Telephone Triage Protocols for Nurses

by Briggs, Julie K.

• ISBN13: 9780781764612
• ISBN10: 0781764610
• Edition: 3rd
• Format: Spiral Bound
• Copyright: 2006-12-07
• Publisher: LWW

Summary

This quick-reference manual presents over 200 triage protocols for evaluating patients' symptoms over the telephone. Each symptom entry lists questions, grouped by urgency level, to determine whether the caller should seek emergency care now, seek medical care the same day, call back for appointment, or follow home care instructions. Detailed home care instructions are then provided. This edition features fourteen new protocols: avian influenza ("bird flu"); congestive heart failure; electrical burns; hand/wrist problems; hip pain/injury; influenza; neurological symptoms; newborn problems; pertussis; severe acute respiratory syndrome (SARS); sickle cell disease problems; substance abuse, use, or exposure; West Nile virus; and wound care: sutures or staples. New appendices include guidelines for scenario practice; difficult caller practice scenarios; mystery caller practice session; temperature conversion guide; weight conversion chart; acetaminophen dosage chart; ibuprofen dosage chart; infant feeding guide; abdominal pain causes and characteristics; chest pain causes and characteristics; and headache causes and characteristics.

Table of Contents

Introduction	p. 1
Abdominal Pain, Adult	p. 4
Abdominal Pain, Child	p. 7
Abdominal Swelling	p. 10
Abrasions	p. 13
Alcohol, Hangover	p. 15
Alcohol Withdrawal	p. 17
Allergic Reaction	p. 19
Altered Level of Consciousness	p. 21
Ankle Injury	p. 24
Ankle Problems	p. 26
Anxiety	p. 29
Appetite Loss, Adult	p. 32
Appetite Loss, Child	p. 34
Arm or Hand Problems	p. 37
Asthma	p. 40
Avian Influenza ("Bird Flu")	p. 42
Back/Neck Injury	p. 45
Back Pain	p. 47
Bad Breath	p. 50
Bed-Wetting	p. 52
Bee Stings	p. 54
Bites, Animal/Human	p. 57
Bites, Insect	p. 60
Bites, Marine Animal	p. 64
Bites, Snake	p. 66
Bites, Tick	p. 68
Black or Bloody Stools	p. 70
Bleeding, Severe	p. 73
Blood/Body Fluid Exposure	p. 75
Body Piercing Problems	p. 77
Bone, Joint, and Tissue Injury	p. 80
Breast-Feeding Problems	p. 83
Breast Problems	p. 88
Breathing Problems	p. 90
Bruising	p. 93
Burns, Chemical	p. 95
Burns, Electrical	p. 98
Burns, Thermal	p. 101
Car Sickness	p. 104
Cast/Splint Problems	p. 106
Chest Pain	p. 108
Chest Trauma	p. 112
Chickenpox	p. 114
Child Abuse	p. 117
Choking	p. 119
Choking Emergency Procedure	p. 121
Circumcision Care	p. 128
Common Cold Symptoms	p. 130
Confusion	p. 133
Congestion	p. 136
Congestive Heart Failure (CHF)	p. 140
Constipation	p. 143
Contact Lens Problems	p. 146
Cough	p. 148
Croup	p. 151
Crying, Excessive, In Infants	p. 153
Dehydration	p. 155
Depression	p. 157
Diabetes Problems	p. 160
Diaper Rash	p. 163
Diarrhea, Adult	p. 165
Diarrhea, Child	p. 168
Dizziness	p. 172
Domestic Abuse	p. 175
Drug and Alcohol Problems	p. 177
Earache, Drainage	p. 180
Ear Injury, Foreign Body	p. 183
Ear Ringing	p. 185
Electric Shock	p. 187
Extremity Injury	p. 190
Eye Injury	p. 193
Eye Problems	p. 195
Facial Pain	p. 198
Facial Skin Problems	p. 200
Fainting	p. 202
Falls	p. 205
Fatigue	p. 208
Feeding Tube Problems	p. 211
Fever, Adult	p. 213
Fever, Child	p. 216
Finger and Toe Problems	p. 219
Food Allergy	p. 221
Food Poisoning, Suspected	p. 223
Foot Problems	p. 225
Foreign Body, Eye	p. 228
Foreign Body, Inhaled	p. 230
Foreign Body, Nose	p. 233
Foreign Body, Rectum	p. 235
Foreign Body, Skin	p. 237
Foreign Body, Swallowing of	p. 239
Foreign Body, Vagina	p. 241
Frostbite	p. 243
Gas/Belching	p. 245
Gas/Flatulence	p. 247
Genital Lesions	p. 249
Genital Problems, Male	p. 252
Glands, Swollen or Tender	p. 254
Hair Loss	p. 256
Hand/Wrist Problems	p. 258
Hay Fever Problems	p. 261
Headache	p. 264
Head Injury	p. 267
Hearing Loss	p. 270
Heartbeat, Rapid	p. 272
Heartbeat, Slow	p. 274
Heartburn	p. 276
Heat Exhaustion	p. 279
Heat Stroke	p. 281
Hemorrhoids	p. 283
Hepatitis	p. 285
Hiccups	p. 288
Hip Pain/Injury	p. 290
Hives	p. 292
HIV Exposure	p. 295
Hoarseness	p. 297
Hospice Problems	p. 299
Hypertension	p. 301
Hyperventilation	p. 304
Hypotension	p. 306
Hypothermia	p. 309
Immunization After Injury	p. 311
Immunization Reactions	p. 314
Impetigo	p. 316
Incontinence, Stool	p. 318
Incontinence, Urine	p. 320
Indigestion	p. 322
Influenza	p. 326
Insomnia	p. 329
Intravenous Therapy Problems	p. 331
Itching	p. 335
Jaundice	p. 337
Jaw Pain	p. 339
Joint Pain/Swelling	p. 342
Knee Pain/Swelling/Injury	p. 345
Laceration	p. 347
Leg Pain/Swelling	p. 350
Lice	p. 353
Menstrual Problems	p. 356
Mouth Problems	p. 359
Mumps	p. 362
Muscle Cramps	p. 364
Nausea/Vomiting, Adult	p. 366
Nausea/Vomiting, Child	p. 369
Near Drowning	p. 372
Neck Pain	p. 374
Neurological Symptoms	p. 377
Newborn Problems	p. 380
Nosebleed	p. 383
Nose Injury	p. 386
Numbness and Tingling	p. 389
Ostomy Problems	p. 392
Overdose	p. 395
Pertussis	p. 398
Pink Eye	p. 401
Pinworms	p. 404
Poisoning, Suspected	p. 406
Postoperative Problems	p. 409
Postpartum Problems	p. 412
Pregnancy, Cold Symptoms	p. 416
Pregnancy, Fetal Movement Problems	p. 419
Pregnancy, Hypertension	p. 422
Pregnancy, Leaking Vaginal Fluid	p. 425
Pregnancy, Nausea and Vomiting	p. 428
Pregnancy Problems	p. 431
Pregnancy, Suspected Labor	p. 435
Pregnancy, Suspected Labor < 36 Weeks	p. 438
Pregnancy, Urination Problems	p. 441
Pregnancy, Vaginal Bleeding	p. 443
Puncture Wound	p. 446
Rash, Adult	p. 449
Rash, Child	p. 453
Rectal Problems	p. 457
Reye's Syndrome, Suspected	p. 459
Roseola	p. 461
Rubella (German Measles)	p. 463
Rubeola (Measles)	p. 465
Scabies	p. 467
Scrotal Problems	p. 469
Seizure	p. 471
Seizure, Febrile	p. 473
Severe Acute Respiratory Syndrome (SARS)	p. 475
Sexual Assault	p. 478
Sexually Transmitted Disease (STD)	p. 480
Shock, Suspected	p. 482
Shoulder Pain/Injury	p. 484
Sickle Cell Disease Problems	p. 486
Sinus Problems	p. 489
Skin Lesions	p. 491
Sleep Apnea, Adult	p. 493
Sleep Apnea, Infant	p. 495
Sore Throat	p. 497
Speaking Difficulty	p. 500
Spitting Up, Infant	p. 503
Stools, Abnormal	p. 506
Stye	p. 509
Substance Abuse, Use, or Exposure	p. 511
Suicide Attempt, Threat	p. 514
Sunburn	p. 516
Swallowing Difficulty	p. 518
Sweating, Excessive	p. 520
Swelling	p. 523
Teething	p. 526
Tongue Problems	p. 528
Toothache	p. 530
Tooth Injury	p. 532
Umbilical Cord Care	p. 534
Urinary Catheter/Nephrostomy Tube Problems	p. 536
Urination, Difficult	p. 538
Urination, Excessive	p. 540
Urination, Painful	p. 542
Urine, Abnormal Color	p. 545
Vaginal Bleeding	p. 547
Vaginal Discharge/Pain/Itching	p. 550
Vision Problems	p. 552
Weakness	p. 555
West Nile Virus	p. 558
Wheezing	p. 561
Wound Care: Sutures or Staples	p. 564
Wound Healing and Infection	p. 567
Abbreviations	p. 570
Sample Telephone Triage Protocol Form	p. 571
Community Resources Telephone List	p. 573
Telephone Triage Quality Improvement Survey	p. 574
Telephone Triage Documentation Form	p. 575
Telephone Triage "Call Back" Log	p. 576
Consulting Nurse Call Tape Review	p. 577
Consulting Nurse Call Documentation Review	p. 578
Telephone Triage Training Outline	p. 579
Guidelines for Scenario Practice	p. 580
Difficult Caller Practice Scenario	p. 584
Mystery Caller Practice Session	p. 586
Communicable Diseases	p. 588
Sexually Transmitted Diseases	p. 593
Typical Immunization Schedule	p. 597
Temperature Conversion Chart	p. 598
Weight Conversion Chart	p. 599
Acetaminophen Dosage Chart	p. 600
Ibuprofen Dosage Chart	p. 601
Infant Feeding Guide	p. 602
Teaching Self-Assessment	p. 603
Abdominal Pain Causes and Characteristics	p. 605
Chest Pain Causes and Characteristics	p. 607
Headache Causes and Characteristics	p. 610
Resources	p. 612
Bibliography	p. 614
Quick Reference Protocol Index	p. 618
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