Primary Clinical Care Manual Queensland Government

Primary Clinical Care Manual Queensland Government-Free PDF

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Mild and moderate allergic reactions,Mild and moderate allergic reactions. HMP Urticaria allergic rhinitis adult child, Be alert to signs of anaphylaxis severe allergic reaction. Background1 2, Mild allergic reactions typically involve skin features urticarial rash or erythema flushing and. or angio oedema Severe allergic reactions anaphylaxis also involves respiratory and or. cardiovascular and or gastrointestinal symptoms, Acute urticaria can last from a few minutes to 24 hours If it lasts longer than 6 weeks it is. considered chronic urticaria, ASCIA Action plan for allergic rhinitis available at https www allergy org au patients allergic.
rhinitis hay fever and sinusitis allergic rhinitis treatment plan. Related topics, Anaphylaxis page 102 Allergic conjunctivitis page 382. Acute asthma page 119,1 May present with,Urticaria3. Central swelling wheal of variable size surrounded by erythema hives. Associated itching or sometimes burning sensation, Angio oedema sometimes co exists swelling of face tongue or lips. Allergic rhinitis hay fever 4, Sneezing itchy nose sniffing upward rubbing of nose. Clear rhinorrhoea nasal obstruction congestion,Itchy throat frequent need to clear throat.
Watery itchy eyes allergic conjunctivitis may occur concurrently. Be alert to signs of anaphylaxis severe allergic reaction. Difficult noisy breathing Wheeze or persistent cough. Swelling of tongue Persistent dizziness or collapse. Swelling tightness in throat Pale and floppy young children. Difficulty talking hoarse voice Vomiting and or abdominal. pain for insect stings bites,And or any acute onset. hypotension bronchospasm or upper airway instruction OR. illness with skin features PLUS respiratory cardiovascular or. persistent severe gastrointestinal symptoms,320 Primary Clinical Care Manual 10th edition. 2 Immediate management,Mild and moderate allergic reactions. If any signs of anaphylaxis give adrenaline epinephrine without delay See Anaphylaxis page. 3 Clinical assessment5,Obtain complete patient history. any known allergies triggers, recent viral infection or insect bite common causes of urticaria in children.
previous episodes treatment used was it effective, contact with irritant allergens e g nickel detergents cosmetics rubber topical medicines. shampoo hair dye clothing dust mite animal dander moulds pollens. contact with plants stinging tree, contact with animals caterpillars bird lice honey bees. recent intake of foods seafood peanuts,time of potential contact with irritant. current medications,coexisting conditions e g asthma eczema. Perform standard clinical observations full Q ADDS CEWT score or other local Early Warning. and Response Tools,Perform physical examination,inspect skin.
describe lesions red swollen flat linear pattern,are lesions diffuse itchy painful. auscultate chest for wheezes See Acute asthma page 119. inspect eyes for watering redness See Allergic conjunctivitis page 382. 4 Management,Consult MO NP if,angio oedema e g swelling of face tongue or lips. suspected irritant is a medicine before recommending to cease. Allergic rhinitis4 6, Treat with intranasal corticosteroid budesonide and or oral non sedating antihistamine. cetirizine or loratadine,Reduce doses as symptoms improve. Check patient has ASCIA treatment plan for allergic rhinitis if not refer to next MO NP clinic. Urticaria5,Usually self limiting, Treat with oral non sedating antihistamine cetirizine or loratadine.
Children 12 years and adults may need another dose late afternoon. If sleep of older children or adults is disturbed add a sedating antihistamine at night. promethazine, Oral antihistamine may be effective to treat angioedema if not MO NP may order oral. prednisolone, Section 4 General Mild and moderate allergic reactions 321. Mild and moderate allergic reactions,Extended authority. Schedule 2 Budesonide Rhinocort,ATSIHP IHW IPAP,ATSIHP IHW IPAP and RIPRN may proceed. RN may administer for supply see Authority to administer and supply medicines page 9. Route of Recommended,Form Strength Duration,administration dosage.
Adult and child 6 years While symptoms,Nasal 4 sprays daily persist. 32 microgram Intranasal,spray OR Supply max one,2 sprays bd bottle. Provide Consumer Medicine Information May cause nasal stinging itching nose bleed sneezing. sore throat dry mouth or cough Avoid spraying at septum Bend neck forward and look down Use. right hand for left nostril and vise versa Put nozzle just inside nose aiming towards outer wall Avoid. sniffing too hard or liquid likely to go straight down thoat Videos on administration https www. nationalasthma org au living with asthma how to videos. Pregnancy Do not use in 1st trimester, Contraindication Severe nasal infection bleeding disorders recent nasal surgery. Management of associated emergency Consult MO NP See Anaphylaxis page 102. Extended authority,Schedule 2 Cetirizine,ATSIHP IHW IPAP. ATSIHP IHW and IPAP may proceed for adults and child 12 only. RIPRN may proceed, RN may administer for supply see Authority to administer and supply medicines page 9.
Route of Recommended,Form Strength Duration,administration dosage. Adult and child 12 years,Tablet 10 mg,10 mg mane,While symptoms. Child persist,1 2 years 2 5 mg bd,Oral liquid 1 mg mL. 2 6 years 5 mg mane,6 12 years 10 mg mane, Provide Consumer Medicine Information May cause drowsiness fatigue headache nausea dry. mouth or diarrhoea Avoid drinking alcohol while taking. Note If renal impairment seek MO NP advice Increased risk of sedation in elderly monitor carefully. Management of associated emergency Consult MO NP See Anaphylaxis page 102. 322 Primary Clinical Care Manual 10th edition,Mild and moderate allergic reactions.
Extended authority,Schedule 2 Loratadine,ATSIHP IHW IPAP. ASTIHP IHW IPAP and RIPRN may proceed, RN may administer for supply see Authority to administer and supply medicines page 9. Route of Recommended,Form Strength Duration,administration dosage. Adult and child 30 kg Once a day in the morning,10 mg while symptoms persist. Child 2 12 years or 30 kg,Tablet 10 mg Oral 5 mg For adult and child.
Child 1 2 years 12 years dose may,2 5 mg tablet can be be repeated in late. quartered and crushed afternoon if needed, Provide Consumer Medicine Information May cause drowsiness fatigue headache nausea and dry. Note If hepatic impairment seek MO NP advice, Contraindication Severe or immediate allergic reaction to loratadine or desloratadine. Management of associated emergency Consult MO NP See Anaphylaxis page 102. Extended authority,Schedule 3 Promethazine,ATSIHP IHW IPAP. ATSIHP IHW and IPAP must consult MO NP,RIPRN may proceed.
RN may administer for supply see Authority to administer and supply medicines page 9. Route of Recommended,Form Strength Duration,administration dosage. 10 mg Adult,Tablet 50 mg nocte,Oral While symptoms. Child 2 12 years,Oral persist,5 mg 5 mL 0 5 mg kg,liquid to a max of 50 mg nocte. Provide Consumer Medicine Information May cause sedation psychomotor impairment dizziness. confusion headache blurred vision dry eyes constipation dry mouth urinary retention Avoid alcohol. and other sedating medicines, Contraindication Avoid use in Phenylketonuria epilepsy respiratory depression Parkinsons disease. the elderly children 2 years, Use in pregnancy Safe Avoid close to delivery risk of neurological disturbance in infant.
Management of associated emergency Consult MO NP See Anaphylaxis page 102. Section 4 General Mild and moderate allergic reactions 323. 5 Follow up,Respiratory, Advise to be reviewed the next day if symptoms continue and at next MO NP clinic. 6 Referral consultation, Referral to an Allergist may need to be considered to identify the allergen s. Respiratory problems,HMP Upper respiratory tract infection URTI adult. Common cold influenza sore throat tonsillitis bronchitis. pharyngitis,Recommend1, Be alert to the relationship between group A streptococcal infections and acute rheumatic fever. ARF acute post streptococcal glomerulonephritis APSGN which are especially common in. Aboriginal and Torres Strait Islander communities, Most URTI are caused by viruses and do not require antibiotics1.
Background1 2 3, A viral upper respiratory tract infection can be complicated by secondary bacterial infection. requiring antibiotics e g acute otitis media sinusitis bronchitis pneumonia. Other complications include exacerbation of asthma chronic obstructive pulmonary disease. Influenza is probably over diagnosed Systemic symptoms such as fever extreme lethargy sore. muscles and joints and headache differentiate it somewhat from a common cold. Recommend influenza vaccination for all persons 6 months of age For high risk groups see the. current Australian Immunisation Handbook4,Related topics. Acute asthma page 119 Pneumonia adult page 329,Acute bacterial sinusitis page 327. 1 May present with5 6,Watery or purulent nasal discharge sneezing. Sore throat red throat and or tonsils with or without pus halitosis. Cough wheeze earache hearing loss,Enlarged tender cervical neck lymph nodes.
Fever headache,General malaise lethargy,Muscular aches and pains. Facial pain,Diminished sense of smell,2 Immediate management Not applicable. 324 Primary Clinical Care Manual 10th edition,3 Clinical assessment7. Respiratory,Take patient history including,past episodes or complications. any history of asthma COPD rheumatic fever heart disease. history of pleuritic chest pain fevers shortness of breath productive cough. Ask about joint pain consider acute rheumatic fever. Perform standard clinical observations full Q ADDS score or other local Early Warning and. Response Tools,note in particular RR T and SpO2,Perform physical examination.
examine upper respiratory tract nose sinuses throat tonsils and cervical lymph nodes and. urinalysis if positive for blood see APSGN page 700. listen to the chest for air entry and added sounds crackles or wheezes. palpate joints for any swelling,Observe for meningism with neck stiffness. 4 Management1 2 3,If the patient has, an increased RR or any chest findings consider other diagnoses see Pneumonia adult page. 329 and Acute asthma page 119, a cough productive of mucopurulent sputum bronchitis consult MO NP and treat See. Pneumonia adult page 329, facial pain or tenderness see Acute bacterial sinusitis page 327. For the adult patient with uncomplicated URTI,Treatment is symptomatic.
encourage rest and increase fluid intake, administer analgesia as clinically indicated See Acute pain management page 35. consider symptomatic treatment such as steam inhalation lemon or honey drinks and. lozenges which help some patients,if severe nasal congestion consult MO NP. For the adult patient with complicated URTI,Indications for antibiotic treatment are. patients aged 2 25 years with sore throat in communities with high incidence of acute. rheumatic fever e g Aboriginal and Torres Strait Islander communities in central and northern. Maori and Pacific Islander people, pustular tonsillitis with fever and local lymphadenitis. existing rheumatic heart disease, quinsy severe infection of the tonsils causing massive enlargement evidence of pus on tonsil.
if quinsy is present consult MO NP May need evacuation hospitalisation for IV penicillin. and or surgical drainage of pus, If not allergic treat with phenoxymethylpenicillin. Section 4 General Respiratory problems 325, Respiratory If a lack of adherence with oral medicine is anticipated treat with IM benzathine benzylpenicillin. Bicillin LA, If allergic to penicillin treat with azithromycin4. Advise exclusion from work and school for 5 7 days. Advise to wash hands frequently to minimise transmission to others. Extended authority,Schedule 4 Phenoxymethylpenicillin. ATSIHP IHW IPAP RIPRN,ATSIHP IHW IPAP and RN must consult MO NP.
RIPRN may proceed,Route of Recommended,Form Strength Duration. administration dosage,Capsule Oral 500 mg bd 10 days. Provide Consumer Medicine Information May cause diarrhoea nausea and candidiasis Food has little. effect on absorption, Contraindication Severe or immediate allergic reaction to a penicillin Be aware of cross reactivity. between penicillins cephalosporins and carbapenems. Management of associated emergency Consult MO NP See Anaphylaxis page 102. Benzathine benzylpenicillin Extended authority,Schedule 4. Bicillin LA ATSIHP IHW IPAP RIPRN,ATSIHP IHW IPAP and RN must consult MO NP.
RIPRN may proceed,Route of Recommended,Form Strength Duration. administration dosage,Injection 1 2 million Adult,pre filled units 2 3 mL IM 1 2 million units stat. syringe 900 mg 900 mg, Provide Consumer Medicine Information May cause diarrhoea nausea and pain at injection site. Note Stop injection immediately if patient shows signs of severe pain See Administration tips for. benzathine benzylpenicillin page 787, Contraindication Severe or immediate allergic reaction to a penicillin Be aware of cross reactivity. between penicillins cephalosporins and carbapenems. Management of associated emergency Consult MO NP See Anaphylaxis page 102. 320 Primary Clinical Care Manual 10th edition Mild and moderate allergic reactions HMP Urticaria allergic rhinitis adult child Recommend Be alert to signs of anaphylaxis severe allergic reaction Background1 2 Mild allergic reactions typically involve skin features urticarial rash or erythema flushing and or angio oedema Severe allergic reactions anaphylaxis also involves

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