Common eye problems that NP student must know

- Conjunctivitis
- Hordeolum (Stye)
- Chalazion
- Blepharitis
- Iritis
- Corneal Abrasion
- Pterygium
- Subconjunctival hemorrhage
- Glaucoma
- Sjorgen's syndrome
- Macular degeneration
- Cataract
- Herpes Simplex conjunctivitis
- Herpes Zoster ophthalmicus
- Orbital cellulitis
- Age-related conditions

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 

ovarian cyst

TB 2-step skin test

In some persons infected with TB, especially older persons, the ability to mount a positive TST reaction may wane over time. An initial TST placed in these individuals may not fully react, and be interpreted as negative. However, a repeat TST within a year or more may react and show a positive reaction. This effect is known as the booster phenomenon, and a positive “boosted” response should be considered the valid baseline for that individual. In a person who has never been infected with TB (assuming no BCG vaccination or non-TB mycobacterial infection), repeated TST testing itself will not elicit a positive reaction.

Two-step testing is a screening method that takes into account a possible booster phenomenon in an individual and should be considered for any person when serial testing is to occur. While boosting is most common in persons aged 55 or older, some employers who require TB screening utilize a two-step test for all new employees regardless of age while others select an age cut-off point of usually 45 to 55 years to reduce the likelihood that a boosted reaction is not misinterpreted as a recent conversion.

Candidates for two-step TST include employees of health care facilities, employees who undergo periodic TB screening, and residents of congregate living settings (details for screening those populations are described in Chapter Seven, page 7-7). Two-step testing should be performed only for initial TB screening. Subsequent periodic testing requires only one TST. Therefore, an individual who can provide documentation of a negative TST by the Mantoux technique within the preceding year has no need for two-step testing, as it is very unlikely the TST result is the result of waning immunity.


 Procedure and interpretation for two-step skin testing (see Figure 2-1, page 2-17):

1. Administer the Mantoux TST.
2. Examine the TST in 48 to 72 hours. If initial TST is negative, repeat TST within one to three weeks using the same dose and strength of tuberculin and have patient return in 48 to 72 hours for the second reading. A positive TST means the individual is considered infected, and should be evaluated for treatment of LTBI.

OR

 As an alternative, the initial TST can be examined in seven days, since a truly positive TST persists for many days beyond 72 hours. If the initial TST is negative, a repeat TST can be administered at the same visit and the individual should be instructed to return in 48 to 72 hours for the second reading. A positive TST means the individual is considered infected, and should be evaluated for treatment of LTBI.

Source: http://publichealth.lacounty.gov/tb/forms/chapter2.pdf   (page 15)

Family practice coding/billing

TB screening:
icd 10  Z11.1 ENCOUNTER FOR SCREENING FOR RESPIRATORY TUBERCULOSIS

cpt86580

SKIN TEST; TUBERCULOSIS, INTRADERMA

Ovarian cyst: icd 10  N83.0 FOLLICULAR CYST OF OVARY

VIS (Vaccine Information Statement) for flu shot: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf  see date at the bottom: 08/07/2015