abd. pain w/ possible ductal dilation

1st degree relative

A parent, sibling, or child.

Source: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=460150

Family med. - preventative screening

Pap smear: @21 y/o up to 70 y/o unless clinically needed.
Colonoscopy: @50 y/o unless clinically nded
Mammogram: up to 70 y/o unless clinically needed

Family med. - insurance

PPO:

• can go to any specialists anytime, no need for a referral.
• can go to any podiatrist's store at anytime and show the store the insurance card. Then, will be given free diabetics shoes (if the store has diabetics shoes)

HMO:

• need referral from PCP even for diabetics shoes

Common Family meds Rx for NP students

• Immunization

HepA - 2-dose series for travelers, usu. those coming from Southeast Asian may not need it since they usually already have the immunity
HepB - Engerix 1mL - VIS Feb 02 2012 - 3-dose series
HPV - 3 dose series 

Tdap 0.5mL - VIS Feb 24 2015 - once every 10 years

Fluvirin (flu vax for <65 y/o) - VIS 08-07-2015 - once every year starting Sep
Fluad (flu vax for >65y/o)  - once every year starting Sep
Pneumovax (pneumonia for >=65 y/o) - once every q5 yrs
Prevnar (pneumonia for >=65 y/o) - once in a lifetime

Zostavax - once every 10 years

• TB screen

TB 0.1mL or 10 units in insulin syringe 

• Insomnia

Hydroxyzine 25mg take PO QHS PRN 30 pills No refills

• Hyperlipidemia

Atorvastatin 20 or 40mg 

• Hypertension

Losartan 50mg

• Rash

Mild: Triamcinolone 80mcg x2 times a day 1 application to the affected area 2x daily

Severe: Fluocinolone

Fungal: Clotrimazole 1% & Betamethasone 0.05% 45g

• Allergy

Loratadine 10mg 1 tab daily 30 tabs

Fluticasone 50mcg 2 sprays nasal daily refill:2 Quantity:1

• Inflammation pain

Ibuprofen 400 mg 240tabs

(Children: 154lbs/2.2 = 70kg *10 = 700mg)

• Cough

Promethazine DM 

Benzonatate (Tenson Perles) 200mg oral capsule 1 capsul PO q8hrs pprn Refill: 0 Quantity: 60 pills

• Severe nasal Nasal d/c unrelieved with Flonase nasal spray & Loratadine:    

Pseudoephedrine HCl 60 MG Oral Tablet Sig: Take 1 tablet (60 mg) by mouth every 6 hours as needed. Refill: 0. Quality:50
Triprolidine & Pseudoephedrine (Aprodine) 2.5-60 MG Oral Tablet Sig: 1 tab po qhs prn

• Restless leg syndrome

Ropiniole 0.5mg tabs - 0.25mgx2, 0.5mgx3. RTCin 1 week for evaluation 

• Antiemetic patch

Scopolamine patch good for 72 hrs

• Menopause symptoms

Estroven OTC 

Atropine

- Atropine is a parasympatholytics that blocks the M2 receptor of the SA node. Therefore, atropine increases the rate of SA node firing & thus => improving the conduction thru the AV node.
=> Therefore, Atropine can be used for sinus bradycardia because the SA node just needs some kicks.
=> Therefore, Atropine can be used for 2nd degree AV block Wenckebach bc the site of the cause of the AV node wenckeback is at the AV node.
=> Therefore, Atropine is not effective for 2nd degree AV block Mobitz type 2 because the site of the problem blockage is below the AV node.

sinus bradycardia

    Causes:
- Electrolyte imbalances
- Acid/Base problem
- Hypoxia
- Temporary or permanent pacing (LOOK FOR THEIR PACEMAKER. If they depend on their pacemaker to fire and it's not working, they probably have permanently slow heart rate! Need the pace maker to be fixed!)

Tx:
None if asymptompatic

If symptomatic (hypotensive, keeps passing out), then:
1 - atropine (atropine is a parasympatholytic, therefore, it will pace the heart making it beat faster; However, be careful not to use atropine on patients with MI because pt will go to V-Tach with the increased myocardial demand workload and oxygen,

2 - pacer, (SA node is not working right, may need pacer)

3 - r/o vagal problem esp. in children bc they like to hold their breath and thus getting into fainting issues a lot!)

sinus arrhythmias

1 - Rate: fast and slow and slow and fast unpredictably

2 - Rhythm:
- P is before each QRS. QRS is after each P.
- Q is normal looking
- Irregular: there's like a pause between some beat

3 - Axis: skip this for now

4 - Width:
- PR interval width is normal (5ss at all beats) and fixed (Remember sinus rhythm has fixed and normal PR interval)
- Q width is normal (<3ss)
- RR: 1/2RR width is less than QT segment= normal

5 - Height:
- No ST elevation
- Upright P wave in lead II (Remember sinus rhythm has upright P wave in lead II)

6 - Pts symptoms:
- Usually EKG sinus arrythmias will have rhythms change as pt breathing in and breathing out
- Usually older pt with syncope, fatigue and worsening HF may have sinus arrhythmias or sinus bradycardia NOT owing to use of beta blocker, that would mean pt may need a pacemaker (sick sinus syndrome)

vfib

Symptoms: pt not looking at u, totally out, no pulse, no breathing,
EKG:

Tx:
CPR, defib, epinephrine, IV, oxygen, intubation, implantable defibrillator to prevent future incident

Work up: Treatable causes: H's & T's

NSR - Normal sinus rhythm

Qt tip:  NSR ALWAYS has upright P wave with normal length PR.
(assuming no dextrocardia or misplaced leads)

ekg leads - localization