[NP-Clinical] cerumen removal
prispunnyfnp at metrocast.net
prispunnyfnp at metrocast.net
Sat Jan 6 14:42:13 PST 2007
Thanks, Priscilla. This information really helps.
Patti NP
I work similar job to yours. I get the company to buy debrox but liquid
colace also works. It's OTC and you could order either from any medical
supply company. Very important to lie them on their side for 10-20 mins
after drops. I use a 100 cc syringe with cut angiocath to flush, plain
warm water with about 1:4 dilution w/ hydrogen peroxide. Hope this helps.
Priscilla Merrill
Original Message:
-----------------
From: pattinp at verizon.net
Date: Fri, 05 Jan 2007 07:26:03 -0600 (CST)
To: np-clinical at nurse.net
Subject: Re: Re: [NP-Clinical] cerumen removal
Ed and Christine,
I am currently working in an Occ Health Clinic where I am actually doing
more "quasi" primary care. I see a fair amount of patients with HEENT
complaints. Half the time I can't see the TM because of the cerumen. I have
heard that colace works well. Where can I get some liquid colace? If a Rx
is needed how do I order it? When you do the irrigation afterwards do you
use a syringe, Water-Pik? The nurses here don't want to be bothered with
doing irrigations and I am working on "attitude adjustments". I am expected
to treat these employees so they don't take off work to go to their PCPs
for "simple" problems.
Thanks in advance for your help.
Patti Robertson NP of VA
>From: Christine Smith <chrisbsmith at mindspring.com>
>Date: 2007/01/02 Tue AM 05:26:29 CST
>To: NP Clinical <np-clinical at nurse.net>
>Subject: Re: [NP-Clinical] cerumen removal
>Ed -Ah... ER hell... so fresh in my mind after just leaving one. If the
canal looks real traumatized after irrigation I do rx otic suspension drops
such as cortisporin. Only because I get concerned about them developing an
Otitis Externa. If just a bit of blood I don't worry much. But lots of
times they were already digging on their ear before they see you so it is
traumatized. For sure I would give the cardiologist the drops just because
he could make my life miserable if an infection developed. Now why are you
doing irrigations???? Nursing can do that or ER techs. I won't let my techs
use a curette but they sure as hell can flush ears. Christine Smith,
NPAntioch, CA ----- Original Message ----- From: ed piasecki To:
np-clinical at nurse.net Sent: Monday, January 01, 2007 9:35 PM Subject:
RE: [NP-Clinical] cerumen removal
>
>I had a new years from hell in the ER here in blessed Iowa.
>One of the cardiologist pops in needing his cerumen impaction resolved
stat. Of course because I am the "mid-level" on duty I get the privlege to
remove his wax.
>The part that urked me was he was upset when it bleed after colace and
irrigation only. This guy had some real potatoes growing up there.
>My question is does the group prophylax with otic antibiotics after they
get bleeding? How far do you go to remove the impaction?
>Thanks for your input in advance,
>
>
>
>
> Ed Piasecki From: "Christine Smith"
<chrisbsmith at mindspring.com>
>Reply-To: NP Clinical <np-clinical at nurse.net>
>To: "NP Clinical" <np-clinical at nurse.net>
>Subject: [NP-Clinical] INGROWN NAILS
>Date: Sun, 31 Dec 2006 19:01:45 -0800
>
> I do about 5 ingrown toe nails a week. If they are really
against a wedge resection then I will have them try the soapy soaks and
wedge a piece of cotton under the nail like Andy does. This seldom
works in my opinion, but I suspect it is because it is painful and
hard to get the cotton under. If you are going to recommend that the best
way to get the cotton under the toe nail is give the patient an cuticle
stick (those wooden sticks that have a beveled edge for pushing
cuticles down sold in cosmetic section). I bought a bunch and just stock
them so I can show them how. Take a regular cotton ball and wrap a dab of
cotton around the beveled portion of the stick like wrapping cotton
candy. Then wedge it under the nail. However, for the most part I
do a resection, wrap with a pressure dressing, have them remove it in
24 hours and start warm soaks TID before our recheck. . I see them 48
hours afterwards. The!
y are doing well by then. I rarely ever give antibiotics unless
the erythema has spread up into the toe - which is seldom. Most times,
once the offending section of nail is removed, it clears up. I also
do the digital block with Bupivicaine and I give them Motrin 800 in the
office with a Vicodin rx #12. I tell them to pop two Vicodin
right after they fill it, go home, elevate foot and sleep. By morning,
almost all of mine return to work on Motrin all day with a Vicodin back
up. Suckers hurt - I know from experience. Especially since most my
patients are male laborers and need to get right back to work the next
day. I try to get them to let me do it the night before their day
off so they can limit walking but not always feasible. I once
"operated" on my daughters boyfriends toe on my bed. I put him on
Motrin and sent him home. That night he called me at 2am in tears due
to the intense pain. I was sure I did !
something wrong, sure I was going to lose my license, sure the kid
was going to lose his toe. I was panicked! I drove one hour to his
house, assessed a normal looking toe and a crying 22 yo 220lb kid. I
repeated the digital block with marcaine (even though the toenail was
now resected) and gave him two old Percocet I had. He ended up fine. I
thought he was a wimp, until I had my own toe done. I am telling you,
these puppies hurt! I talked to my own podiatrist about this
(Lorraine Loretz's old professor). He told me that he always give Motrin
800 to women and Vicodin to most men. He said men are either wimpier or
just need it more - he is not sure why, but that Motrin seems to be
enough for females. He also told me antibiotics are rarely needed but
if there is very much infection it can be more difficult to get a good
digital block. I am sure Lorraine has her own thought on
this. Christine Smith, NP Antioch, CA -----
Original Message ----- F!
rom: Andy Craig To: 'NP Clinical' Sent: Sunday, December
31, 2006 12:09 PM Subject: RE: [NP-Clinical] Foot/nail
care by NP's
> If I see someone with an ingrown nail that is real early and mild
severity, I offer conservative treatment as an option: warm soapy soaks
TID and a small piece of cotton tucked under the end of the nail to lift
it up a bit off the nail fold and relieve some of the pressure. But
9 times out of 10, my tx of choice is cold, hard steel ;) (wedge
resection.) Especially if it's infected. And if it is I typically
rx Keflex for 7 days while they heal. I leave them in a bulky
dressing with a small piece of vaseline gauze tucked into the
proximal nail fold for the first 2 days; After 2 days I see them back,
remove the gauze, apply a band aid and have them do warm soapy soaks TID
for a week
>Andy Craig, NP
>Charlotte, NC -----Original Message-----
>From: np-clinical-bounces at nurse.net
[mailto:np-clinical-bounces at nurse.net] On Behalf Of ed piasecki
>Sent: Sunday, December 31, 2006 2:27 AM
>To: np-clinical at nurse.net
>Subject: RE: [NP-Clinical] Foot/nail care by NP's
>
>
>To the Group:
>Same topic, different piece:
>Infected ingrown toe nails. Do most treat with antibiotics and then
remove nail or do both together?
>
>
>
>
> Ed Piasecki
>
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>>_______________________________________________
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>>
>>FnP Associates offers a complimentary continuing education program.
>>Pain: Current Understanding of Assessment, Management, and
Treatments
>>Receive 6.0 Contact Hours of Pharmacology
>>NPCENTRAL.NET/CE/PAIN
>
>
>
>_______________________________________________
>NP-Clinical mailing list
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>
>FnP Associates offers a complimentary continuing education program.
>Pain: Current Understanding of Assessment, Management, and Treatments
>Receive 6.0 Contact Hours of Pharmacology
>NPCENTRAL.NET/CE/PAIN
>
>_______________________________________________
>NP-Clinical mailing list
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>
>FnP Associates offers a complimentary continuing education program.
>Pain: Current Understanding of Assessment, Management, and Treatments
>Receive 6.0 Contact Hours of Pharmacology
>NPCENTRAL.NET/CE/PAIN
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