General Guidelines
A-C
D-H
I-R
S-W
100
How soon does a patient need to be seen after a kite request?
24 hours after the kite is open
100
What are the objective Data you should gather for abdominal pain?
1. VS
2. Bowel Sounds- auscultation
a. normal 5-34 min
b. absent <5 per min
c. Hypo or hyperactive
3. Palpate- soft, firm, tender, rigidity, guarding
4. Current Medications- use of ASA, NSAIDS, Warfarin
100
Dental pain protocol
objective- VS, appearance of tooth and surrounding area, sensitivity, bleeding, airway assessment.
Action taken- Penicillin VK and Flagyl. Allergy to pcn- azithromycin loading dose and every day for 4 days. Ibuprofen TID for 14 days or Tylenol. warm saltwater rinses qid prn soft diet if requested. Place on dental list.
100
Mental Health Referrals
Meds given within 60 days restarted except stimulants or sedatives.
Stims: Strattera, adderall, concerta, ritalin
Sedative: ambien, lunesta, belsomra, rozerem, sonata, temazepam
Requesting to see mental health, change in their mental health medication/including sleep.
Send inbox message to Mental health team- We do not place patients on their PM list.
100
Skin and Nail Problems Protocol
acne, hives, eczema, dermatitis, dry skin, nail dsicoloration, weeping, induration blisters, scaling, purulence and dandrugg.
Dry skin- advise detainee to obtain lotion through canteen, avoid using soap on dry skin, avoid long hot showers.
non diabetics can not be given lotion as part of this protocol.
200
How many times can an RN renew a protocol
Twice
200
Medications prescribed for anxiety
Hydroxyzine 25mg two capsules TID PRN for seven days OR Benadryl 25mg two capsules TID prn seven days. DO NOT REPEAT COURSE OF TREATMENT WITHOUT AUTHORIZATION FROM PRECRIBING MENTAL HEALTH CARE PROVIDER.
200
Ears- Otitis pain protocol
inflammations of the middle ear or the external auricle and auditory canal which may be caused by virus or bacteria.
Ibuprofen BID for 7 days or Tylenol, avoid getting water in the ear, do not insert foreign bodies into ear canal. increase po fluid intake. irrigate canal if needed. 
200
Musculoskeletal Sprains and Strains- Action Taken
Ibuprofen BID PRN 7 days or Tylenol BID PRN 7D. May offer cold pack NO MORE THAN 2 DAYS for visible swelling. Encourage rest until pain subsides with elevation of joint. JW alert for an additional pillow for specific extremity.
Can reach out to car provider for xray
Follow up with care provider- lack of improvement in one week, inability to bear weight or use area or concerns.
200
Sleep disturbance or insomnia
Advice detainee to employ good sleep hygiene behaviors and allow this to be worked on for a period of at least 5 days since first nurse visit.
a. avoid napping
b. avoid beverages containing caffeine after noon meal
c. avoids vigorous exercise after evening meal or near bedtime.
d. provides patient information fact sheet related to sleep hygiene.
reassure that poor sleep is normally a self-limiting condition and is common in the correctional setting.
after that can start melatonin 6mgs po q hs ongoing.
300
What do you do if the patient asks for a protocol for the third time?
Add to provider visit
300
Patient complaining of no bm for three days what should be done?
Encourage increase intake of fluids and level of activity
Senna 2 tablets once daily for up to 2 days bm should happen 6-12 hours. Schedule follow up with patient to ensure bm in 2 days- if not call provider.
objective- look, listen, feel.
300
Hypertension Protocol
Normal <120/80 -- recheck next visit
Pre 120-129 or DBP <80 recheck in 3m
Stage 1 130-139 or 80-89 recheck in 4 weeks
2 >140 or >90 Elevated measure bp on both arms- difference of >20 suggestive of aortic dissection. Recheck next day and one week. Chart check to medical provider, restart medications if applicable.
>180 or >110 recheck in 10 min, symptomatic handled as hypertensive emergency.
Asymptomatic- hypertensive urgency- check blood pressure daily 4d- chart check to medical provider.
300
Influenza Protocol
Flu vaccine- Sept- March and they can put a kite request in.
VS, lung sounds
action-single cell, 2 days past febrile period (5-7 days after symptoms), increase fluids, adequate rest, containment strategy- hand washing, avoiding face to face contact.
Nasopharyngeal swabs available.
300
MRSA Protocol
Clean and cover draining lesion with apporpriate dressing. Do not pop blisters or boils. good handwashing. Include wound culture if purulent drainage. Single cell detainee if drainage unable to be contained by dressings or detainee not compliant with keeping lesions covered. warm soaks or compress for 20 min TID. Instruct to report back to nursing- fever, red streaks, increase in drainage, increase foul smell, enlarging or spreading of infection.
Add to provider schedule if requiring antibiotics, pus pocket.
Add to PM for daily wound care.
400
For a kite request- what type of visit do you open in NextGen?
Nurse- Sick Call and make sure to copy and paste the state of the complaint (in patient's words)
400
Back Pain Protocol
Assess pain level, location, bowel/bladder habits, chronic condition, ROM.
Ibuprofen OR Tylenol bid 7 days, muscle rub bid prn 7 day. Initial application of bold pack for first 48 hours followed up by heat prn.
Work/sports restrictions.
400
Gastrointestinal Upset protocol
Subjective
: stomach hurts, acid refulx, PUD, gastritis, food intolerances.
Objective: VS w/ weight, abd assessment- look, listen, feel, oral inspection, nsaids, abx?
Action: education- don't lie down immediately after eating, reduce carbonated beverages and caffeine, liquid antacid between meals QHD prn and omeprazole QD 14 days. avoid asa or nsaids. modify diet to lactose free or bland.
400
Lice or scabies Treatment Protocol
place all bedding and clothing, towels in a laundry bag intended for contaminated and infectious laundry (red bags)
shampoo all hair on body- apply permethrin lotion saturating affected areas which may include scalp, genitalia and other hairy areas. Leave on for 10 min. Rinse hair thoroughly until water becomes clear and comb out tangles. dress in all new clothing new bedding and towels. may need to retreat in 7-10 days.
500
What does 2 complaints in 72 hours for the same reason initiate?
Initiate a provider visit or a call to the provider if there is an urgent need
500
What is the procedure for if a patient is prescribed anticoagulation medication?
verify anticoag prescription
VS
any signs of bleeding
Instruct no ASA or NSAID
Continue verefied meds
notify nurse if experienceing any signs of bleeding- brusiing, dark stools, blood in urine, vomiting, diarrhea, fever
lower bunk
Contact provider if not taking anticoag as ordered or current dose is unclear
ROI for clinic following up with
schedule appt with provider for initial visit
500
Headache protocol
VS, any injury, recent loc, confusion, visual changes, blurring, n/v, htn,
ibuprofen Tylenol
cold pack prn
schedule with provider if reoccurring
500
Pregnancy Care
Confirm pregnancy, gather background data- last menses, estimated date of confiement, prenatal history, drugs etoh, vs and weight, offer schedule visit with the onsite public health clinic 555 nurse for sti testing. request doula services- MN doula prison project.
Order pregnancy diet, prenatal vitamins, no ibuprofen or asa.
bleeding- instruct to save the pad for monitoring.
ten weeks or greater with no prenatal care schedule to be seen by provider at next clniic.
Prenatal care in the community- verify last date and ROI.
10-28 weeks every 4 weeks seen
29-36 weeks every 2 weeks seen
>36 weeks weekly
Contact provider- after first trimester and spotting.