Ahlta Shortcuts Acne11 Tretinoin - USE AT NIGHT, a pea-sized amount of medication is usually sufficient to cover the face. Skin should be dry at the time of application Benzoyl Peroxide - Use in Morning. Do not use at the same time as Tretinoin! May bleach clothing. Wash face and gently pat dry prior to application. Apply thin layer to cover face or areas where pimples occur. When using these medications: Avoid using over-the-counter irritating products, such as harsh soaps, toners, astringents, and alpha hydroxy acid or salicylic acid products. Use a gentle skin cleanser (Dove, Ceta-klenz) ---------------- bigwe Normal growth and development, reviewed growth chart w/parent, BMI is normal/low/high. Needs 2-3 servings of Calcium containing foods/day, no juice. Fruits + Vegies should be 5 servings/day. Cut down screen time to 2 hrs or less. Increase activity to at least 1 hour per day (after school). Brush teeth bid, Dental visits 1-2/yr. Anticipatory guidance given. Sent to Immunizations. Next well visit in 1 year. Cleared for sports/school/daycare. --------------- Ciprodex11 Ciprodex otic drops: Instill 4 drops into affected ear(s) twice daily for 7 days. -------------- F11 Follow up with pcm if symptoms worsen or fail to improve with current therapy or if any new concerns arise. Parent verbalized understanding. -------------- FU11 Follow up with pcm if symptoms worsen or fail to improve with current therapy or if any new concerns arise. Parent verbalized understanding. -------------- LOM11 physical exam consistent with L Otitis Media. Treat with course of antibiotics, NSAIDs for fever/pain, increased fluids and rest. Follow up for worsening pain, persistent fever or any new concerns. Recommend follow up in 4-6 wks to re-evaluate ear. Parent verbalized understanding. -------------- M11 Mother verbalized understanding -------------- PCM11 Follow up with pcm prn, Parent verbalized understanding -------------- ROM11 physical exam consistent with R Otitis Media. Treat with course of antibiotics, NSAIDs for fever/pain, increased fluids and rest. Follow up for worsening pain, persistent fever or any new concerns. Recommend follow up in 4-6 wks to re-evaluate ear. Parent verbalized understanding. --------------- Sprain11 Treat as Sprain: (PRICE) Treat Pain with NSAIDs, rest, Ice for 15min q3-4h, Compression with ace bandage and elevation when possible. No PE for 1week, will follow up with xray results. -------------- viral11 Likely Viral in origin. Recommend supportive treatment with rest, increased fluids, NSAIDS for fever/pain. Follow up for worsening symptoms not responding to current therapy or any new concerns. Parent verbalized understanding. -------------- Well11 presents for routine well visit. No parental complaints or concerns -Growth and development appropriate for age -Physical exam unremarkable -Immunizations up to date -Anticipatory guidance given. Age Appropriate Bright Futures handout given -Follow up in one year for next routine well visit or sooner if concerns arise. Parent verbalized understanding. ---------- X11 Discussed importance of repeated daily application of topical emollient (i.e. eucerin, aquaphor) as foundation of eczema care. --------- Lcon11 Physical exam reveals erythema and discharge of the L eye most consistent with Conjunctivitis. TM’s Clear. No pain with EOM. Recommend antibiotic ophth drops, Warm or cool compresses for symptomatic relief. Follow up if symptoms fail to improve or worsen with current therapy or any new concerns arise. Symptoms should improve within 1-2 days, patients not responding to appropriate therapy should be referred to ophtho for further evaluation/management Parent verbalized understanding. ----------- Rcon11 Physical exam reveals erythema and discharge of the R eye most consistent with Conjunctivitis. TM’s Clear. No pain with EOM. Recommend antibiotic ophth drops, Warm or cool compresses for symptomatic relief. Follow up if symptoms fail to improve or worsen with current therapy or any new concerns arise. Symptoms should improve within 1-2 days, patients not responding to appropriate therapy should be referred to ophtho for further evaluation/management. Parent verbalized understanding. ------------- Stye11 Physical exam consistent with Stye. No evidence of preseptal cellulitis, vision unaffected. Recommend Warm compresses applied for 15min repeated 4 times daily. Follow up for fever, swelling, rash, or if lesion is not improving or decreasing in size. If no improvement or worsening of lesion noted after 2 wks of warm compress therapy, consider referral to Ophthalmology for further management. Parent verbalized understanding. ----------- ADHD11 Discussed with parents and patient diagnosis of ADHD and Treatment including behavioral interventions as well as pharmacotherapy to include use of stimulant medications. Counseled patient regarding most common side effects. No significant personal or family cardiac history. Parent verbalized understanding of plan and decision made to initiate treatment at this time. Will start at lowest dose with plan to follow up via phone in 2 weeks to assess effectiveness and evaluate for side effects with likely increase in dose at that time. Parent verbalized understanding. ---------------- Uncir11 Counseled parent regarding uncircumcised. Separation of foreskin begins in late gestation by desquamation. only about 4% of newborns have fully retractable foreskins and only about 50% of 7th graders have fully retractable foreskins! As the child grows, penile growth and erection aid the process and the foreskin naturally begins to retract. Cleaning and drying underneath the foreskin can then be performed. After bathing, the retracted foreskin should always be pulled down to its normal position covering the glans penis in order to avoid paraphimosis. Forceful retraction of the foreskin should never be performed. Reasons to refer to urology include: Pain, alteration of urine stream, phimosis, paraphimosis. ---------------- Wart11 Discussed diagnosis of natural history of these viral skin lesions. Discussed options for therapy including topicals, cryotherapy, and biopsy/excision. Decision made by parents to proceed with cryotherapy. Patient tolerated procedure well. Aftercare instructions given. Will give duofilm to apply each night, follow up in 1-2wks for re-evaluation and repeat therapy if needed. Parents verbalized understanding. --------------- 2wk11 presents for 2 wk well visit. -Mother continuing to breastfeed, making appropriate wet diapers with transitioned stool -Reassuring weight gain, above birthweight -Physical exam unremarkable -Anticipatory guidance given Follow up in 2-4wks for next routine well visit or sooner if concerns arise. Parent Verbalized understanding. -------------- Auralgan11 Fill ear canal, then moisten cotton pledget, place in external ear; repeat every 1-2 hours until pain and congestion are relieved ----------- Ciprodex11 Ciprodex otic drops: Instill 4 drops into affected ear(s) twice daily for 7 days. --------- Colic11 Discussed colic and other symptoms to watch for that would suggest alternate diagnosis. Peak symptoms occur between 3wks and 3months of age. Treatment options reviewed, although; counseled parent that no therapy is very effective and symptoms typical resolve with time. Parent Verbalized Understanding Constipation11 history of chronic constipation and pattern of holding. Recommend miralax in addition to current supportive treatment (increased water and fiber in diet, timed toileting) Goal of miralax is to produce soft stool daily until patient can trust that daily soft stool will not hurt, then gradually wean from miralax. Follow up with any new symptoms or concerns. Mother verbalized understanding. -------- Er11 Counseled mother regarding reasons to seek emergent medical attention. -------- Kp11 Discussed Diagnosis as variation of normal skin, not disease state. Counseled Parent/Patient that there is no single proven and effective treatment. Decision made to try Ammonium Lactate 12%. Follow up with pcm if symptoms worsen or fail to improve with current therapy or if any new concerns arise. Parent verbalized understanding. -------- Nail11 Discussed nail biting. Approx 23% of school age children bite their nails and many will continue into high school/college age as well. Usually family history of nail biting. Discussed strategies to encourage patient to stop biting nails which typically occurs in response to stress. Counseled parent to avoid punishment or negative responses to nail biting. Instead to use reassurance, reward system (sticker chart), and encouragement to stop nail biting. Identification of stress in childs life may help. May try bitter tasting nail polish or spray as reminder but evidence suggests that this method alone is not as effective as it is combined with reward system. Parent verbalized understanding. ---------- Olo11 Olopatadine: Instill 1 drop into each affected eye twice daily --------- Pmc11 Follow up with pcm prn, Parent verbalized understanding ---------- Teen11 presents for annual well visit/ physical. No complaints or concerns -No significant cardiac history -Growth and development appropriate for age. -Vision 20/20 -HEADSSS and Physical exam unremarkable. -Immunizations up to date. -Anticipatory guidance given -Follow up in one year or sooner for new concerns. Patient and parent verbalized understanding. ---------- Trait11 -Newborn screen results reveal sickle cell trait. No intervention required. -Sickle Cell Trait is benign hereditary condition and not a disease. -There is a rare risk for sudden death in athletes with sickle cell trait following prolonged physical conditioning and exercise (eg, military boot camp, training for athletic competition). -There is a 25 percent risk for a subsequent child to be born with sickle cell disease if both parents are carriers. Follow up with pcm prn. ---------- Uncirc11 Counseled parent regarding uncircumcised. Separation of foreskin begins in late gestation by desquamation. only about 4% of newborns have fully retractable foreskins and only about 50% of 7th graders have fully retractable foreskins! As the child grows, penile growth and erection aid the process and the foreskin naturally begins to retract. Cleaning and drying underneath the foreskin can then be performed. After bathing, the retracted foreskin should always be pulled down to its normal position covering the glans penis in order to avoid paraphimosis. Forceful retraction of the foreskin should never be performed. Reasons to refer to urology include: Pain, alteration of urine stream, phimosis, paraphimosis. ------------ Weight11 Discussed weight percentiles and strategies for maintaining healthy weight including 5,2,1,0. Making healthy food choices, staying active, and limiting screen time. No significant cardiac risk factors. Follow up at next well visit. Parent verbalized understanding ----------- Reflux11 Counseled parent regarding neonatal reflux, typically peaks around 4mo of age and resolves over the first year of life. Discussed supportive treatment options including frequent burping, smaller more frequent feeding, holding baby upright for 30-45 min after feeds, and small angle elevation of head of bed/crib. --------- umbilical11 Discussed diagnosis of Umbilical hernia. Most of which close during the first year of life, the remaining typically close within the first 4 years and surgical intervention to close lesions are not usually performed until that time. Counseled parent regarding reasons to seek emergent medical attention. Follow up at next well visit or sooner with any new symptoms or concerns. Parent Verbalized understanding. ------------ Enuresis11 Discussed Bedwetting: prevalence is about 15% at 5 years, 5% at 10 years, and 1% at >15years. Normal night-time bladder control is not expected until 5-7years of age. Primary nocturnal enuresis therefore not diagnosed until after age 5. Almost all cases resolve spontaneously and may have a genetic component. Ddx includes: UTI, Sickle cell, DM, Thyroid, Constipation, Psychogenic polydipsia. ----------- ADHDFU Presents for ADHD follow up visit. Patient on stable dose of medication. No academic or behavioral concerns from parent or teachers. No side effects reported (no headaches, stomach aches, no chest pain, or palpitations, no tics, no insomnia or significant appetite suppression.) Physical exam unremarkable. Continue current dose, follow up in 3 months for re-evaluation or sooner if concerns arise.