 Primary Care Medical Protocols - Errata
Introduction
The protocols in Nurse Practitioner Protocols Second Edition, Physician Assistant Protocols, (which is a first edition), and Ambulatory Family Practice Protocols (which is also a first edition), should be corrected to be up to date. Some of these corrections reflect new research and some are from recent changes in clinical practice promulgated through various initiatives. These will be discussed below as "Update 1995" and where changes are substantive, replacement pages have been printed. Again, the authors take this opportunity to remind you that you should annually review and update your protocols.
Errata
for Nurse Practitioner Protocols Second Edition
This book has been very popular. So much so, that there have been nine printings of the Three-ring Binder format and six of the Soft Cover format. Consequently, a Revised Second Edition will be published in 1995 but the authors do not feel a complete revision to a Third Edition is necessary. The instructions that follow in this Supplement will update your Second Edition which should continue to be useful in the future.
These corrections are minor and in some instances reflect typographical errors not detected before going to print.
In Chapter 1, p1-10 through 1-16 should have HC, HC% deleted from the Physical Exam, Vital Signs parenthetical.
In Chapter 2, p2-5 Seizures, Children in the "General Measures" section, for the last sentence you and your clinician colleagues must decide whether ten minutes is when you want to call emergency medical services. Future editions will have an underlined blank space.
In Chapter 3, p3-6 in the "Physical Examination" section, after the word "acuity" add "(with and without correction)". There are now AHCPR Guidelines about Cataracts which will be addressed later in this Supplement.
In Chapter 5, p5-9 Acute Asthma, (Children) under "Immediate Transfer," after the words must define criteria our newer protocol books have a parenthetical that includes pulse or the added "PEFR" in the parenthetical that follows "criteria". However, the authors strongly recommend completely revamping both asthma protocols to follow the recommendations of the National Institutes, National Heart, Lung, Blood Institute, National Asthma Education Project, (NIH/NHLBI/NAEP) which will be discussed when the completely new protocols included in this supplement are introduced. Coincidentally, the NAEP reports were published in 1991 after the Second Edition.
In Chapter 9, p9-26 Menopause under "Lab" should read "Pap smear (increased superficial cells) and FSH (increased) to assist in diagnosis. Consider endometrial sampling/biopsy as indicated." The italics would be handwritten in.
In Chapter 15, p15-6 Varicella you should add a line under "Specific Measures" Consider oral Acyclovir ____________________________ *(MIS).
Also, in this chapter, p15-11 HIV Positive under "Physician Consultation" the last three words should read "ARC or AIDS."
The Index entry for Appendicitis should read p2-17 or p 2-18. Tuberculosis should read p15-10.
Errata
for Nurse Practitioner Protocols Second Edition
and for Physician Assistant Protocols
and for Ambulatory Family Practice Protocols
The authors hope that the latter two books will enjoy the popularity of Nurse Practitioner Protocols Second Edition
In Chapter 1, all readers should be aware that the Immunization recommendations for children have changed considerably as have the schedules for updating those who are behind. Please consult the most recent recommendations of the U.S. Public Health Service Immunization Practices Advisory Committee (ACIP) and expect these to continue to change as additional data is accumulated by the ACIP. Consequently, you should revise all of the Child Health Supervision visit protocols in Chapter 1, these are found under the Plan, Specific Measures section. A reprint of the Florida Immunization Recommendations a public domain document is included in this supplement. Additionally, clinicians must provide the federally mandated brochures (even as revision proposals are before Congress) to parents and keep a vaccine administration record.
In Chapter 1, to supplement your parent education program at these American Academy of Pediatrics mandated visits you might be interested in the Anticipatory Guidance Sheet Collections just published at the end of 1994 (ordering information is included in this supplement).
In Chapter 12, p12-4 Parkinson's Disease under "General Measures" the next to the last word should read 'Consumer.'
In Chapter 14, p14-3 Depression be aware that the U.S. Public Health Service Agency for Health Care Policy and Research published Clinical Practice Guideline, Depression in Primary Care in two volumes in 1993. Our published protocol is compatible though obviously simplified even compared to the Agency's published Quick Reference Guideline. These contain elaborate algorithms and flow charts regarding diagnosis and management. These are available from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. Phone 1-800-358-9295.
The AHCPR plans to publish upwards of six guidelines annually on a variety of clinical matters. Please stay abreast of these publications which in effect establish "National Standards of Care."
In Chapter 16, "Newborn Care" the paragraph about sleep position should be updated to reflect the 1992 official recommendation of the American Academy of Pediatrics to "place healthy infants on their sides or backs" because of the association of the prone position with Sudden Infant Death Syndrome. Recent research continues to corroborate this recommendation as well as the importance of placing the infant on a firm crib mattress. This supplement contains new versions of both Your Newborn and Newborn Care.
Physical Examination Complete visual exam; acuity (with and without correction), lids, conjunctiva, cornea, pupils, lens (retina), EOM, to assist in diagnosis. Consider endometrial sampling/biopsy as indicated.
Consider oral Acyclovir ____________________________ *(MIS).
ARC or AIDS
The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure contains a revised classification schema of blood pressures for adults. This is different from that in "Hypertension, Adults, Initial Visit" in Chapter 6.
Category Systolic Diastolic
Normal <130 <85
High Normal 130-139 85-89
Hypertension
Stage 1 (Mild) 140-159 90-99
Stage 2 (Moderate) 160-179 100-109
Stage 3 (Severe) 180-209 110-119
Stage 4 (Very Severe) >209 >119
The JNC report also has new recommendations regarding treatment including renewed emphasis on the use of diuretics for initial monotherapy.
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