future seizures reviewed. - Seizure precautions reviewed.- Call 911 if seizure > 5 minutes or atypical.- Handout providedFEVER, VIRALLikely viral syndrome, benign exam.- Acetaminophen or ibuprofen as needed for fever or pain.- Encourage hydration. - See pediatrician if fever not resolved in 5 days, lethargy, less than 3 wet diapers/voids per day, any other concerns. - Handout provided.FRACTURE- RICE (rest, ice, compression, and elevation) for 24 to 48 hours. - See your pediatrician or return to ED if numbness, tingling or pain in extremity which does not resolve after readjusting splint- Acetaminophen as needed for pain. - Orthopedics follow up for casting / further management. - Handout provided. GASTROENTERITISLikely self-resolving viral gastroenteritis. Benign exam, well hydrated. - Supportive care measures reviewed.- Maintain good hydration, frequent small amounts of oral rehydration solution.- Once keeping fluids down, ok to allow solids ad lib, but avoid sugary juices/foods, greasy/fatty foods. Avoid dairy if diarrhea persists longer than 7 days. - Return for signs of dehydration, urinating less than 3 times in 24 hours. - Return if blood develops in stool or fever lasts longer than 5 days. - Zofran as needed for nausea/vomiting, prescription provided.- Hand washing to prevent spread of infection.- Handout provided. GERDHistory consistent with reflux. Benign exam. - Keep baby upright for 30 minutes after feeding.- Burp after every 10 minutes / 2 oz of feeding. - Elevate head of bed (from floor, do not place extra bedding in crib)- See pediatrician for worsening symptoms or if not improved. - Handout provided.IMPETIGO- Complete antibiotics for infection. - Wash area thoroughly with soap and water twice daily. - Hand washing to prevent spread of infection.- See pediatrician if worsening or not improved. - Handout providedINGROWNTOENAIL, PARONYCHIA- Warm soaks twice daily- Proper nail care reviewed, keep nails long, rectangular cut.- Loose fitting shoes, bare feet or sandals whenever possible. - See pediatrician if no improvement for management or referral to podiatry.- Handout provided. INSECT BITES- Diphenhydramine every 6 hours as needed for pruritus.- Topical hydrocortisone cream BID as needed for itch. - Encourage child to refrain from scratching bites, keep fingernails short and clean.- Handout provided.HANDFOOT&MOUTH, COXSACKIE, HERPANGINA- Soft bland diet until oral lesions resolve, avoid citrus and spicy foods.- Acetaminophen / ibuprofen as needed for pain and fever. - Hand washing to prevent spread of infection.- See pediatrician if unable to tolerate liquids or less than 3 wet diapers per day, or if fever persists > 5 days. - Handout provided.HEADACHE- Blood pressure, visual acuity and neuro exam reassuring. - Ibuprofen as needed as soon as headache begins. - Keep well hydrated with plenty of water. - Minimize screen time to 2 hours or less per day. - Record headaches in diary and bring to follow up with pediatrician, if headaches persist. - Handout provided.HEAD INJURY, CONCUSSIONNo findings concerning for serious traumatic brain injury, normal mental status and neurologic exam.- Instruction provided for ongoing observation at home – return to ED for change in mental status, persistent vomiting, seizures. - Patient may experience ongoing headaches, or other symptoms of concussion; supportive care with rest, minimized screen time/stimulation, no return to play until cleared by pediatrician discussed. - Handout provided.NOSEBLEED, EPISTAXISSuspect onset with ***. Hemostasis now achieved. - Saline nasal spray BID. - Petroleum jelly to nares QHS. - If recurs, discussed proper pressure application and positioning.- Handout provided.OTITIS EXTERNA, SWIMMERSEAR- Apply eardrops as instructed.- No swimming or submerging ear for 5-7 days.- No headphones or ear plugs until symptoms resolve.- In future, dry ears promptly after swimming (blow-dry, towel dry) and use earplugs while swimming. - See pediatrician if worsens or no response. - Handout provided. PHARYNGITIS, SORETHROAT, STREPTHROAT- Negative rapid strep: Culture sent, will call if positive and prescribe antibiotics, otherwise assume viral infection and manage with supportive care. - Positive rapid strep: Antibiotics prescribed. - Promote hydration. - Analgesia and fever control with acetaminophen, ibuprofen.- See pediatrician if worsening, fevers persist for > 5 days, severe pain with swallowing or unable to swallow (drooling), any other concerns. PNEUMONIA- Complete antibiotics as prescribed.- Ibuprofen / acetaminophen as needed for pain/ fever.- See pediatrician for respiratory check in 2-3 days.- See pediatrician or return to ED if respiratory distress, signs of dehydration. Any other concerns. - Handout provided.LICE, SCABIES- Apply permethrin as prescribed.- Handout provided with instructions for cleaning of house, linens, etc. - May require a repeat treatment in 7 days. - Household contacts should be evaluated and treated simultaneously, if positive.- Handout provided. SEIZURE- Reviewed seizure first aid in case of recurrence: place pt side lying, confirm nothing in mouth, give rectal diastat if > 5 minutes and call 9-1-1. - Reviewed safety precautions: no climbing in high places, swimming only with lifeguard present/close supervision, always wear helmet with on bike/scooter and riding only in non-traffic areas. SPRAIN- RICE (rest, ice – q4h, compression, and elevation) for 24 to 48 hours. - Sprain wrapped for comfort, if numbness, tingling or pain in extremity splint should be removed- Ibuprofen as needed for pain. - Handout provided. TINEA CORPORIS- Apply antifungal cream as directed; continue to apply for 2 weeks after rash disappears. - See pediatrician if worsens or if no response after 2 weeks of consistent treatment. - Handout provided.TINEA PEDIS, ATHLETES FOOT- Apply antifungal cream as directed; continue to apply for 2 weeks after rash disappears. - Change socks twice daily and remove shoes/wear sandals whenever possible.- See pediatrician if worsens or if no response after 2 weeks of consistent treatment. - Handout provided.UTI- Complete antibiotics as prescribed. - Encourage hydration. - See pediatrician if worsening symptoms, flank pain, persistent fevers. - Handout providedURILikely self-resolving viral infection. Benign exam. - Supportive care reviewed. - Elevate head when sleeping and use humidifier (or warm shower before bed).- Nasal saline and suctioning reviewed. - Acetaminophen or ibuprofen for pain or fever. - Discussed cough syrups not recommended in children under 4; recommended honey, tea, warm fluids in children older than one year. - Anticipate 1-2 weeks of cough. - See pediatrician if fevers persist for total of 5 days, respiratory distress, or signs of dehydration. - Handout provided. VAGINITIS- Reviewed hygiene, wiping front to back- Parent to clean perineum daily- Avoid bubble baths- Handout providedURTICARIA, HIVESEtiology: ***.- Use diphenhydramine as needed for itching.- Avoid allergens / triggers as able. - Seek immediate medical attention if evidence of serious allergic reaction (facial swelling, difficulty breathing) - Handout provided. ................
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