November 7, 2019 Thursday. Went to TMC Lakewood hospital at 4 pm.
First nurse weighed me, tried and failed to take my blood pressure 3 times on my right
arm and twice on my left arm while I wore two sweaters and a long sleeve
shirt underneath. I told her in the beginning I would remove my sweaters.
She said I didn't need to. Finally, after several unsuccessful attempts of
trying to get my blood pressure, she said Ok you need to remove the sweater.
I did and it registered immediately. 119/78.
She checked my oxygen content.
96%. She took my temperature. 98.1.
She asked me my symptoms as I sat in
the chair hacking, coughing up yellow phlegm and sneezing into my elbow.
The next nurse (or doctor's assistant) came in and asked me what symptoms
I had. I told her it started on October 21, 2019 with a very bad
sore throat as I still sat in the chair coughing, sneezing and blowing my
nose. I told her I cough every 30 minutes to 1 hour and cough up yellow
or green mucus
and blow it out my nose. I have a mild fever and can't get warm enough.
I sleep with a stocking cap on my head, cover my head and lay on
a heating pad so I can
try to sleep which is hard to do since this coughing and sneezing goes
on all night long and all day since the fourth day of the sore throat
October 25.
She looked at my throat and said it wasn't red.
She looked in my left ear and said it was okay.
She asked me to lean forward while she held a stethoscope on my
back and told me to breathe in deeply then breathe out several times.
I had the same productive, deep and loud cough and wheezed loudly.
She asked if I had allergies. I said Yes, hay fever.
She asked me if I smoked.
She asked if I used any over the counter cold medicines, cough drops or
syrups. She asked if I used any herbs. She asked if I was using any
pain relievers. I answered no to all of these questions.
What are you using? she asked. I answered " lemon,
honey, tea, homemade chicken and vegetable soup and I drink
lots of water"
She asked me if I have been around anyone who is sick.
I said, Yes my husband and my grandson.
My husband has had the sore throat and symptoms since October 21,
the same day I came down with them.
Her conclusion was that it was my allergies and claimed that the
pollen and other allergen content was high right now and they travel long distances
by blowing through the air.
Later after I get home I check weather.com and the tree pollen, ragweed and
other allergens are at 0% today.
She also said that it could be a virus and it would do not good
to prescribe an antibiotic as antibiotics don't work on viruses;
something I already know.
She tells me to get some Mucinex and Flonase,
used Zyrtec and some other dehydrating antihistamine daily
to control my allergies.
She prints out a list of recommended things to do for these symptoms
which includes a plethora of home remedies, things that I already do.
At last, the doctor opens the door as I am coughing deeply and spitting
into the trash can on my left. She said Would you like some tessalon pearls
for that cough. I can prescribe it for you. I said I don't know what that is.
She said I will send it to the (Walgreens) pharmacy. That is the only interaction with
this doctor. She never examined me and did nothing else but walk in
the room and say the above.
Hospital Discharge Instructions
Patient Education
11/07/2019 16:40:09
FreeText Instructions (Custom)
1. Mucinex as needed for coughing
2. Tessalon Pearls TID as needed for coughin
3. Flonase 1 spray each nostirl two times per day
4. Zyretec, Claritin, or Allegra daily
11/07/2019 16:40:09
Allergic Rhinitis
Allergic Rhinitis
Allergic rhinitis is when the mucous membranes in the nose respond to allergens. Allergens are particles in the air that cause your body to have an allergic reaction. This causes you to release allergic antibodies. Through a chain of events, these eventually cause you to release histamine into the blood stream. Although meant to protect the body, it is this release of histamine that causes your discomfort, such as frequent sneezing, congestion, and an itchy, runny nose.
CAUSES
Seasonal allergic rhinitis (hay fever) is caused by pollen allergens that may come from grasses, trees, and weeds. Year-round allergic rhinitis (perennial allergic rhinitis) is caused by allergens such as house dust mites, pet dander, and mold spores.
SYMPTOMS
• Nasal stuffiness (congestion).
• Itchy, runny nose with sneezing and tearing of the eyes.
DIAGNOSIS
Your health care provider can help you determine the allergen or allergens that trigger your symptoms. If you and your health care provider are unable to determine the allergen, skin or blood testing may be used. Your health care provider will diagnose your condition after taking your health history and performing a physical exam. Your health care provider may assess you for other related conditions, such as asthma, pink eye, or an ear infection.
TREATMENT
Allergic rhinitis does not have a cure, but it can be controlled by:
• Medicines that block allergy symptoms. These may include allergy shots, nasal sprays, and oral antihistamines.
• Avoiding the allergen.
Hay fever may often be treated with antihistamines in pill or nasal spray forms. Antihistamines block the effects of histamine. There are over-the-counter medicines that may help with nasal congestion and swelling around the eyes. Check with your health care provider before taking or giving this medicine.
If avoiding the allergen or the medicine prescribed do not work, there are many new medicines your health care provider can prescribe. Stronger medicine may be used if initial measures are ineffective. Desensitizing injections can be used if medicine and avoidance does not work. Desensitization is when a patient is given ongoing shots until the body becomes less sensitive to the allergen. Make sure you follow up with your health care provider if problems continue.
HOME CARE INSTRUCTIONS
It is not possible to completely avoid allergens, but you can reduce your symptoms by taking steps to limit your exposure to them. It helps to know exactly what you are allergic to so that you can avoid your specific triggers.
SEEK MEDICAL CARE IF:
• You have a fever.
• You develop a cough that does not stop easily (persistent).
• You have shortness of breath.
• You start wheezing.
• Symptoms interfere with normal daily activities.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
Document Released: 09/12/2002 Document Revised: 01/08/2016 Document Reviewed: 08/25/2014
Elsevier Interactive Patient Education ©2016 Elsevier Inc.
11/07/2019 16:40:09
Upper Respiratory Infection Treatment (Custom)
Upper Respiratory Infection Non-medication Treatment Options
Lifestyle Therapies: Nutrition
• Give plenty of fluids!!!
• Chicken soup
• Inhale the steaming broth
• Effects only last approximately 30 minutes
• Miso soup
• Spicy foods
• Hot chilli peppers, horse radish, mustard, Tabasco sauce, salsa, wasabi, etc.
• Thins nasal secretions and opens sinuses.
Decongestant:
Botanical- Peppermint
• Peppermint Steam
• Place 6 peppermint tea bags in a bowl of boiling water
• Keep eyes closed, lean forward over bowl, cover your head with a towel, and breathe in for 10 minutes.
• You can also use eucalyptus, oregano or rosemary essential oils (3-5 drops).
• Avoid peppermint and rosemary if pregnant as it may cause contractions.
Antitussives
Honey
• More effective than dextromethorphan (Robitussin) with fewer side effects
• Do NOT give to children less than a year old
• Give 1-2 tsp. at bedtime
• Ginger-Honey Tea (for over 2 years of age)
• 1 inch ginger root, cut into slices
• 1 tsp. honey
• 1 tsp. lemon juice
• 1 ½ c water
• In saucepan, add water and ginger, and gently bring to a boil. Cover and simmer on low heat for 15-20 minutes. Strain and add honey & lemon.
• Dosage:
• Child under 12 years old – ¼ - ½ c, 1 – 3 times / day
• Teens / adults : 1-3 cups / day
Thyme Cough Syrup
• The science shows it has potent tracheal and laryngeal anti-spasmodic action
• 2 – 4 tbsp. fresh thyme or 1 – 2 tbsp. of dried thyme
• 1 tsp. lemon juice
• 1 c water
• ¼ c of honey (preferably raw) or ¼ c of maple syrup for children less than 12 months.
• Pour near-boiling water over thyme and steep, covered, for 15 minutes. Strain. Add honey and lemon juice. Refrigerate for up to 1 week.
• Dosage:
• Children under 12 months: Substitute the maple syrup with honey and give ½ tsp. every 2 – 3 hrs.
• Children over 12 months: 1-2 tsp. for every 2-3 hours
• Adults: 1 – 2 tbsp. every 2-3 hours
Ginger
• Breaks up mucous
• Anti-inflammatory & shrinks nasal swelling
• Inhibits airway contraction
• Safe and well tolerated
• Theoretical prolongation of bleeding time
Antitussive Botanicals – Slippery Elm Bark
• Soothes throat irritation
• Demulcent
• Rich in mucopolysaccharides
• Can be used every 2 hours
• NOT USEd with gallstones or bile duct obstruction
• NOT USED in pregnancy or breastfeeding
Botanicals – Echinacea
• Antiviral and immune stimulatory effects.
• Clinical trials mixed
• Serious adverse effects are rare - occurs more frequently in patients with eczema
• Use in first 48 hours of symptoms for 2-3 days.
• Do NOT use if pregnant or with multiple sclerosis, HIV/AIDS, or autoimmune diseases
Botanicals – Elderberry
• Fruit is source of bioflavonoids (anthocyanidins), tanins, and essential oils.
• Anthocyanins – antiviral and immune priming effects
• Safe with no herb-drug interactions.
• An ‘immunomodulator’ – NOT to be used for long periods if patient is taking immunosuppressive agent (for example, prednisone, medications for lupus or rheumatoid arthritis)
• Take within 48 hours of initial symptoms
• Symptomatic improvement seen in 2-4 days
• Dose:
ο 15 ml twice daily for 3 days in kids
ο 15 ml four times daily for 3-5 days in adults
Botanicals – Garlic
• Antimicrobial due to allicin and metabolites.
• Traditionally used for cough, colds, catarrh and rhinitis
• No significant toxicity, but theoretical effect on bleeding times at 4 gm/d
• Lowers serum levels of INH (tuberculosis drugs) and protease inhibitors (HIV medications)
Botanicals – Licorice
• Anti-inflammatory, expectorant, and demulcent.
• Saponins stimulate ciliary activity and antiviral activity, and reduce surface tension of sputum (easier to expectorate)
• Ingredient in cough syrups and lozenges
• Traditional Medicinal “Throat Coat” Limit to 3-4 days, as can lead to HTN and/or potassium loss (syndrome of mineralocorticoid excess)
• Induces cytochrome P450 metabolism (avoid if taking certain medicines such as warfarin)
• Do NOT use if pregnant or breastfeeding
Botanicals – Pelargonium
• Derived from South African geranium
• Used in sinusitis, bronchitis and pharyngitis
• Stimulates release of anti-bacterial cytokines, including TNF and interferon
• Enhances phagocytosis and NK cell activity
• Safe to use, no adverse effects, other than rare hypersensitivity
• Umcka (Nature’s Way) – safe for young children & adults
Dietary Supplement – Zinc
• Necessary for the maintenance of a potent immune system
• Several studies demonstrated a decrease in the duration of cold symptoms with zinc supplementation.
• Take every 2-3 hours while awake, no longer than 2-3 days (depletes copper)
• Avoid intranasal zinc gels and sprays → irreversible loss of smell
Dietary Supplements – Vitamin C
• Very safe, with few adverse effects at a daily dose of 3 grams or less BUT
• Higher doses can cause gastrointestinal upset and osmotic diarrhea
• Cochrane review of 30 trials – daily supplementation with large dosese does NOT appear to prevent colds
• Benefits of vitamin C therapy from trials are weak
Remember Probiotics
• Take at least 2 hours apart from antibiotics
• Take for 7 days after completing antibiotics
• For children up to 12 years old
• Saccharomyces boulardi: 250 mg BID
• Lactobacillus GG: 1 billion CFU once a day
• For 12 years and older
• Saccharomyces boulardi: 500 mg BID
• Lactobacillus GG: 1 billion CFU BID
Reason for Referral
No data available for this section
Health Concerns
No data available for this section
Medical Equipment
No data available for this section
First nurse weighed me, tried and failed to take my blood pressure 3 times on my right
arm and twice on my left arm while I wore two sweaters and a long sleeve
shirt underneath. I told her in the beginning I would remove my sweaters.
She said I didn't need to. Finally, after several unsuccessful attempts of
trying to get my blood pressure, she said Ok you need to remove the sweater.
I did and it registered immediately. 119/78.
She checked my oxygen content.
96%. She took my temperature. 98.1.
She asked me my symptoms as I sat in
the chair hacking, coughing up yellow phlegm and sneezing into my elbow.
The next nurse (or doctor's assistant) came in and asked me what symptoms
I had. I told her it started on October 21, 2019 with a very bad
sore throat as I still sat in the chair coughing, sneezing and blowing my
nose. I told her I cough every 30 minutes to 1 hour and cough up yellow
or green mucus
and blow it out my nose. I have a mild fever and can't get warm enough.
I sleep with a stocking cap on my head, cover my head and lay on
a heating pad so I can
try to sleep which is hard to do since this coughing and sneezing goes
on all night long and all day since the fourth day of the sore throat
October 25.
She looked at my throat and said it wasn't red.
She looked in my left ear and said it was okay.
She asked me to lean forward while she held a stethoscope on my
back and told me to breathe in deeply then breathe out several times.
I had the same productive, deep and loud cough and wheezed loudly.
She asked if I had allergies. I said Yes, hay fever.
She asked me if I smoked.
She asked if I used any over the counter cold medicines, cough drops or
syrups. She asked if I used any herbs. She asked if I was using any
pain relievers. I answered no to all of these questions.
What are you using? she asked. I answered " lemon,
honey, tea, homemade chicken and vegetable soup and I drink
lots of water"
She asked me if I have been around anyone who is sick.
I said, Yes my husband and my grandson.
My husband has had the sore throat and symptoms since October 21,
the same day I came down with them.
Her conclusion was that it was my allergies and claimed that the
pollen and other allergen content was high right now and they travel long distances
by blowing through the air.
Later after I get home I check weather.com and the tree pollen, ragweed and
other allergens are at 0% today.
She also said that it could be a virus and it would do not good
to prescribe an antibiotic as antibiotics don't work on viruses;
something I already know.
She tells me to get some Mucinex and Flonase,
used Zyrtec and some other dehydrating antihistamine daily
to control my allergies.
She prints out a list of recommended things to do for these symptoms
which includes a plethora of home remedies, things that I already do.
At last, the doctor opens the door as I am coughing deeply and spitting
into the trash can on my left. She said Would you like some tessalon pearls
for that cough. I can prescribe it for you. I said I don't know what that is.
She said I will send it to the (Walgreens) pharmacy. That is the only interaction with
this doctor. She never examined me and did nothing else but walk in
the room and say the above.
Hospital Discharge Instructions
Patient Education
11/07/2019 16:40:09
FreeText Instructions (Custom)
1. Mucinex as needed for coughing
2. Tessalon Pearls TID as needed for coughin
3. Flonase 1 spray each nostirl two times per day
4. Zyretec, Claritin, or Allegra daily
11/07/2019 16:40:09
Allergic Rhinitis
Allergic Rhinitis
Allergic rhinitis is when the mucous membranes in the nose respond to allergens. Allergens are particles in the air that cause your body to have an allergic reaction. This causes you to release allergic antibodies. Through a chain of events, these eventually cause you to release histamine into the blood stream. Although meant to protect the body, it is this release of histamine that causes your discomfort, such as frequent sneezing, congestion, and an itchy, runny nose.
CAUSES
Seasonal allergic rhinitis (hay fever) is caused by pollen allergens that may come from grasses, trees, and weeds. Year-round allergic rhinitis (perennial allergic rhinitis) is caused by allergens such as house dust mites, pet dander, and mold spores.
SYMPTOMS
• Nasal stuffiness (congestion).
• Itchy, runny nose with sneezing and tearing of the eyes.
DIAGNOSIS
Your health care provider can help you determine the allergen or allergens that trigger your symptoms. If you and your health care provider are unable to determine the allergen, skin or blood testing may be used. Your health care provider will diagnose your condition after taking your health history and performing a physical exam. Your health care provider may assess you for other related conditions, such as asthma, pink eye, or an ear infection.
TREATMENT
Allergic rhinitis does not have a cure, but it can be controlled by:
• Medicines that block allergy symptoms. These may include allergy shots, nasal sprays, and oral antihistamines.
• Avoiding the allergen.
Hay fever may often be treated with antihistamines in pill or nasal spray forms. Antihistamines block the effects of histamine. There are over-the-counter medicines that may help with nasal congestion and swelling around the eyes. Check with your health care provider before taking or giving this medicine.
If avoiding the allergen or the medicine prescribed do not work, there are many new medicines your health care provider can prescribe. Stronger medicine may be used if initial measures are ineffective. Desensitizing injections can be used if medicine and avoidance does not work. Desensitization is when a patient is given ongoing shots until the body becomes less sensitive to the allergen. Make sure you follow up with your health care provider if problems continue.
HOME CARE INSTRUCTIONS
It is not possible to completely avoid allergens, but you can reduce your symptoms by taking steps to limit your exposure to them. It helps to know exactly what you are allergic to so that you can avoid your specific triggers.
SEEK MEDICAL CARE IF:
• You have a fever.
• You develop a cough that does not stop easily (persistent).
• You have shortness of breath.
• You start wheezing.
• Symptoms interfere with normal daily activities.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
Document Released: 09/12/2002 Document Revised: 01/08/2016 Document Reviewed: 08/25/2014
Elsevier Interactive Patient Education ©2016 Elsevier Inc.
11/07/2019 16:40:09
Upper Respiratory Infection Treatment (Custom)
Upper Respiratory Infection Non-medication Treatment Options
Lifestyle Therapies: Nutrition
• Give plenty of fluids!!!
• Chicken soup
• Inhale the steaming broth
• Effects only last approximately 30 minutes
• Miso soup
• Spicy foods
• Hot chilli peppers, horse radish, mustard, Tabasco sauce, salsa, wasabi, etc.
• Thins nasal secretions and opens sinuses.
Decongestant:
Botanical- Peppermint
• Peppermint Steam
• Place 6 peppermint tea bags in a bowl of boiling water
• Keep eyes closed, lean forward over bowl, cover your head with a towel, and breathe in for 10 minutes.
• You can also use eucalyptus, oregano or rosemary essential oils (3-5 drops).
• Avoid peppermint and rosemary if pregnant as it may cause contractions.
Antitussives
Honey
• More effective than dextromethorphan (Robitussin) with fewer side effects
• Do NOT give to children less than a year old
• Give 1-2 tsp. at bedtime
• Ginger-Honey Tea (for over 2 years of age)
• 1 inch ginger root, cut into slices
• 1 tsp. honey
• 1 tsp. lemon juice
• 1 ½ c water
• In saucepan, add water and ginger, and gently bring to a boil. Cover and simmer on low heat for 15-20 minutes. Strain and add honey & lemon.
• Dosage:
• Child under 12 years old – ¼ - ½ c, 1 – 3 times / day
• Teens / adults : 1-3 cups / day
Thyme Cough Syrup
• The science shows it has potent tracheal and laryngeal anti-spasmodic action
• 2 – 4 tbsp. fresh thyme or 1 – 2 tbsp. of dried thyme
• 1 tsp. lemon juice
• 1 c water
• ¼ c of honey (preferably raw) or ¼ c of maple syrup for children less than 12 months.
• Pour near-boiling water over thyme and steep, covered, for 15 minutes. Strain. Add honey and lemon juice. Refrigerate for up to 1 week.
• Dosage:
• Children under 12 months: Substitute the maple syrup with honey and give ½ tsp. every 2 – 3 hrs.
• Children over 12 months: 1-2 tsp. for every 2-3 hours
• Adults: 1 – 2 tbsp. every 2-3 hours
Ginger
• Breaks up mucous
• Anti-inflammatory & shrinks nasal swelling
• Inhibits airway contraction
• Safe and well tolerated
• Theoretical prolongation of bleeding time
Antitussive Botanicals – Slippery Elm Bark
• Soothes throat irritation
• Demulcent
• Rich in mucopolysaccharides
• Can be used every 2 hours
• NOT USEd with gallstones or bile duct obstruction
• NOT USED in pregnancy or breastfeeding
Botanicals – Echinacea
• Antiviral and immune stimulatory effects.
• Clinical trials mixed
• Serious adverse effects are rare - occurs more frequently in patients with eczema
• Use in first 48 hours of symptoms for 2-3 days.
• Do NOT use if pregnant or with multiple sclerosis, HIV/AIDS, or autoimmune diseases
Botanicals – Elderberry
• Fruit is source of bioflavonoids (anthocyanidins), tanins, and essential oils.
• Anthocyanins – antiviral and immune priming effects
• Safe with no herb-drug interactions.
• An ‘immunomodulator’ – NOT to be used for long periods if patient is taking immunosuppressive agent (for example, prednisone, medications for lupus or rheumatoid arthritis)
• Take within 48 hours of initial symptoms
• Symptomatic improvement seen in 2-4 days
• Dose:
ο 15 ml twice daily for 3 days in kids
ο 15 ml four times daily for 3-5 days in adults
Botanicals – Garlic
• Antimicrobial due to allicin and metabolites.
• Traditionally used for cough, colds, catarrh and rhinitis
• No significant toxicity, but theoretical effect on bleeding times at 4 gm/d
• Lowers serum levels of INH (tuberculosis drugs) and protease inhibitors (HIV medications)
Botanicals – Licorice
• Anti-inflammatory, expectorant, and demulcent.
• Saponins stimulate ciliary activity and antiviral activity, and reduce surface tension of sputum (easier to expectorate)
• Ingredient in cough syrups and lozenges
• Traditional Medicinal “Throat Coat” Limit to 3-4 days, as can lead to HTN and/or potassium loss (syndrome of mineralocorticoid excess)
• Induces cytochrome P450 metabolism (avoid if taking certain medicines such as warfarin)
• Do NOT use if pregnant or breastfeeding
Botanicals – Pelargonium
• Derived from South African geranium
• Used in sinusitis, bronchitis and pharyngitis
• Stimulates release of anti-bacterial cytokines, including TNF and interferon
• Enhances phagocytosis and NK cell activity
• Safe to use, no adverse effects, other than rare hypersensitivity
• Umcka (Nature’s Way) – safe for young children & adults
Dietary Supplement – Zinc
• Necessary for the maintenance of a potent immune system
• Several studies demonstrated a decrease in the duration of cold symptoms with zinc supplementation.
• Take every 2-3 hours while awake, no longer than 2-3 days (depletes copper)
• Avoid intranasal zinc gels and sprays → irreversible loss of smell
Dietary Supplements – Vitamin C
• Very safe, with few adverse effects at a daily dose of 3 grams or less BUT
• Higher doses can cause gastrointestinal upset and osmotic diarrhea
• Cochrane review of 30 trials – daily supplementation with large dosese does NOT appear to prevent colds
• Benefits of vitamin C therapy from trials are weak
Remember Probiotics
• Take at least 2 hours apart from antibiotics
• Take for 7 days after completing antibiotics
• For children up to 12 years old
• Saccharomyces boulardi: 250 mg BID
• Lactobacillus GG: 1 billion CFU once a day
• For 12 years and older
• Saccharomyces boulardi: 500 mg BID
• Lactobacillus GG: 1 billion CFU BID
Reason for Referral
No data available for this section
Health Concerns
No data available for this section
Medical Equipment
No data available for this section
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