Internal Medicine Reference Master

Common Symptoms. 1

Pain. 1

Fatigue. 1

Migraines 1

Cough. 1

Heartburn. 1

Cardiovascular. 1

Hypertension. 1

Dermatology. 1

Contact Dermatitis. 1

Endocrinology. 1

Diabetes. 1

Gastrointestinal. 1

GERD. 1

Peptic Ulcer Disease. 1

Hematology. 1

Oncology. 1

Infectious Diseass. 1

Musculoskeletal. 1

Neurology. 1

Migraines 1

Respiratory. 1

Viral URI 1

Bacterial Pneumonia. 1

Asthma. 1

COPD. 1

Genitourinary & Renal. 1

 


Acute analgesia

Pharmacology

PO Acetaminophen 1000mg QID (max)

PO Ibuprofen 800mg TID (max) | PO naproxen 1000mg BID (max) | IM Ketorolac 60mg (max)

PO methocarbamol 1500mg QID (max)

 

Patient Education

Your pain will begin to go away over the next few days to weeks as your body starts to heal itself. To control your pain in the meantime, you can do the following things:

– Place ice or heat pack on area for 10-15 minutes, 2-3 times a day. Be careful to not damage your skin.

– Take Tylenol (acetaminophen) 1000mg every 8 hours

– Take Advil (ibuprofen) 800mg every 8 hours

– Take Aleve (naproxen) 1000mg every 12 hours

– Let your body tell you how much activity to do. If it hurts to do something, then don’t do it.

– If your pain is not improved in the next 2 weeks, call to make an appointment.

– This plan has been shown to be as effective and safer than opioid medications in your type of pain.

 

In addition to the above, we will prescribe the following medications:

– Methocarbamol (Robaxin) 1500mg every 8 hours for 2 weeks

Chronic analgesia

Non-pharmacology

Bond with others

Physical therapy

Acupuncture

Massage

Yoga

TENS

Regular Exercise

 

Pharmacology

Duloxetine

Gabapentin

Acetaminophen

 

 

Patient Education

 

 

Patient Education

What can you do to prevent migraines?

– Keep a migraine diary and note any differences in sleep, diet, or stress in the past 24hrs.

– Stop all caffeine to include coffee, tea, and soda.

– Do not take abortive medications (Excedrin, ibuprofen, Tylenol, triptans, opioids, etc) for headache more than 4 times per month.

– Keep a regular sleep schedule with good sleep hygiene.

– Eat regular meals of good quality.

 

– If you are having more than 4 migraines per month, you may benefit from a medication that prevents migraines.

– Not every headache is a migraine. Migraines have specific characteristics and associated symptoms.                                                                                                 

 

https://www.thewaltoncentre.nhs.uk/uploadedfiles/leaflets/Migraine%20-%20A%20Comprehensive%20Guide.pdf (comprehensive guide, not to be printed)

 

Cough

Heartburn

Chest Pain

Chest Pain

–  

Patient Education

It is normal for your blood pressure to go up and down throughout the day. When you are diagnosed with “high blood pressure” it means your blood pressure at rest is higher than it should be.

Having a high blood pressure is dangerous because it can lead to heart attack, stroke, vision loss, heart failure, kidney disease, and sexual dysfunction

 

Most people cannot feel their blood pressure go up.

What can you do to control your blood pressure?

– Avoid smoking, vaping, or using tobacco products

– Incorporate DASH diet

– Reach and maintain a healthy weight

– Get regular physical activity

– Limit your alcohol intake

 

– When measuring blood pressure at home, make sure to do the following:

1. Sit quietly without moving for 5 minutes before checking

2. Rest your arm at about the level of your heart

3. Completely relax your body when taking the measurement.

 

https://www.healthvermont.gov/sites/default/files/documents/pdf/HPDP-Diabetes_dash%20eating%20plan.pdf

 

Preop

Stratify risk of procedure and calculate RCRI. AAFP article 2013. Has good image with workflow. Signs/symptoms gets EKG. High risk surg gets EKG. Low risk does not. Mod risk requires assessment of RCRI. If >0, then EKG warranted.

 

Congestive Heart Failure

Patient Education

– The biggest impact on the control of your diabetes comes from your diet, not from medicines.

– Your body cannot handle certain kinds of foods that it used to.

– For good control of your diabetes, it is important to have a regular routine and eat 3-4 small meals per day.

– Fasting can be dangerous if you have diabetes so if you are interested in fasting, we should discuss it before starting.

 

http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_492053.pdf (page 6)

http://main.diabetes.org/dorg/PDFs/awareness-programs/hhm/what_can_i_eat-best_foods-American_Diabetes_Association.pdf

 

Provider Assessment

DX: IDT2DM w/o complications

CONTROL: A1c 13.7 (5/6/19) -> 11.1 (9/3/20)

HOME CHECKS: Glucometer, test strips re-prescribed multiple times due to breakage: 5/6/19, 9/2/20

MEDICINES: Levemir 40u BID, metformin stopped previously due to dizziness, pt disinclined to oral medicines, prefers to just take insulin

NEUROPATHY SCREENING: Foot exam wnl 9/2/20

RETINOPATHY SCREENING: Eye exam wnl at HP (5/6/19)

NEPHROPATHY SCREENING: Cr 1.10, GFR 55 (5/6/19), Alb/Cr 189.2 (5/15/19)

DIET: Has reduced rice, avoiding juice/soda completely (9/2/20)

EXERCISE: Walks >/= 30 mins, has a stationary bike at home

– Maintain Levemir 40u BID

– Long discussion today re: restarting oral medications (metformin/Januvia/etc) but she is disinclined to take anything other than insulin. Will work with her on nutrition and careful glucose monitoring at home and follow-up closely through phone visits to readdress

– Prescribed new home glucometer & testing supplies. Encouraged regular glucose level checks at home, record in log.

– Recheck urine microalb – due now

– Encourage reduction in carbs, avoid juice

– Encouraged cardiovascular exercise at least 30mins/day

– RTC for shoulder exam (doorknob complaint today)

– Phone visit in 1-2 weeks with PCP for follow-up of labs

– Next foot exam due Sep 2021