Otc Questions & Referral

Front 1

Generic Questions

Back 1

• Is it for you?
• What are the symptoms?
• How long have you had it for?
• Have you had it before? What did you use?
• What makes it better/worse?
• Do you have any medical conditions?
• Are you taking any prescription medications?
• Are you taking any OTC meds or vitamins?
• Have you had any adverse reactions to drugs?
• Do you have any allergies?
• Are you pregnant or breastfeeding?
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Front 2

Generic Referral Points

Back 2

• Treatment failure
• Long duration of symptoms
• Unacceptable side effects of treatment
• Severe symptoms
FLSS

Front 3

Cough - Questions

Back 3

• Is it worse at night?
• Rule out asthma.

Front 4

Cough - Referral Points

Back 4

• Duration > 3 weeks
• Worse at night
• Yellow, bloody, green or brown phlegm
• Wheezing, shortness of breath, chest tightness
• Pain on inspiration
• < 6 years old
• Regular and recurring
• Severe pain, fainting, vomiting or exhaustion
• Fever, rash, weight loss, sinus pain or malaise

Front 5

Cold - Questions

Back 5

• Do you have heart disease?
• Ensure cold NOT allergy? (ask about symptoms)

Front 6

Cold - Referral

Back 6

• Longer duration than 7-10 days
• Yellow, bloody, green or brown phlegm
• Severe headache, vomiting, malaise, rash
• Fever >38oC for >3 days
• Wheezing, difficulty breathing
• Chest/ear/sinus pain
• Toothache, tender sinuses, stiff neck

Front 7

Chicken Pox - Questions

Back 7

• Do any other family members have symptoms?
• Vaccination status? (can vaccinate within 5 days of exposure)

Front 8

Chicken Pox - Referral

Back 8

• Newborn < 12 months
• Pregnant
• Pus, red sores
• High fever, severe headache, vomiting
• Joint pain

Front 9

Chicken Pox - Treatment

Back 9

• Pinetarsol or solosite
• Sedating antihistamines
• NOT calamine lotion
• No school until blisters have dried (5 days post rash)
• Cool or wet compress
• Cool bath - sodium bicarb or oatmeal
• Paracetamol
• Rest/ fluids/ don't scratch

Front 10

Allergy - Questions

Back 10

• Do you know what triggers it?

Front 11

Allergy - Referral Points

Back 11

• Fever
• Chest/ear/sinus pain
• Wheezing, difficulty breathing
• Recurrent nose bleeds
• Unilateral nasal obstruction
• Infection symptoms - discharge, sore throat, myalgia
• Child < 12 years (if first episode)

Front 12

Headache - Questions

Back 12

• Where is the headache (bilateral/unilateral)?
• Any other symptoms? (nausea/photophobia)
• Determine type - cluster, tension or migraine?
• Triggers (stress, hormones, caffeine, allergy, sleep deprivation)?
• Could it be drug induced?

Front 13

Headache - Referral

Back 13

• Migraine or cluster headache
• Frequent (>15 days/month)
• Starts after exercise, sex, coughing
• Develops while on the pill
• Develops suddenly or after a head injury or when older than 50
• Associated confusion, drowsiness, vomiting, fever, stiff neck, rash, seizures

Front 14

Sleep - Questions

Back 14

• How is your sleeping habits?
• Rule out apnoea (trouble breathing), restless legs, narcolepsy?
• Any new medicines?
• Identify cause (TV in room, coffee late at night)

Front 15

Sleep - Referral Points

Back 15

• Waking up coughing, wheezing or unable to breathe
• Snoring
• Sleeping tablets > 4 weeks
• Tired during the day

Front 16

GORD/ Heartburn/ Indigestion - Questions

Back 16

• Are you an infant or pregnant?
• Are you or the baby vomiting? If yes, how much?

Front 17

GORD/ Heartburn/ Indigestion - Referral

Back 17

• First time symptoms and >40 years or <12 months
• Symptoms several times a week
• Wakes you up at night
• Constant symptoms, despite treatment
• Difficult/painful to swallow
• Bowel motion - black/tar-like or bloody
• Vomit looks like coffee grounds or is bloody
• Lost weight or failure to thrive (baby)
• Shortness or breath, sweating, pain radiating to jaw, neck or arm
• Long term NSAIDs
• Family history of GI cancer
• Fever
• Diarrhoea or projectile vomit

Front 18

Constipation - Questions

Back 18

• What is normal for you?
• When was your last bowel movement?
• What do you mean by constipation (no bowel movements for days or daily movements that are hard and dry)?
• What makes it better or worse?
• Can you describe the stool? (what does it look like, size, thin, has it changed, colour, any blood/mucus present)
• Have you experienced diarrhoea & constipation (back and forth)
• Have you had any recent changes in diet or routine?
• Have you lost weight recently?

Front 19

Constipation - Referral

Back 19

• Changes in bowel habits lasting 2+ weeks
• Blood in stool
• Pain/ nausea/ vomiting/ bloating/ diarrhoea
• Weight loss
• Symptoms not responding to treatment/recurrent symptoms
• No cause
• <3 months

Front 20

Dermatitis (Eczema/Psoriasis) - Questions

Back 20

• Identification of triggers?
• Changes to routine?
• Where else is the rash?
• Any drugs recently ceased?
• Other symptoms? (e.g. flu)
• Recent travel?
• Other family members affected?

Front 21

Dermatitis (Eczema/Psoriasis) - Referral

Back 21

• Signs of infection
• Severe

Front 22

Diarrhoea - Questions

Back 22

• What is normal for you?
• When was your last bowel movement?
• How often are you going to the toilet?
• Recent travel?
• Describe your stools?
• What is your alcohol consumption like?
• Do you use laxatives?

Front 23

Diarrhoea - Referral

Back 23

• Constipation alternating with diarrhoea
• Blood, mucus or both in stools
• High fever
• Abdominal distension/signs of mass
• Marked abdominal pain
• Unintentional weight loss
• Moderate - severe dehydration (dark or no urine, dry mouth, headache)
• <6 months or elderly
• Recent travel
• Infection outside GIT
• Other chronic med conditions will be affected
• Laxative misuse
• Lasting more than a few days

Front 24

Haemorrhoids - Questions

Back 24

• What is the pain like?
• Have you noticed bleeding?

Front 25

Haemorrhoids - Referral

Back 25

• Bleeding or oozing from anus
• Persistent change in bowel habits
• Protruding from anus
• Sharp, stabbing pain when defecating
• Stomach pain or vomiting
• Fever
• Worsening symptoms
• Medicine induced constipation

Front 26

Haemorrhoids - Lifestyle Treatment

Back 26

• Eat plenty of food with fibre and drink lots of water
• Toilet hygiene, sit in warm bath, apply cold compress to relieve swelling, sit on doughnut ring cushion to remove pressure, don't strain to pass a motion, exercise regularly, wear cotton undies
• Medicines

Front 27

Thrush - Questions

Back 27

• What is the smell, colour and texture like?
• Have you recently finished antibiotics?
• Are you on any other medication (the pill)?

Front 28

Thrust - Referral Points

Back 28

• Never had it before
• <16 years or >60 years
• Bleeding, odd colours/smells, fever, sores, blisters
• Treatment failure
• Diabetic or pregnant
• Painful urination (burning is common)
• >3 infections a year
• Abdominal pain or fever

Front 29

Thrush - Symptoms

Back 29

• Bacterial Vaginosis - more discharge, white-grey, watery, fish smell, less acidic
• Thrush - Itchy and sore, red and swelly, white, thick discharge, no smell (or little), pain during sex and urination.

Front 30

Nappy Rash - Questions

Back 30

• Recent diarrhoea (caused by antibiotics)?
• How often do you change bubs nappy?
• Have you applied any chemicals to the area (change creams, skin wipes, cloth nappies with detergent)?
• Does bub have a fever?
• Is the rash in the creases or has it been spreading?

Front 31

Nappy Rash - Treatment Lifestyle

Back 31

• Good skin care - change nappies frequently, immediately change if wet or dirty (especially cloth), don’t use plastic overpants, clean baby’s bottom at each change with lukewarm water and a soft cloth or cotton wool, avoid soap or talcum powder and skin wipes, pat skin dry and leave uncovered until completely dry, avoid vigorous scrubbing of nappy area.
• Apply water-repellant, soothing barrier cream after cleaning bottom at each change, have nappy free time, use highly absorbant disposable nappys while bub has nappy rash, non-soap bath solutions & oils can be added to bath to settle skin irritation (oilated oatmeal)

Front 32

Nappy Rash - Referral

Back 32

• Rash spreads outside nappy area
• No better after 5 days treatment
• Skin is broken or rash is severe
• Rash shows signs of bacterial infection (pus, weeping, blisters, crusts)
• High fever, irritable, not eating well or generally ill

Front 33

Nappy Rash - Symptoms/Infected

Back 33

• Burn-like rash – red, swollen, moist, shiny & slightly rough with creases less affected • Can become infected – brighter red, shiny rash with sharply outlined patches (often smaller spots outside the main area), involves the creases, buttocks, thighs, abdomen, anal area and genitalia.
• Bacterially infected – weeping or yellow crusting of rash and a fever

Front 34

Conjunctivitis/Eye Issues - Questions

Back 34

• What are the symptoms?
• Do you have any pain?
• Any other symptoms?
• Do you normally get allergies?
• Are your eyelids stuck together on waking?

Front 35

Conjunctivitis/ Eyes - Lifestyle Treatment

Back 35

• Resting eyes, avoiding bright light, eye bath, warm/cool compress applied to the eyes, identify and avoid triggers, do not rub eyes, take breaks from reading/using a computer, avoid smoke, discard drops 28 days after opening.

Front 36

Conjunctivitis/ Eyes - Referral Points

Back 36

• Discomfort in bright light
• Distortion/ loss of vision
• Clouding of the cornea
• Irregular shaped pupil
• Redness localized around the iris or pupil
• Eye pain
• Headache, nausea or vomiting
• Spilt a chemical in the eye
• A cold with clear discharge from the eyes for more than a few days
• Discharge of pus from the eyes
• Dry mouth as well as dry eyes
• Eyelids that are irritated, have crusts or flakes on them
• A lower eyelid that turns in or down, allowing tears to run out of the eye

Front 37

Conjunctivitis - Symptoms Irritant, Allergic, Infective

Back 37

• Irritant conjunctivitis – red, itchy, burning, swelling, watery discharge, no pus
• Allergic conjunctivitis – same as irritant, no pain, usually both eyes + other allergy symptoms
• Infective conjunctivitis
- Bacterial (red, burning, gritty, pus, eyelids stuck on waking)
- Viral (red, gritty, watery, no pus, eyes sensitive to light)

Front 38

Burns - Questions

Back 38

• When did it happen?
• What does it look like (size, depth, colour, exxudate)?
• Where is it?
• What caused it?
• Do you have diabetes or are you immunocompromised?

Front 39

Burns - Referral

Back 39

• No pain
• On joints
• Blisters burst - infection
• Chemical burn
• Involves the airway
• Involves hands, face, feet or genitals
• Deep
• Unsure of severity
• Superficial burn larger than 20c

Front 40

Burns - Treatment

Back 40

• Medications - solosite gel, allevyn adhesive, opsite waterproof film dressing

Front 41

Worms - Questions

Back 41

• Recent travel?
• Pregnant or breastfeeding?

Front 42

Worms - Referral Points

Back 42

• Recent travel
• Blood in faeces
• Abdominal pain
• Diarrhoea or vomiting
• Unexplained weight loss
• Scratching has damaged the skin around your anus

Front 43

Worms - Treatment Lifestyle

Back 43

• Treat everyone in the household whether or not they have symptoms at the same time
• Shower the night the med is given and again the next morning (remove eggs laid overnight)
• Apply protective ointment (nappy rash cream) to anal area at bedtime to stop scratching
• Change/wash underwear, nightwear, bed linen, and towels daily for a few days (hot water)
• Shower each morning
• Don’t share towels
• Scrub fingernails to remove eggs – stop nail biting, finger sucking and bottom scratching
• Keep nails short and clean
• Wear firm undies at night
• Vacuum and dust furniture, bedrooms and around the toilet
• Wash hands when looking after kids and using the toilet and changing nappies and handling food
• Clean and disinfect toilet regularly

Front 44

Tinea - Questions

Back 44

• Where is the rash?
• Is it anywhere else?
• Do you have any systemic symptoms?

Front 45

Tinea - Referral

Back 45

• Rash is spreading
• Long duration
• Rash oozes, weeps or smells
• Treatment failure
• Hair loss on scalp
• Nail infection
• Diabetes or immunocompromised
• Need for systemic therapy - extensive, inflamed, recurrent, on palms, soles or scalp or nail infection

Front 46

Tinea - Lifestyle

Back 46

• Athletes foot- Dry between toes, separate towel for feet, creams preferred, avoid nylon/acrylic socks, don’t go barefoot in public showers or pool areas, go barefoot or wear sandals to air feet (especially in summer), change socks daily, use antiperspirant if feet sweat a lot
• General - Don’t share towels, shoes, socks, underwear, hats or hair brushes, wash socks, underwear, towels and bathmats in hot water and detergent, Avoid transferring tinea to other areas of the body (e.g. separate towel)
• Groin - Wear loose, cotton clothing – boxer shorts allow more airflow and reduce rubbing, Dry skin carefully after showering, Wash and dry skin after physical activity or if sweaty

Front 47

Cold Sores - Questions

Back 47

• Have you had a cold sore before?

Front 48

Cold Sores - Lifestyle

Back 48

• Self-care - If blisters have opened keep area clean and dry, Apply ice or warm compress to blister for pain, Avoid getting cream in eyes or mouth, Wash hands before and after applying cream, Avoid breaking blisters or picking a scab as this will delay healing and increase the risk of infection, Identify and avoid triggers, Eat regular, healthy meals (lots of fruit, veggies, grain foods, limit high fat, sugar and salt), Exercise

• Prevent spreading - Avoid touching sores, Don’t let other people touch or come into contact with your sores, Don’t touch eyes after touching sores, Don’t share creams, eating or drinking utensils, toothbrushes, towels, face cloths or lipstick, Avoid saliva and genital contact

Front 49

Cold Sores - Referral

Back 49

• Near eyes or going into nose (spread rapidly or are widespread)
• Hasn't healed in 14 days
• Sever cold sore
• Frequent occurence
• High fever
• Another illness
• Weakened immune system
• Painful, red, watery eye that is sensitive to light
• Sore in the genital area
• Babies, young children, pregnant
• Uncertain diagnosis

Front 50

Head Lice - Referral

Back 50

• Secondary infection from scratching (weeping, crusting of skin, swollen glands, fever)
• Unclear diagnosis
• Topical Pediculicides have failed

Front 51

Head Lice - Lifestyle

Back 51

• Examine family members and close contacts for infestation
• Prevention - Avoid sharing brushes, combs, hats and pillows, Wash brushes and combs once a week in hot soapy water, Keep long hair tied back, Notify school