Note: M.D. and Psychiatrist to be notified of ER trips

Standing medication orders:

Acetaminophen (Tylenol) – Indicated for temporary reduction of fever or for relief of minor aches and pains.
Adults and children over 12: Regular strength (325 mg) Take two tablets every 4-6 hours as needed not to exceed more than 12 tablets in 24 hours.
Children: 48 to 59 pounds: 6 to 8 years: 320 mg
Children: 60 to 71 pounds: 9 to 10 years: 400 mg

Antacids- Indicated for the relief of heartburn, acid indigestion, and stomach upset.
Liquid- Adults and children over 12: take 2-4 teaspoons between meals and at bedtime. No more than 24 teaspoons in 24 hours.
Tablets- Chew 2-4 tablets between meals and at bedtime. No more than 24 tablets in 24 hours.

Benzoyl peroxide- Indicated for the treatment of acne. It can be used alone or with other treatments, including antibiotics and products that contain retinoic acid, sulfur, or salicylic acid.
Cleanse skin thoroughly prior to applying a thin layer to affected area once daily, may increase to 2-3 times if needed. Decrease applications if dryness or peeling occurs. Use sunscreen when outside.

Chlortrimeton (chlorpheniramine maleate) – Indicated for temporary relief of allergy/ hay fever symptoms. This may include runny nose, itchy, watery eyes, and sneezing.
Adults and children over 12: one tablet every 4-6 hours; not to exceed 6 doses in 24 hours
Children 6-12 years: ½ tablet every 4-6 hours; not to exceed 6 doses in 24 hours

Claritin (loratadine)- indicated for the relief of nasal and non-nasal symptoms of seasonal allergic rhinitis and for the treatment of chronic idiopathic urticaria in patients 2 years of age or older.
Adults and children 6 years of age and over: The recommended dose of claritin is one 10 mg tablet or reditab, or 2 teaspoonfuls (10 mg) of syrup once daily.

Colace (ducosate sodium)- indicated for the relief of constipation, irregularity.
Adults and children over 12: Take 1-2 (100-200) softgels daily until first bowel movement, 1 softgel thereafter.

Debrox (carbamide peroxide)- Indicated to soften, loosen and remove ear wax.
Adults and children over 12: Tilt head to the side, place 5-10 drops into ear canal. May use twice daily as needed. May gently flush canal with warm water to remove remaining wax.

Diphenhydramine- Indicated for the relief of runny nose, itchy watery eyes, itchy throat and non-anaphylactic allergic reactions.
Adults and children over 12: 25-50 mg every 4-6 hours not to exceed 6 doses in 24 hours.
Children 6-12 years: 12.5- 25 mg every 4-6 hours not to exceed 6 doses in 24 hours.

Hydrocortisone 1% cream- Indicated for the temporary relief of minor skin irritations, itching, and rashes caused by eczema, insect bites, poison ivy, poison oak, poison sumac, soaps, detergents, cosmetics, and jewelry.
Hydrocortisone cream is applied to affected area one to four times a day for skin issues.

Ibuprofen (Advil, Motrin)- Indicated for temporary reduction of fever or for relief of minor aches and pains as well as inflammation and dysmenorrhea.
Adults and children over 12: (200 mg) Take 1-2 tablets every 4-6 hours while symptoms persist. May use 600mg for more moderate pain not to exceed 2400 mg daily. Any other dosage should be ordered by the physician.
• Children 48 to 59 lb or 6 to 8 y of age, give 200 mg.
• Children 60 to 71 lb or 9 to 10 y of age, give 250 mg.
• Children 72 to 95 lb or 11 y of age, give 300 mg.

Milk of Magnesia- for relief of mild constipation, heartburn and upset stomach.
Adults and children over 12: 2-4 tablespoons every 8 hours (laxative); 1-3 teaspoons up to 4 times daily (antacid) not to exceed more than 12 teaspoons in 24 hours.
Children 6-12 years: 1-2 tablespoons every 8-12 hours as laxative only.

Miralax (polyethylene glycol)- Indicated for relief of occasional constipation.
Adults and children over 12: 17 grams of powder mixed with 4-8 oz of fluid daily for up to 2 weeks or as directed by physician.

Mucinex- Guaifenesin Extended-Release 600 mg Tablets. Indicated to loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive.
Adults and children 12 years of age and over:1 or 2 tablets every 12 hours. Do not exceed
4 tablets in 24 hours.Children under 12 years of age: do not use.
Mucinex D- Guaifenesin 600 mg Pseudoephedrine HCl 60 mg. Indicated to loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive, along with temporary relief of nasal or sinus congestion.
Adults and children 12 years of age and over:1 or 2 tablets every 12 hours. Do not exceed
4 tablets in 24 hours.Children under 12 years of age: do not use.
Mucinex liquid for kids- (grape)-Guanifensin 100 mg. Children age 6-12 years: 1-2 teaspoons every four hours.
Mucinex cough mini melts- Guanifensin 100 mg, dextromethorphan 5mg. Children age 6-12 years: 1-2 packets every four hours.

Orasol gel- (benzocaine) Indicated for the temporary relief of minor pain and sore mouth associated with toothache, dental procedures and irritations.
Dry affected area and apply medication with cotton swab. May use up to four times daily, but no more than every two hours.

Phenylephrine- Indicated for temporary relief of nasal congestion and sinus pressure caused by allergies, the common cold, or the flu.
Adults and children over 12: Take (1) 10 mg tablet every 4 hours not to exceed more than 6 doses in 24 hours.

Robitussin- Indicated for the temporary relief of cough due to minor throat and bronchial irritation.
Adults and children over 12: 2 teaspoons every 6-8 hours not to exceed 4 doses in 24 hours.
Robitussin DM- Indicated for the temporary relief of cough due to minor throat and bronchial irritation. Also helps to loosen mucous and thin bronchial secretions.
Adults and children over 12: 2 teaspoons every four hours not to exceed 6 doses in 24 hours

Silvadene- Indicated as a topical treatment for prevention of wound infections in second and third degree burns. It is a sulfa derivative and should not be used in anyone with sensitivity to sulfa drugs such as bactrim.
Apply a thin layer to affected area once or twice daily until healed.

Tinactin (Tolnaftate) –
Indicated for treating fungal growth causing skin infections such as athlete’s foot or jock itch. It comes in liquid, powder, cream and spray.
Apply light application to clean, dry affected area twice daily for 2 weeks.

Eye, Ear, Nose, and Throat Conditions

A. Routine
1. Vision Screening- on campus, done with and without glasses.
• Baseline on admission, then annually or as insurance allows (refer for eye exam if less than 20/40)
Students who are taking Quetiapine (Seroquel) need to have ophthalmologic exams at baseline, then q 6 months.
2. Audiologic Screening- on campus
Baseline on admission, then annually

B. Ocular Trauma / Foreign Body in Eye
1. If possible, obtain vision assessment.
2. Assess for presence of foreign body.
3. Attempt to remove superficial foreign body with eye wash solution ,
4. If unable to remove foreign body, or if there is presence of corneal clouding, irregular pupils, severe conjunctival swelling, excessive tearing, pain, photophobia, or significant vision changes, apply eye patch with non-allergic tape, and transfer to E.R.

C. Acid or Alkali Chemical Burn to the Eye
1. Irrigate eye copiously with running water from the nearest available eye wash station for at least 15 minutes.
2. Contact poison control and transport to ER for further evaluation ASAP.

D. Conjunctivitis / Inflammation
1. Can be bacterial, viral, or allergic.
2. Bacterial is usually associated with purulent discharge; common pathogens are
staph aureus, strep pneumo, and H. influ-non-typeable. Notify physician for prescription for antibiotic eye drop / ointment.
3. Viral tends to be more uncomfortable for the patient, discharge is watery, and preauricular nodes are slightly tender. Instruct patient to wash hands frequently and to avoid touching their eyes. Call physician for recommendations. .
4. Allergic tends to be marked by prominent itching and a very boggy-looking conjunctiva. It can have a stringy, mucoid discharge so sometimes difficult to distinguish from bacterial. Usually bilateral. May give a trial of Chlortrimeton or Claritin by mouth and notify physician if no improvement.

F. Otic exam

1. Examine both ears with an otoscope. If able to visualize T.M.’s, and no obvious pathology is noted, treat symptomatically, and reexamine in 24 hours.
2. If unable to visualize T.M.’s due to wax, may administer 4-6 drops of Debrox qhs x3 days. Irrigate PRN. Reexamine in 3 to 5 days; may repeat Debrox if persistent wax.

3. Report any redness, drainage, or swelling of canals or T.M.’s to the
F. Epistaxis [Nose Bleed]
.
1. Have student sit upright at a 45 degree angle.
2. Place gentle pressure against septum x10 minuets by the clock.
3. Rinse mouth with cool water
4. Place ice pack on back of neck.
5. If bleeding persists, check B/P and call physician.

G. Sore Throat
1. Examine throat and glands. Take temperature.
2. If mild ST or from irritation or overuse, use salt water gargles, push fluids, rest voice, and use acetaminophen or ibuprofen PRN.
3. A strep assay with the ICON Fx Strep A should be done if accompanied by a T of 101 or greater and other symptoms of illness such as tender cervical nodes. Notify physician if positive. If negative and there is high suspicion for strep, send throat culture to lab to rule out strep.
4. Warm compresses may be applied to the neck to reduce the discomfort of enlarged neck glands.
5. Notify physician immediately if patient is unable to manage own secretions (drooling), uvula is shifted beyond midline (tonsillar abscess), or if patient appears toxic.