Shade Tree Clinic Volunteer Manual

Volunteer Handbook
222 Grace Street
Nashville, TN 37207
615615-422422-5262
www.shadetreeclinic.org
Copyright ©2010 by Shade Tree Clinic
Shade Tree Clinic Training Manual
Wrien and compiled by:
Ravi Patel
Benjamin Deschner
Meredith Sellers
Anjali Shah
Natalie Ausborn
Tyffany Chen
Klint Peebles
Shannon Jordan
Abby Stufflebam
Craig Sheedy
Edit Versions:
©2010—Primary Version Created.
2
Vishruth Reddy
Anna Fahy
Amanda Harris
TableofContents
General Shade Tree Informaon, Staff, and Programs
Introduc3on and History
Shade Tree Clinic Loca3on and Opera3ons
Clinic Posi3on Descrip3ons
Specialty Days
Specialty Clinics
Shade Tree Clinic Community Programs
Volunteer Informaon and General Clinical Operaons
Volunteer Informa3on
Clinic E3quee
Clinic Flow
In-Clinic Forms and Guidelines
5
6
8
9
16
17
19
21
22
23
24
26
StarPanel and EMR Guide for All Notes and Lab Order Forms
Adding Vitals to a Pa3ent’s Charts
Ordering Labs at Shade Tree
Upda3ng a Pa3ent Summary
Upda3ng a Pa3ent’s Medica3on List
Pos3ng a StarPanel Note
Crea3ng Your Own Panel on StarPanel
Diabe3c Foot Exam Form
Checking Pa3ent Lists Before Clinic
In-Clinic Resources Available for Paents
Pa3ent Health Educa3on
Social Work
Spanish Reference Guide
Pharmacy
33
34
35
40
41
42
43
44
45
47
48
49
50
55
Out of Clinic Resources Available for Paents
Referrals
61
62
In-Clinic Skills for Shade Tree Volunteers
65
E3quee and Cultural Competency
Taking a History for a Pa3ent
Taking Vitals
Basic Physical Exam
Presen3ng to an Aending
Administering Vaccine Injec3ons to Adults
Drawing Labs
Blood Tube and Test Ordering Guide
Wri3ng a Clinic Visit Note
67
68
72
75
77
78
80
82
84
Community Outreach Informaon for Volunteers
87
Community Outreach Overview
Community Outreach Programs
E3quee and Cultural Competency
Diabetes and Hypertension Educa3on
3
88
89
90
92
4
General Shade Tree
Clinic Information,
Staff, and Programs
5
IntroductionandHistory
History of the Shade Tree Clinic
In October 2005, medical students at Vanderbilt Medical School
opened a community clinic in East Nashville. The idea for the clinic
arose eighteen months earlier from Ka3e Cox and Kris3na Collins, who
were then first year medical students. They believed that Vanderbilt
medical students could contribute to the health of the Nashville community, while at the same 3me enhancing their medical educa3on.
They worked with the administra3on and many community agencies
to create a clinic that would provide significant benefits to a large,
medically underserved community in Nashville.
During the following year, Ka3e and Kris3na engaged the student body
with their idea, and asked for its help to take the next steps in opening
a clinic. Students contributed by raising funds, finding a loca3on for
the clinic, visi3ng other student-run clinics in the country, and spending 3me at neighborhood mee3ngs,. By recognizing the needs of the
community and involving community members in the development of
the clinic, the medical students at Vanderbilt aimed to create a clinic
that would provide quality healthcare for those most in need.
Under the directorship of second year medical students Dana Guyer
and Sara Horvitz and with the help of nearly fiIy ambi3ous and dedicated students from Vanderbilt, Ka3e and Kris3na’s vision for a free
clinic became a reality. The Shade Tree Family Clinic (STFC) opened its
doors on October 1, 2005. Since the incep3on of the clinic, Vanderbilt
medical students have seen their dreams of a clinic where students
can learn and serve others, grow, and blossom. Now termed simply
the Shade Tree Clinic (STC), the ins3tu3on is an accepted and proven
asset to the East Nashville community and beyond. It has enhanced
medical educa3on for hundreds of Vanderbilt Medical School students
and has provided hands-on clinical teaching opportuni3es for faculty.
6
The Neighborhood
While the health care industry thrives in Nashville, many residents
have no access to these resources. In a survey conducted by Vanderbilt
Medical students before the TennCare disenrollment, 35% of residents
in the Dickerson Pike area (the neighborhood where STC is located)
were found to be uninsured, and 49% stated that they used the Emergency Room as their primary care provider. Strikingly, 83% of those
surveyed believed that health services were not available to them. In
addi3on to ranking low in most health indicators, the Dickerson Pike
area has one of the highest rates of poverty, violent crime and pros3tu3on in the city and a local high school gradua3on rate of only 42%.
All of these factors convinced Vanderbilt medical students that the
presence of a free clinic could have a major impact on the quality of
health in this neighborhood.
Shade Tree Clinic Partner: United Neighborhood Health Services
The United Neighborhood Health Services Northeast Clinic is one of
many clinics operated by the UNHS group. We have come to an agreement with UNHS and the Northeast clinic in par3cular to use their loca3on on Tuesday evenings and Saturday aIernoons. In exchange for
their space, we fill out the UNHS paperwork to show the official counts
of pa3ent visits seen within the clinic.
This federally qualified healthcare center provides care from Monday
to Friday from 9 AM to 4 PM. They operate on a sliding scale basis and
the clinic is staffed by two Vanderbilt physicians: Dr. Jule West and Dr.
Morgan McDonald. If you are interested in doing any research or emphasis projects within the McFerrin Park community they can be of
great assistance.
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ShadeTreeClinicLocationandOperations
The Shade Tree Clinic is located at 222 Grace Street, in Nashville, TN.
Operang Hours:
Tuesdays from 6 PM to 10 PM
Saturdays from 12 PM to 5 PM
Specialty Clinics on Saturdays from 9 AM to 12 PM
Contact Info:
Mailing Address:
Shade Tree Clinic
222 Grace Street
Nashville, TN 37207-5802
Phone:
Fax:
Español:
Email:
615-422-5262
615-255-8224
615-414-7986
[email protected]
8
ClinicPositionDescriptions
All contact persons for Shade Tree staff is available at
www.shadetreeclinic.org/who_is_who.php
Execuve Directors
Execu3ve Directors make sure clinic runs smoothly, answer ques3ons,
solve problems, fill in for other posi3ons, and see pa3ents if necessary.
They are responsible for pa3ent follow up, referrals and lab repor3ng
with Dr. Miller, and are liaisons to UNHS, the Advisory Board,
Vanderbilt, CHS, MVA and the Deans’ Office.
Clinic Operaons Posions
Director of Clinic Operaons
The Director of Clinic Opera3ons oversees all of the clinic coordinators,
the pa3ent scheduler, and the volunteer coordinator to make sure we
have the right people where they are supposed to be. Act as head
clinic coordinator, facilitate training, scheduling, and picking up food.
Clinic Coordinator
Clinic Coordinators get to know every aspect of the clinic inside and
out and make a posi3ve impact on work flow. They arrive early to set
up clinic, check in pa3ents (this entails geSng the pa3ent’s chart and
entering them into the UNHS and Vanderbilt record systems), maintain
pa3ent records, collect pa3ent notes, ensure lab forms are filled out
correctly, bring labs back to VUMC, and help clean up aIer clinic.
Spanish Services Coordinator
This person is responsible for overseeing the care of all of our Hispanic
pa3ents. They recruit interpreters from all over Vanderbilt. They assess the competency of poten3al interpreters and train them. They
also ensure that Spanish speaking pa3ents get to their appointments
at Vanderbilt - this may mean walking them to their appointments or
leaving Spanish direc3ons with the Informa3on Desk.
Spanish Services Representaves
Our pa3ents appreciate it tremendously when they’re able to
communicate with a student in their na3ve language. They serve as a
regular interpreters for the clinic to provide complete care.They facilitate pa3ent arrival and check-in. They also help advocate for social and
medical services for our Spanish speaking pa3ents.
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Documentaon Coordinators
These coordinators are responsible for ensuring that pa3ent records
are updated in a 3mely fashion in the UNHS char3ng system. They also
coordinate chart reviews for grants and the annual report. They verify
that all pa3ent notes are posted to StarPanel and aested by the
aending physician in a 3mely manner. If you have problems pos3ng
your notes these are the team members to call.
Paent Scheduler
The pa3ent scheduler returns pa3ent messages and speaks with each
pa3ent briefly on the day before their appointment. They check the
voicemail box on the appointment line daily and return phone calls to
pa3ents seeking an appointment. On the aIernoon before a clinic
session, they call all pa3ents to remind them of their appointments
and give them any special instruc3ons they might need. They also will
work with the directors to coordinate any changes in the clinic
schedule to beer serve our pa3ents and help clinic run smoothly.
Volunteer Coordinator
Shade Tree is student run and student operated clinic! The coordinator
emails volunteers 1-2 days before each clinic and 1-2 days aIer clinic
to remind them that they are signed up and to post notes. They will
also include important updates about clinic as informed by Directors.
Paent Lab Results Coordinator
This person is responsible for following up on all the labs done at
Shade Tree. They check the lab results on Star Panel for all of our pa3ents from the week and prepare the results to present to Dr. Miller
and the team every Friday morning at 7am in the Student Lounge. At
this session Dr. Miller will tell you what follow up care is needed and
you must call the pa3ent to communicate results by Monday.
Medical Provider Recruiters
These are the only defined upperclassman posi3ons. These appointed
volunteers are responsible for medical provider volunteer recrui3ng. It
is their responsibility to coordinate the Clinical Care Leaders and also
help find new physician and nurse prac33oner recruiters. They organize the Clinical Care Leaders schedule and coordinate with Execu3ve
Directors and Director of Clinic Opera3ons on the number of
physicians needed per clinic session.
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Paent Health Educaon
Director of Paent Health Educaon
This posi3on focuses on health educa3on and preven3on-oriented
projects at the Shade Tree Clinic and within the community. They oversee all of the posi3ons in the Pa3ent Health Educa3on department.
They ensure that the Educators are mee3ng standards of care, which
includes staying current on the health status of all pa3ents enrolled in
the program, and verifying adequate follow-up for all pa3ents.
Paent Health Educator
Two Pa3ent Health Educators will be present at each clinic session to
counsel our diabe3c pa3ents about their lifestyle choices. Addi3onally,
each PHE will be available to assist their assigned pa3ents and be their
contact to Shade Tree Clinic. They aend weekly mee3ngs with other
PHEs to receive training on how to screen and counsel pa3ents with
these condi3ons as well as to review the weekly labs.
Nutrion Care Planning Coordinator
The Nutri3on Care Planning Coordinator manages the NCP program in
coordina3on with the Nutri3onist Internship Training program to manage pa3ents that are non-diabe3c, hypertensive, and/or
hyperlipidemic pa3ents. They aend weekly mee3ngs with the PHEs
to review the weekly labs for all of the NCP pa3ents.
Shade Tree Resources in Diabetes Educaon Coordinator (STRIDE)
The STRIDE is a support group was designed to help individuals with
diabetes work towards healthy exercise, nutri3onal, and emo3onal
habits. Classes include clinical counseling, emo3onal support, exercise
sessions, including Tai Chi, salsa dancing, and walking; and nutri3onal
educa3on. STRIDE is open to non-Shade Tree Pa3ents.
Weight Management Program Coordinator
These students design and implement a Weight Management program
with the help of Vanderbilt staff. The program is for both Shade Tree
pa3ents and other community members. Weight Mgmt. is open to non
-Shade Tree Pa3ents
Smoking Cessaon Program Coordinator
The smoking cessa3on coordinator will support pa3ents in their desire
to quit smoking by consul3ng with them and connec3ng them to
resources to help them quit. They iden3fy and meet with pa3ents in
clinic as necessary for those who wish to quit smoking.
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Social Work
Director of Social Work
The director works in3mately with Shannon Jordan, our official Shade
Tree Social Worker. They oversee social workers, mental health,
dental, and physical therapy programs. They help develop The
Advocate and a training manual for all of the Social Work Team. They
seek out organiza3ons interested in addressing the social needs of our
pa3ents, and work with outreach to develop community rela3onships.
Social Work Team Member
The Social Work team assists pa3ents in need of social services such as
disability, food stamps, health insurance, legal aid, employment
search, housing assistance, etc. They iden3fy and track pa3ents who
require social services based on the social services screen. They help
pa3ents access several social services such as obtaining food stamps,
applying for disability, health insurance, housing, mental health
counseling, etc.
Dental Referrals Coordinator
The Dental Referrals Coordinator contacts pa3ents and follows up with
dental referrals. They help run the dental health booth at Shade Tree
Community Health Fair and possibly others as well. They also assist
with Shade Tree kids dental hygiene referral days.
Mental Health Coordinator
This posi3on assists pa3ents with mental health needs iden3fy
appropriate treatment resources, and provide pa3ent educa3on and
support. They organize and oversee monthly Psychiatry Nights on the
second Tuesday of each month. They provide educa3on and follow-up
when pa3ents receive mental health treatment outside Shade Tree.
Physical Therapy Coordinator
This posi3on assists pa3ents who need physical therapy and is
responsible for organizing and planning the monthly Physical Therapy
clinic. Clinics are on the second Saturday morning of every month.
Vision Coordinator
This posi3on is responsible for organizing and coordina3ng vision
resource referrals, specifically with Prevent Blindness Tennessee (PBT).
The vision coordinator networks with PBT and works with pa3ents to
complete applica3ons for available resources.
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Pharmacy
Director of Pharmacy and Supply
Oversees and hold regular mee3ngs with the Pharmacy assistants, the
Pa3ent Assistant Program,and develop clinic educator/trainer
posi3on. This director orders and stocks all drugs and supplies for
clinic. They pick up drugs at the VUMC pharmacy and supplies in Med
Center East. They also ensure safety and con3nue to improve the
pharmacy system.
Pharmacy Assistants
These students work directly with the Director of the Pharmacy
primarily in clinic. They staff the pharmacy and help physicians and
students dispense prescrip3on medica3ons. They dispense medica3ons and deliver/explain them to the pa3ent in the
wai3ng area. They also par3cipate in a drug inventory at least once a
semester.
Pharmacy Assistance Program Coordinator
The pharmacy assistance program (PAP) coordinator works with
Pa3ent Health Educators, the social work team, and the Director of the
Pharmacy. Many pharmaceu3cal companies provide free medica3ons
to pa3ents with low income. Since many of the Shade Tree pa3ents
qualify, this is a great way to ensure all of our pa3ents get their
medica3ons.
Community Outreach
Director of Community Outreach
Oversees a Community Outreach Assistant, the Shade Tree Ini3a3ve
for Health Policy Educa3on(STIPE), LeVowitz Hour, and Shade Tree
Early Prenatal Program (STEPP). The posi3on involves sub-direc3ng in
clinic, planning Shade Tree’s Annual Fall Health Fair, assis3ng with
health fairs headed by other organiza3ons (Summer-October), and
coordina3ng the vaccine program (October-February). It is also important to establish and maintain rela3onships with other community
organiza3ons (i.e. Salva3on Army), assist with Shade Tree’s other
outreach programs as needed, and work with students and student
organiza3ons interested in star3ng new community ini3a3ves.
13
Shade Tree Early Pregnancy Program Coordinator
The Shade Tree Early Pregnancy Program (STEPP) works with pregnant
women and provides them early prenatal care as well as social services
during their pregnancy. This posi3on coordinates pa3ent recruitment,
runs the clinic sessions, and pa3ent follow-up.
Shade Tree Early Pregnancy Program Assistants
The STEPP assistants manage community contacts, coordinate the
STEPP drive for baby items, distribute collected materials, and aend
monthly STEPP prenatal clinics.
Clinical Case Conference (Le,owitz Hour) Coordinator
This student coordinates the LeVowitz Hour, which happens 4 3mes
each year. The goal for the conference is to provide a unique forum
for interac3on between medical students, faculty, and house staff, to
enhance medical knowledge regarding an unknown case, and to share
the complexi3es of accessing care without insurance.
Coordinator of Community Monitoring and Evaluaon
This coordinator maintains rela3onships with other community
organiza3ons, keeping them informed of Shade Tree ini3a3ves and
keeping Vanderbilt students informed about important issues/
ac3vi3es in the community.
Coordinator of Community Fairs
This posi3on coordinates our annual Shade Tree Clinic Community Fair
occuring in the fall. We provide health screenings and educa3on, social
services, and an outlet for local business and service providers to
inform the community about exis3ng resources.
Coordinator of Community Relaons
Serve as primary liaison between Meharry and Vanderbilt in community outreach affairs , help direct vaccine outreach and preven3ve
medicine sites, receive social work and nutri3on educa3on training for
outreach events, and recruit Meharry student and physician
volunteers for outreach events.
Coordinator of Caldwell Academic Enrichment Program
The Caldwell Academic Enrichment Program is an aIer-school ini3a3ve
at Caldwell Elementary. The goal of the program is to promote
wellness, nutri3on, and posi3ve outlook in youths. The biweekly
program will feature dance workshops, music lessons, arts and craI
ac3vi3es, recrea3on, and nutri3on educa3on.
14
Finance
Director of Finance
This posi3on manages the finances for Shade Tree Clinic as well as the
annual accoun3ng and annual report produc3on. The posi3on oversees two Finance Assistants, coordinates fundraising events and
communicates with Shade Tree Trot Leadership, comes up with ideas
for fundraisers, and searches and apply for ins3tu3onal or founda3on
grants. The posi3on is also responsible for grant repor3ng for the
current grants and coordina3ng the Annual Report
Assistant Directors of Finance
This person works with our Director of Finance to make sure we
con3nue to have the means to see pa3ents and ini3ate new
endeavors. It is their responsibility to help maintain our clinic budget
and assist in grant wri3ng. Lastly, they also manage all public rela3ons,
including publicizing all events and maintaining a roster of all
volunteers.
Quality Assessment and Data Management
These posi3ons help track the progress of ini3a3ves, provide data for
presenta3ons and publica3ons, assess addi3onal needs within the
clinic, and give us a beer understanding of how Shade Tree is
func3oning. They work with other students on the chart review to
process the data and beer understand our pa3ent popula3on.
Technological Systems Management Coordinator and Assistant
This coordinator monitors all of the computer systems, StarPanel
coordina3on, and the Pharmacy system. They will also be responsible
for an assistant and the Webmaster to make sure all technological
resources or correctly managed and used. Experience with IT
management and programming is desired. Also the ability/desire to
work with StarPanel would be helpful.
Webmaster
This posi3on manages the website, which is the central loca3on for
managing volunteer sign-ups and collaborate between all of the different departments. Addi3onally, it is the webmaster’s responsibility to
add all new programs to the website as it is the first line of publicity for
all grants, donors, and community members.
15
SpecialtyDays
Shade Tree offers many specialty consulta3ons and referrals services.
A large part of the reason we can provide such quality care to our pa3ents is through our “In-House” specialty referral clinics. These clinics
are when we have specialist physicians come in during regular clinic
hours, in addi3on to more general prac33oners, to see a specific subset of pa3ents.
Some specialty physicians come oIen when needed, and some are so
specialized they only come to clinic once or twice for a consult on a
single pa3ent. This is a great part of Shade Tree as we bring leading
experts in their respec3ve fields to people of the Nashville community
who would never have access to such resources! OIen this makes for
great teaching cases and wrap-ups, as specialty physicians offer a
unique perspec3ve of healthcare to the clinic. Also, some specialty
clinics are held regularly by a team of physicians. Other specialty consults are uncommon, so we have them less frequently and only bring a
physician in when the number of pa3ent consults jus3fies doing so.
Regularly Scheduled Specialty Days (and predominant providers)
•
•
•
•
Endocrinology—1st Tuesday of the month (Dr. Michael Fowler)
OB/GYN—1st Saturday of the month
Nephrology—2nd and 3rd Tuesdays of the month (Dr. Roy Zent)
Psychiatry—2nd Tuesday of the month
Specialty Days Scheduled as Needed
• Cardiology (Dr. Glazer, Dr. Churchwell)
◊ Usually every other month on the 1st Tuesday, but can vary
• Dermatology (Dr. Kantrow)
• Rheumatology (Dr. Sergent, Dr. Fuchs)
Other specialty consults are either referred to be seen by one of our
volunteer physician contacts actually in Vanderbilt, or have their own
separate clinic, as described below.
16
SpecialtyClinicsSaturdaymorningsfrom9:00-12:00
Shade Tree Early Pregnancy Program (STEPP)
The Shade Tree Early Pregnancy Program (STEPP) is a morning clinic on
the 1st Saturday of every month that sees pregnant Shade Tree and
non-Shade Tree pa3ents. Pa3ents can have their pre-STEPP appointment screening during regular clinic hours (rou3ne labs, pap smear,
etc.) to assess during their STEPP appointment.
We bring in Vanderbilt Nurse-Midwives to see pa3ents during the
morning clinic, who provide care throughout their first trimester. AIer
that 3me we can refer them to the Franklin Road Women’s Health
Center for more appropriate care. We also provide social work services
to these pa3ents to make sure they will get prenatal coverage and coverage for their children through TennCare and CoverKids.
Both first and second year students work alongside third and fourth
year students to provide pa3ent care to those scheduled at the clinic.
If you are interested in volunteering, visit the STEPP website at
www.shadetreeclinic.org/STEPP.
The clinic flow mimics that of regular clinic flow. Please refer to clinic
flow for direc3ons. The only difference is in the use of lab forms. The
STEPP clinic uses the “Shade Tree Early Pregnancy Program Lab Requisi"on Form”. Please con3nue reading in the labs sec3on of the booklet
to see the list of labs available.
Physical Therapy Clinic
Our PT clinic meets mornings every 2nd Saturday of the month. We
bring cer3fied physical therapists from Vanderbilt into clinic to see pa3ents consulted to our PT clinic.
The clinic does not need a regular volunteer pool, but those interested
the methods of care for physical therapy are welcome to join the clinic
on the Saturday mornings. Please contact the Shade Tree Clinic Physical Therapy Coordinator before coming to volunteer.
The Physical Therapy program is closed to pa3ents of Shade Tree Clinic
and is currently not open to the community.
17
Shade Tree Neurology Specialty Clinic
The Shade Tree Neurology Clinic is held every third Saturday of the
month. Pa3ents are referrals from our regular hours clinic, but also by
Vanderbilt Neurology residents who need a place to further evaluate
pa3ents they have seen at the hospital previously with lile or no insurance.
The clinic flow mimics that of regular clinic flow. Please refer to clinic
flow for direc3ons. Both first and second year students work alongside
third and fourth year students to provide pa3ent care to those scheduled at the clinic. If you are interested in volunteering, visit the Shade
Tree Neurology Clinic website at www.shadetreeclinic.org/neuro.
The clinic is managed and pa3ent follow-up is controlled by the
Neurology Interest Group. If you are interested in pursuing leadership
with regards to the clinic please contact the Neurology Interest Group
leadership directly. Current fourth years are responsible for organizing
clinic and managing pa3ent flow. Physicians from the Vanderbilt Neurology department volunteer regularly at the clinic to provide con3nuity of care.
Shade Tree Renal Exams
Re3nal exams are performed at clinic every 3 months for our diabe3c
pa3ents (and anyone else who many be in need of one). Prevent Blindness Tennessee, a local organiza3on we partner with on occasion,
brings in all of the equipment needed, and thus all STC needs to provide is clinic coordinator and director support should any ques3ons
come up. Re3nal exams are typically scheduled on the 4th or 5th Saturday of the month (again, only every 3rd month). Contact the Director
of PHE to refer anyone for a re3nal exam.
18
ShadeTreeClinicCommunityPrograms
Vaccine Outreach
Twice a month we provide free seasonal flu, booster TDaP, and Pneumovax vaccines to various sites in the community, such as Mahew’s
House, St. Luke’s, and Soup Wagon.
Preventave Health Educaon
With our vaccina3on site visits, we provide free diabetes and hypertension screenings, social work informa3on, and chronic care referrals.
Our clinic sites are staffed by student, physician/nurse prac33oner,
and undergraduate volunteers.
Annual Shade Tree Health Fair
Each Fall, we organize a large health fair in East Nashville. The fairs include health screenings in diabetes, hypertension, and vision, HIV
tes3ng, vaccina3ons, social work, employment help, healthcare coverage informa3on, nutri3on educa3on, and various other resources.
Caldwell Enrichment Program
The Caldwell Enrichment program provides aIer-school enrichment
ac3vi3es for elementary school kids. Lessons include dance, music,
nutri3on, and visual art. The goal is to promote wellness and nutri3on
among young kids, and to provide a safe environment.
Shade Tree Resources in Diabec Educaon (STRIDE)
This program is designed to teach community members about the reali3es of having diabetes. They help guide community members through
lifestyle changes to help transform their habits to beer manage their
blood glucose levels.
Shade Tree Weight Management Program
This program is designed to teach adults how to maintain a healthy
lifestyle. Our program discusses basics of nutri3on and exercise, such
as designing a meal plate, reading nutri3on labels and exercise techniques. While this is a weight loss program, we recognize that six
weeks is not long enough to accomplish or maintain significant
weight loss. Through this program we hope that pa3ents establish a
fulfilling and healthy rela3onship with both food and exercise.
19
20
Volunteer Information
and General Clinic
Operations
21
VolunteerInformation
How to volunteer?
Volunteers can sign up on our website at www.shadetreeclinic.org.
AIer reaching the site click on “For Volunteers” in the upper right corner, then “volunteer sign-up” on the leI bar. Then sign-in using the
VUnetID and Epassword or Meharry username and password.
For non-Vanderbilt and non-Meharry students or volunteers, please
contact the Volunteer Coordinator (contact informa3on available under “For Volunteers”) to ask about available volunteer 3mes.
All medical and non-medical student volunteers must complete HIPPA
and Blood Borne Pathogen Training, which is available by contac3ng
the Volunteer Coordinator.
There are a number of volunteer opportuni3es available for nonmedical students, both undergraduate and non-undergraduate. Our
Clinic has general volunteers as well as interpreters who are a vital
part of its func3oning.
If you are in need of a ride to clinic, please Reply All to the reminder
email sent to all volunteers for the day.
Cancellaons
If you have signed up to volunteer for a clinic session and need to cancel, it is Clinic Policy that you find a replacement volunteer. OIen this
can be accomplished by sending an email out to your class listserv. If
you are having trouble finding a replacement, you should email the
volunteer coordinator immediately.
22
ClinicEtiquette
Punctuality
Volunteers should arrive at clinic at least 20 minutes before the clinic
session is scheduled to begin.
• Tuesdays, arrive by 5:40pm. (allow 15 min. travel 3me)
• Saturdays, arrive by 11:40am. (allow 15 min. travel 3me)
• Specialty Clinics, arrive by 9:40 am. (allow 15 min. travel 3me)
It is important to arrive on 3me so that the Execu3ve Directors can
hold a brief mee3ng, organize student teams, and assign pa3ents to
teams before clinic starts. When volunteers arrive late, pa3ent visits
begin late, and the en3re clinic session is slowed down.
Factor in travel 3me when planning when to leave for clinic. Note that
traffic is oIen bad on the interstates and through town on Tuesday.
A4re
It is very important to dress in an appropriate and professional manner
at Shade Tree. Always wear your White Coat and Closed-Toed shoes.
Please see this excerpt for the OAR (the guide to VMS III) addressing
professionalism in aSre:
“Your physical appearance IS important. Whether for be-er or
worse, your pa"ents and a-endings see you for only a few moments at a "me, and how you present yourself is
huge. Pa"ents’ confidence is vital to their rela"onship with
their medical teams.”
• Men: Dress pants or khakis, buon-down shirt, 3e, dress shoes
• Women: Dress pants, khakis, or skirts below the knee (no den-
im); buon-down shirt, blouse, nice top, or nice sweater (no
cleavage); dresses may also be worn if the hem is below the
knee; closed-toe, closed-heel shoes
Note: “Rules” for professional a2re are not as well-defined for
women as they are for men. Thus, you must use your best judgment when selec"ng what to wear for clinic. Please do not
wear clothes that are too "ght, skirts that are too short, or
tops that are too revealing. For example, leggings or bra straps
showing are not acceptable..
23
ClinicFlow
Volunteers arrive to clinic no later than 5:40 pm on Tuesdays and
11:40 am on Saturdays. The Directors and Clinic Coordinators will already be there geSng things ready. Typically, ten minutes before clinic, one of the Execu3ve Directors will start the “huddle.” This is a brief
introduc3on of everyone at clinic that day, as well as a run-through
summary of each of the forms, things to keep in mind, and new developments at clinic.
Checking Paent Lists Before Clinic
Most third and fourth years are assigned pa3ents to view before clinic.
They prepare for the pa3ents by checking the pa3ent’s chart on StarPanel. They read the pa3ent summary, the last clinic visit note, and
any recent labs that may have been ordered. If you are interested in
doing this, follow the direc3ons below.
1. Login to StarPanel on campus or using a SecurID
2. Click on “Outpt. Visits” on the leI naviga3on bar
3. Click on “change Provider/Date/Locaon/Type” below the Pt
Lists Tab that opens
4. Choose the appropriate date
5. Choose the “Locaon” buon
6. Type in “3752” for the department and hit “OK”
7. The pa3ent list should come up. For Appointment notes, look
for the visible column. If not visible, click on “Customize”,
choose “Columns”, then choose “Appt. Notes”.
24
General Paent Assignment and Visit
A pa3ent visit begins when the student team receives a chart from the
Execu3ve Director. The following list describes the basic steps the
team takes to complete the pa3ent visit.
1.
2.
3.
4.
5.
1.
8.
9.
10.
11.
12.
13.
14.
Review pa3ent chart
Call pa3ent from wai3ng room, take their height and weight.
Escort pa3ent to assigned exam room
Take pa3ent history and do physical exam
Present the pa3ent to an aending.
a. If the pa3ent is diabe3c, hyperlipidemic, or hypertensive direct the PHE or NCP to see the pa3ent.
Return to pa3ent room with aending; aending may examine
the pa3ent further
a. Draw any labs that the student team and aending
agree are necessary
b. Fill out appropriate lab paperwork (see Labs Informa3on Sec3on)
c. LABEL the vials with pa3ent labels found in the front
cover of the pa3ent chart
d. Store the labs in the refrigerator in the pharmacy
Formulate a plan with the aending and discuss the plan with
pa3ent
Return completed pharmacy sheet to pharmacy coordinators,
who will fill prescrip3ons while the remaining tasks are done.
Once the pa3ent’s ques3ons are answered, escort pa3ent back
to wai3ng room
Give pa3ent completed follow-up form and instruct him or her
to make a new appointment at the front desk
Fill out paperwork: face sheet, fee 3cket, pharmacy sheet
Return completed face sheet, fee 3cket, and chart to clinic coordinators at front desk, who will give you a copy of the face
sheet to use for wri3ng the note
While pa3ent waits for medica3ons, he or she may talk to the
social worker and make their next appointment
25
In-ClinicFormsandGuidelines
Face sheet
The face sheet is a form that you need to complete your note and that
the Execu3ve Directors need in order to follow up on the pa3ent’s
needs (labs, referrals, etc.). Thus, it is important that you fill out this
form thoroughly.
The front side of the face sheet is designed to help you organize informa3on gleaned from the pa3ent history and physical exam. The reverse side of the face sheet is the pa3ent summary/problem list from
StarPanel. There are sec3ons for notes on the history of the present
illness, vital signs, physical exam data, and assessment/plan. These
sec3ons are all important to fill out because they will help you to write
a good note.
You will also find three important sec3ons on the lower right corner of
the page:
• Vitals: Both height and weight should be taken for every pa3ent.
These Vitals should be entered into StarPanel during clinic. For
direc3ons please check the StarPanel sec3on
• Referrals: indicate if the pa3ent needs a referral outside of
Shade Tree Clinic. Examples might include an x-ray, a mammogram, or a colonoscopy. Referrals do not include specialty days
that are held in the clinic.
• Labs: indicate if labs were drawn on the pa3ent and if the pa3ent was fas3ng for these labs
• Follow-up: note when the pa3ent should be seen back in clinic
It is very important that you fill out these sec3ons because the Execu3ve Directors use the informa3on about labs and referrals to follow up
with the pa3ents. Also, please be sure to put the names of the students who saw the pa3ent as well as the aending on the face sheet.
At the end of a pa3ent visit when you return completed forms and the
chart to the clinic coordinators, you will be given a copy of the face
sheet to use when wri3ng your note.
Please see the highlighted loca3ons on the form to the right and make
sure to fill these out when in clinic.
26
27
Pharmacy sheet
Use the pharmacy sheet to indicate what prescrip3ons should be filled
for the pa3ent. The pharmacy sheet includes the pa3ent’s current
medica3ons, so please check to see if these medica3ons need to be refilled, adjusted, or discon3nued.
• For each medica3on, indicate the dosage, the instruc3ons for
taking the medica3on, and how many days worth of the medica3on should be filled.
• Make sure the pa3ent’s 6-digit UNHS MRN is listed on the form
in the highlighted sec3ons below.
• Pa"ent’s Medica"on List from StarPanel will be
printed in this area. All medica"ons need to be
checked with the pa"ent.
• If incorrect medica"ons are listed, cross them
out and correct them. If medica"ons need to be
added list them in the available empty space.
28
Fee cket
The fee 3cket is a document that is important for the UNHS day clinic
to have for their records. Student teams should put at least one ICD-9
code in the box at the boom of the page to indicate why the pa3ent
was seen in clinic (i.e. hypertension, diabetes, headaches).
A list of common ICD-9 codes can be found taped to the wall in the lab
area or the huddle area. ICD-9 codes can also be found on-line. Addi3onally, make sure to have the aending sign the fee 3cket.
29
Follow-up form
The follow-up form should be filled out completely so the clinic coordinators will know when and why to make the pa3ent’s next appointment. Please indicate in how many weeks’ 3me the next appointment
should be made, if the appointment should be made for a specialty
day, and if there are any important notes.
For example, if the pa3ent needs to be fas3ng for labs that should be
drawn at the next appointment, please write this in the comments sec3on of the form. Addi3onally, write whatever the follow up plan is for
the next clinic to give the next team a heads up for the appointment.
Give this form to the pa3ent when it has been completely filled out,
and direct the pa3ent to the front desk where the next appointment
can be made. This is an extremely important form that helps guide future clinic sessions.
On the back of the sheet, contact informa3on for all of the various
Shade Tree program is available. If you would like to refer the pa3ent
for Dental Work, the STRIDE class, Weight Management Class, etc then
please send the contact person an email directly with the pa3ent’s
contact informa3on.
30
Paent Sasfacon Survey
The Pa3ent Sa3sfac3on survey is an ini3a3ve that is being developed
by the Vanderbilt Healthcare Improvement Group VHIG) and Shade
Tree Clinic. The surveys allow pa3ents to give honest and anonymous
feedback to the clinic in order to improve the services that are provided at Shade Tree Clinic. It is the underclassmen’s responsibility to
make sure each pa3ent receives the survey with a pen, so that they
can fill out the survey and return it before leaving clinic. The survey for
reference is pasted below.
This survey is updated annually and the ques3ons may change in future years to beer accommodate the pa3ent’s needs and requests,
while also evalua3ng new programs implemented throughout the
year. All surveys are available in Spanish also.
31
32
StarPanel and EMR
Guide for all Notes and
Lab Order Forms
33
AddingVitalstoaPatient’sChart
All pa3ent’s that come to Shade Tree should have vitals taken. These
include their weight and height which should be taken before they are
taken back to their room. Then in the room, the pa3ent’s blood pressure, pulse, respiratory rate, and if necessary, temperature, should be
taken. These values should be added while in clinic before the paent
chart is returned to the Clinic Coordinator. In order to add these values to the pa3ent’s chart, follow the direc3ons below:
1.
2.
3.
4.
5.
6.
7.
8.
Login to StarPanel using Internet Explorer
Open the Pa3ent’s chart
Click on “Vital Signs”
If the “Vital Signs” link is not visible, click on “Enter Data” then
on “Vital Signs”
The first 3me you enter Vital Signs, choose the “Non-metric
Units” checkbox and then refresh the page. This seSng will be
saved thereaIer.
Then enter in the Date, Height, Weight, Blood Pressure, Pulse,
and Respiratory Rate
Then click on “Save”
These vitals will automa3cally be imported into the Shade Tree
Clinic Medical Team Note, the Pa3ent Health Educator Note,
and/or the Nutri3on Care Planner Note.
34
OrderingLabsatShadeTree
All Laboratory services are done at Vanderbilt. Basic pregnancy tests
and urinalyses can be performed in clinic; more detailed labs and
blood draws are placed in a biohazard bag, a lab form is filled out on
StarPanel and saved to the system, then printed and placed in the
front pocket of the lab bag.
Three types of labs are sent to the laboratory service at Vanderbilt.
Each of these types of labs should be placed in its own bag with its
own order form. Only one order form should be placed in each bag.
• Blood and Urine
• GC (Gonorrhea-Chlamydia) Probe
• Pap Smear
A8er collecng the specimens the following list of direcons should
be followed for each type of sample.
1. All specimens collected should have a label placed on them.
Labels are available on the front panel of each paper chart.
2. The order forms should be filled out for the tests as shown on
the next two pages.
3. Blood samples—To make sure the correct tube is used check on
the wall above the lab cart or visit labvu.com to check for tests
that are not listed on the sheet.
4. Urine Culture samples—AIer using a urine collec3on cup to get
a sample from a pa3ent, this is the first test that should be
done if a culture might be needed.
a. Place the collec3on aspirator in the collec3on cup
b. Press the gray topped Urine Culture tube (available in
the urine sample container box) onto the needle and
wait for the sample to fill
5. Urinalysis samples—For exact values, the sample needs to be
send to Vanderbilt. The urine sample should be moved using a
dropper to a falcon tube to be sent to Vanderbilt.
6. Urinalysis Dipsck samples—This is the third test that should
be performed. The dips3cks in the black container on the lab
counter should be dipped into the urine sample and read using
the guide on the side of the black container.
7. Pregnancy Tests—Available on the lab cart, put four drops of
urine in the S spot, if there are two lines, the pa3ent is pregnant
35
Shade Tree Clinic Lab Requision Form
AIer collec3ng the specimen, place a label from the front panel of the
chart onto the specimen. Use these direc3ons for any blood, urine, or
GC probe samples. Remember GC probes should be placed in their
own bag with their own requisi3on form.
Using Internet Explorer
Login to StarPanel
Open the correct Pa3ent’s Chart
Click on the “Forms” tab at the top
Then Search “Shade Tree” and click on the checkbox for the
“Shade Tree Clinic Lab Requision” to save it as a favorite.
6. Then click on the link of the form to open the form.
7. Choose the correct Sample Type—Blood, Urine, GC, or other
8. Choose the correct tests
9. If you need a test not listed, go to www.labvu.com and search
for the test using the test directory. Make sure to collect the
sample in the correct container and use the three leer code in
the other box of the form.
10.Click on “Save as Final” at the boom.
11.Click on “Print the Document”
12.Right-click on the pane at the boom where the form appears
13.Choose “Print”
14.Then Click “Print” on the pop-up window
1.
2.
3.
4.
5.
36
37
Shade Tree Clinic Gynecologic Cytology Requision Form
AIer collec3ng the Pap smear specimen, place a label from the front
panel of the chart onto the specimen. Use these direc3ons for any pap
smear. For GC probe samples use the direc3ons on the prevuous page.
Remember GC probes should be placed in their own bag with their
own requisi3on form.
Using Internet Explorer
Login to StarPanel
Open the correct Pa3ent’s Chart
Click on the “Forms” tab at the top
Then Search “Shade Tree” and click on the checkbox for the
“Shade Tree Clinic Gynecologic Cytology Requision” to save it
as a favorite.
6. Then click on the link of the form to open the form.
7. Fill out the appropriate informa3on that should have been
marked on the small sheet in each pap smear bag.
8. Click on “Save as Final” at the boom.
9. Then the colored (blue or yellow) on the boom shelf of the lab
computer cart should be inserted into the printer paper feed
tray with the already printed side up (facing you).
10.The Pap Smear order form should always be printed on the
back of this form
11.Click on “Print the Document”
12.Right-click on the pane at the boom where the form appears
13.Choose “Print”
14.Then Click “Print” on the pop-up window
1.
2.
3.
4.
5.
38
39
UpdatingaPatientSummary
AIer you have completed the pa3ent visit, it is always important to
update the Pa3ent Summary on StarPanel. This is the first line of informa3on for everyone at Shade Tree Clinic and at Vanderbilt when a pa3ent visits again. If there is a new major diagnosis, change in social or
family history, or allergies, they need to be noted in the Pa3ent’s
Chart. Please make sure the Pa3ent Summary is as up-to-date as possible aIer each visit. If you want to see what the Pa3ent Summary contains during your visit with the pa3ent ,check the back of the facesheet
given to you on top of the Pa3ent’s Chart.
Using Internet Explorer
Login to StarPanel
Open the correct Pa3ent’s Chart
Click on the “Update (free text)” buon in the Pa3ent Summary
Start at the Top and make sure that the “Pt. Summary Doctor”
says “Miller, Robert F.”
6. Update all of the appropriate informa3on and make sure to put
a check mark in all of the boxes that say “I reviewed this secon” for the sec3ons that you did review.
7. Then scroll to the top and click on “Send Changes” to make sure
these changes get saved and updated on StarPanel.
1.
2.
3.
4.
5.
40
UpdatingaPatient’sMedicationsList
AIer a pa3ent visit, the Pharmacy and Supply Coordinators will update
all of the pa3ent’s medica3ons list if any medica3ons were ordered. If
you have marked changes on the medica3ons list these changes will be
made in StarPanel. If there were changes made and you never submied the pharmacy sheet then you will be responsible for upda3ng
the medica3ons list on StarPanel yourself.
Using Internet Explorer
Login to StarPanel
Open the correct Pa3ent’s Chart
Click on the “Update” (Not the free text) buon in the Pa3ent
Summary
5. Start at the Top and make sure that the “Pt. Summary Doctor”
says “Miller, Robert F.”
6. Update all of the appropriate medica3ons by dele3ng or adding
medica3ons as follows.
7. Use the “x” next to the medica3ons to delete the medica3on
8. Use the box at the boom of the list to “Enter a New Name”
for a new medica3on for the pa3ent. Use the “Sig” box to mark
the direc3ons for the medica3on.
9. Then click on “Save” at the boom of the medica3on list.
10.Then scroll to the top and click on “Send Changes” to make
sure these changes get saved and updated on StarPanel.
1.
2.
3.
4.
41
PostingaStarPanelNote
Every student team is responsible for pos3ng a Shade Tree Clinic Visit
Note two days aIer the clinic session is complete. These notes are important for providing complete and appropriate care for every pa3ent.
Below are the direc3ons on how to post a note.
AIer each note is posted, it must be Aested by the Aending Physician that the medical team presented to during clinic. Please email the
aBending physician within the two day (forty-eight hour) me period
leCng them know the note has been posted along with the medical
record number for the paent. If underclassmen are wri3ng the note
please make sure the note is s3ll posted within the 2 day limit.
To post a note on StarPanel for a Pa3ent, follow these direc3ons:
1. In StarPanel, open the Pa3ent’s Chart
2. Click on the “StarNotes” tab at the top of the screen
3. Search “Shade Tree Clinic” in the “Search for a Template Box”
4. Hit Go. In the pop-up Blue Box, click on “Add” next to the
“Shade Tree Clinic Visit Note (July 2009)”
5. This will Add the Note as a favorite.
6. Then to write the Note simply click on “Shade Tree Clinic Visit
Note (July 2009)” in the panel on the right.
7. The note Template will open, then fill in the appropriate boxes.
8. Use the “Acons” menu to change the date of service to the
appropriate date and 3me.
9. At the end, hit Ac3ons at the top leI and click on “Save to StarPanel” (the first op3on in larger text) or “Save as DraG” based
on the plan for wri3ng the note that your team made in clinic.
42
CreatingYourOwnPanelonStarPanel
Students who wish to follow pa3ents they would like to see in clinic
can follow the direc3ons below to create a panel to monitor when pa3ents will be in clinic next and what the pa3ent’s results have been
over 3me. The Pa3ent Health Educators and Nutri3on Care Planners
have their own pa3ent lists to follow pa3ents within each of the programs. To create your own panel do the following:
1. In StarPanel, click on “Panels” buon on the leI naviga3on bar
2. Click on “Create a Panel” and type in an appropriate list name
3. Then open the Pa3ent’s Chart and click “Add to Panel”
4. Choose the appropriate panel.
5. To remove the pa3ent, click on the “Acons” menu within the
panel and then click “Remove”.
43
DiabeticFootExamForm
All of our diabe3c pa3ents need a foot exam every three months, so if
you are seeing a pa3ent for a follow-up exam, please make sure to
quickly perform a foot exam. However, if a foot exam is performed and
not documented then it never really happened, so please make sure
you fill out the form with the direc3ons below.
Using Internet Explorer
Login to StarPanel
Open the correct Pa3ent’s Chart
Click on the “Forms” tab at the top
Then Search “Diabetes Foot” and click on the checkbox for the
“Shade Tree Clinic Lab Requision” to save it as a favorite.
6. Then click on the link of the form to open the form.
7. Fill out all of the appropriate informa3on.
8. Click on “Complete” at the boom of the form.
1.
2.
3.
4.
5.
44
CheckingPatientListsBeforeClinic
Most third and fourth years are assigned pa3ents to view before clinic.
They prepare for the pa3ents by checking the pa3ent’s chart on StarPanel. They read the pa3ent summary, the last clinic visit note, and
any recent labs that may have been ordered. If you are interested in
doing this, follow the direc3ons below.
1. Login to StarPanel on campus or using a SecurID
2. Click on “Outpt. Visits” on the leI naviga3on bar
3. Click on “change Provider/Date/Locaon/Type” below the Pt
Lists Tab that opens
4. Choose the appropriate date
5. Choose the “Locaon” buon
6. Type in “3752” for the department and hit “OK”
7. The pa3ent list should come up. For Appointment notes, look
for the visible column. If not visible, click on “Customize”,
choose “Columns”, then choose “Appt. Notes”.
45
46
InIn-Clinic Resources
Available for Patients
47
PatientHealthEducation
There will be a Pa3ent Health Educator (PHE) at every clinic session
(two most of the 3me). If they don’t approach you before you go in to
see a pa3ent who has diabetes, please make an aempt to find them
to ask about any informa3on you may need. The PHE has prepared to
see each scheduled pa3ent, and thus can tell you about any labs needed, changes needed, special issues to address, etc.
Should you need them and a PHE is not available, strips and a glucometer are available on the lab cart. More are available in one of the
pharmacy cabinets if a pa3ent is in need of one. If you have a newly
diagnosed diabe3c pa3ent, please make sure to find a Pa3ent Health
Educator.
Please try to perform a foot exam on every diabe3c pa3ent you see.
Microfilaments are in the pharmacy in the diabe3c resources box
(shelf below eye level on the leI when you come in the door). Once
you have completed it, fill out the foot exam form. Go to StarForms
(the tab at the top) on the pa3ent’s chart and type in “Foot”, and the
appropriate form will come up. Please fill this form out, so we have the
appropriate documenta3on of the exam.
As a reference, PHEs will ask you to make sure that every diabe3c pa3ent has an A1C every 3 months, a foot exam every 3 months, and a
BMP, Lipid Panel, and Urine/Crea3nine ra3o every 6 months. Diabe3c
pa3ents should be seen AT LEAST every 3 months. Typically, a regular
clinic visit is fine for these pa3ents (i.e. not every pa3ent needs to be
seen by endocrinology). For complicated cases, please refer pa3ents to
an endocrinology night as needed.
48
SocialWork
Social Work is available in clinic at every clinic. They are able to provide
a more complete picture of care for our pa3ents by geSng them in
touch with already exis3ng resources within Davidson County and
Metropolitan Nashville.
Some Resources Available in Clinic:
• We have social service packets prearranged for varying topics for
our pa3ent popula3on including the following
◊ Food security through food stamps, canned food programs
◊ Health Insurance or Disability programs depending on qualifica3ons that can be determined in clinic
◊ Pregnancy programs such as CoverKids to cover all prenatal
care and some post-natal care
◊ Hispanic resources within the community with available
Spanish-speaking resources
◊ Employment and educa3onal opportuni3es, as needed
• We provide bus passes to those who are unable to locate transporta3on to future medical appointment and mental health appointments
• Should a need arise that we do not have a resource on site to
provide the family, the Social Work team will work closely to locate addi3onal resources within the community that may be of
assistance to the pt. and their family.
If you have pa3ents with social service needs, please simply direct
them to the SW team and we will provide them with resources, contacts, and pamphlets as needed for the resources.
• Please let the Social Worker know of the pa3ent needing resources and the Social Worker will call the pa3ent back to the
office as 3me allows.
The Social Work teams explains the resources to the pa3ents, and advises them to call and visit these agencies as needed to seek addi3onal
assistance. They also follow up with our pa3ents when they return for
future medical appointments and oIen will speak with them over the
phone should further needs arise.
49
SpanishReferenceGuide
Spanish Interpreters (both medical students and undergraduates) are
available for all of the services provided in clinic from Check-In to
Check-Out. It is important for us to provide these services to provide
the most complete care possible, while also adequately addressing all
issues that the pa3ent may have. Since nearly one-third of our pa3ents
are Hispanic, there will be 3mes where you may need to ask pa3ents
ques3ons without the help of an interpreter, so we have included a
short Spanish Reference Guide that you can use as necessary. This is
also helpful in making your pa3ent feel comfortable with you.
Clinic Basics
Appointment
Tuesday
la cita
el martes
Saturday
el sábado
Suggested Greeng
In your gree3ng you want to introduce yourself as a medical student,
find out the name and age of your pa3ent, and tell the pa3ent you
want to talk about their problem.
Hola / Buenos días / Buenas tardes
Me llamo ______________________.
Yo soy un(a) estudiante de medicina.
¿Cómo se llama? / ¿Cuál es su nombre?
Mucho gusto / Encantado(a) / Un placer
Más tarde le voy a examinar pero ahora me gustaría hablar
con Usted.
¿Cuántos años 3ene? / ¿Cuál es su fecha de nacimiento?
50
Body Parts
Head and Neck
la cabeza
el cuello
los ojos
las pupilas
la barbilla
las orejas
los oídos
la nariz
la garganta
los labios
los dientes
la lengua
la mejilla
head
neck
eyes
pupils
chin
ears (outside)
ears (inside)
nose
throat
lips
teeth
tongue
cheek
Orthopedics
el cráneo
los huesos
la espina
los hombros
el brazo
los codos
las muñecas
los dedos
las caderas
las piernas
las rodillas
los tobillos
los pies
dedos de pie
las manos
la espalda
las sentaderas
los músculos
skull
bones
spine
shoulders
arm
elbows
wrists
fingers
hips
legs
knees
ankles
feet
toes
hands
back
rear end
muscles
Gynecological
los senos
los ovarios
el útero
la vagina
breasts
ovaries
uterus
vagina
Urogenital
los riñones
los tesNculos
el pene
kidneys
tes3cles
penis
Gastrointesnal
el estómago stomach
el hígado
liver
la vesícula
gall bladder
Dermatology
la piel
el pelo
skin
hair
Cardiovascular
el pecho
chest
el corazón
heart
los pulmones lungs
51
Queja Principal
Tengo dolor de _________.
Tengo dolor al _________.
orinar
respirar
Defecar
tragar
Common Chief Complaints
My ______________ hurts.
It hurts when I __________.
urinate
breathe
defecate
swallow
Tengo ______.
tos
fiebre
catarro
gripe
nariz tapada
conspación
sensación de falta de aire
dificultad para respirar
escalofríos
mareo/náusea
vómitos
estreñimiento
diarrea
calambres
desmayo
pérdida de conocimiento
picazón/comezón
sudores por la noche
I have _________________.
cough
fever
a cold
flu-like symptoms
runny nose
stuffy nose
shortness of breath
difficulty breathing
chills
dizziness/nausea
vomi3ng
cons3pa3on
diarrea
cramps
fain3ng
loss of consciousness
itch
night sweats
Tengo sangre en ________.
I have blood in ___________
el excremento
my stool
la orina
my urine
la flema
my mucus
Estoy muy cansado(a) todo el empo. I am very 3red all the 3me.
Tengo ardor al orinar.
It burns when I urinate.
52
Chief Complaint
¿Por qué ha venido para visitar a
un doctor hoy?
¿Qué le molesta hoy?
¿Qué le trae al doctor?
¿Cómo puedo ayudarle hoy?
Why have you come to visit a
doctor today?
What is bothering you today?
What brings you to the doctor?
How can I help you today?
Past Medical History
¿Hasta ahora, cómo ha estado su
salud?
Un3l now, how has your health
been?
Medical Condions
¿Tiene otros problemas médicos?
¿Tiene la diabetes?
¿Tiene el colesterol alto?
¿Tiene la hipertensión?
¿Tiene la presión alta?
¿Ha tenido un ataque de corazón?¿Ha tenido otras enfermedades en el pasado?
¿Toma medicinas?
Do you have other condi3ons?
Diabetes?
High cholesterol?
Hypertension?
High blood pressure?
Have you had a heart aack?
Have you had other illnesses in
the past?
Do you take medica3ons?
Allergies
¿Tiene alergias a unas medicinas? Are you allergic to medicines?
Examen de Sistemas
¿Tiene o ha tenido:
sensación de falta de aire?
al hacer ejercicio?
al descansar?
cuando está molestado?
dificultad para respirar?
sentado (a)?
al acostarse?
al descansar?
al hacer ejercicio?
al trabajar en el jardín?
Review of Systems
Do you have or have you had:
shortness of breath
while exercising
while res3ng
while upset
difficulty breathing
seated
while lying down
while res3ng
while exercising
while gardening
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Examen de Sistemas(connuar)
sudores o escalofrios?
fiebre?
tos por la mañana o la noche?
tos con dolor?
tos con flema?
hormigueos?
mareos?
Review of Systems (cont.)
sweats or chills
fever
morning or evening cough
painful cough
produc3ve cough
3ngling?
dizziness?
¿Tiene o ha tenido problemas para
tragar?
mascar?
¿Tiene o ha tenido frequentemente
náusea?
vómitos?
Do you have problems
swallowing?
chewing?
Do you frequently have
nausea?
vomi3ng?
Respiratorio/Cardiología
respirar
aspirar/inhalar
exhalar
toser
estornudar
sangrar
hinchar
Respiratory/Cardiovascular
to breathe
to inhale
exhale
cough
sneeze
to bleed
to swell
Urinary
¿Tiene dolor al orinar?
¿Tiene ardor al orinar?
que orinar con más frecuencia?
urgencia para orinar?
que orinar mucho por la noche?
Do you have painful urina3on?
Does burn when you urinate?
to urinate more oIen
urgency to urinate?
to urinate oIen at night?
OBGYN
Papanicolaou
mamograma
Senos
¿Cuándo fue su úlmo período?
flujo vaginal
pap smear
mammogram
breasts
When was your last period?
vaginal discharge
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Pharmacy
Shade Tree Clinic has its own pharmacy on site that we use to fill all of
our pa3ent’s prescrip3ons as many of the pa3ents would not be able
to afford the medica3ons otherwise. The list of drugs available in clinic
follows as well as some common $4 prescrip3ons that are available at
Target, Walmart, Kroger, and Publix.
Medicaons Available in Clinic:
ALLERGY (An-Histamines)
Diphenhydramine (Benadryl) 25mg
EpiPen (catecholamine)
ANTI-MICROBIALS
An-Bacterials
Amoxicillin 250, 500mg, 125mg/5ml Oral
Suspension
Amoxicillin & Clavulanate Potassium
(Augmen3n) 875/125mg
Azithromycin 250mg
Bacitracin Zinc Ointment, Ophthalmic
Ointment
CeIriaxone (injec3on) 250, 500mg
Cephalexin 250, 500mg
Ciprofloxacin 500mg
Clarithromycin 500mg
Clindamycin 150mg, 1% Topical Solu3on
Doxycycline 100mg
Isoniazid 300mg
Gentamicin Sulfate 3mg/ml Ophthalmic
Solu3on
Metronidazole 250, 500mg, 0.75% Gel
Minocycline 100mg
Mupirocin 2% Ointment
CENTRAL NERVOUS SYSTEM
An-Convulsant
Carbamazepine 100, 200mg
Gabapen3n 100, 300, 600mg
Keppra 500mg
Lamotrigine (Lamictal)
Lyrica 150mg
Phenytoin 100mg
Valproic Acid 250mg
Fexofenadine (Allegra) 180mg
Lora3dine (Clari3n) 10mg
An-Bacterials (connued)
Neomycin/Polymyxin B/Hydrocor3sone
o3c solu3on
Sulfacetamide 10% Ophthalmic Solu3on
Sulfamethoxazole / Trimethoprim
(Bactrim) 400/80, 800/160mg
Thermazene 1% cream
Trimethoprim 100mg
An-Fungals
Clotrimazole 1% Cream
Fluconazole 150mg
Miconazole Nitrate 2% Cream, Vaginal
suppositories 100mg
Nysta3n Topical Powder
An-Virals
Acyclovir 200, 400mg
An-Parasic
Permethrin 5% Cream (scabies)
An-Depressant
Amitriptyline 10mg
Bupropion (Wellbutrin) 75mg
Citalopram (Celexa) 20mg
Fluoxe3ne (Prozac) 20mg
Sertraline (ZoloI) 25, 50mg
Venlafaxine (Effexor) 37.5mg
Psychotropic
Trazodone 50mg
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CONTRACEPTIVES
Camilla
Depo-Provera
Kariva (Mircee)
Ortho-Tri-Cyclen
Plan B
Premarin 0.625mg
Prometrium 200mg
Provera (medroxyprogesterone acetate)
10mg
Trinessa
Yazmin
DERMATOLOGIC
Clobetasol Propionate 0.05% Cream
Fluocinonide 0.05% Cream
Hydrocor3sone 2.5% Cream
Triamcinolone Acetonide 0.1% cream, ointment
DIABETES
Sulfonylurea
Glimepiride 2, 4mg
Glyburide 2.5, 5mg
Other
Meaormin 500, 1000mg
Glucose Tablets
DYSLIPIDEMIA
HMG-CoA Reductase Inhibitors
Crestor 5, 10mg
Lovasta3n 20, 40mg
Simvasta3n 10, 20, 40, 80mg
GASTROINTESTINAL
Antacid
Calcium Carbonate 648mg
An-emec
Metclopramide (Reglan) 10mg
Ondansetron (Zofran) 4 mg
Cholelithiasis
Ursodeoxycholic acid (ursodiol)
Insulins
Apidra
Lantus
Humalog
Novolog
Novolin N and Novolin R
Novolin 70/30
Triglyceride Lowering
Gemfibrozil 600mg
Niacin 500mg
Laxaves / Stool So8eners
Docusate 100mg
Lactulose
Polyethylene glycol 3350 (Miralax)
Proton Pump Inhibitor
Omeprazole (Nexium) 40mg
Prevacid 15mg
H2-Blocker
Rani3dine 150mg
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HYPERTENSION
α-Blockers
Clonidine 0.1, 0.2, 0.3mg
Terazosin 2mg (prostate)
ACE Inhibitors
Lisinopril 5, 10, 20, 40mg
Angiotensin II Receptor Blockers
Benicar 20, 40mg
Diovan 160mg
Micardis 40, 80mg
β-Blockers
Atenolol 25, 50mg
Carvedilol 3.125, 6.25, 12.5, 25mg
Metoprolol 25, 50mg
Propranolol 20mg
Calcium Channel Blockers
Amlodipine Besylate 2.5, 5, 10mg
Dil3azem 120mg
Verapamil 80, 120mg
Diurecs
Furosemide 20, 40mg
Hydrochlorothiazide(HCTZ) 12.5, 25mg
Metolazone 2.5, 5mg
Spironolactone 25, 50mg
Torsemide 20mg
PAIN RELIEF
NSAIDs
Aspirin 81, 325mg
Celebrex 200mg
Ibuprofen 200, 400, 600mg
Indomethacin 25mg
Naproxen 375, 500mg
Anesthecs
Lidocaine 1% Injec3on
Lidocaine/Epinephrine
RESPIRATORY MEDICATIONS
Contains β2-agonists
Advair Diskus 250/50, 500/50
Advair HFA 115/21, 230/21
Albuterol Inhaler 90mcg, 0.08% Inhala3on
Solu3on
Symbicort
Steroids
Flu3casone 27.5, 50mcg
NasaCort Nasal Spray (Triamcinolone
acetonide)
Pulmicort Flexhaler 180mcg
Pulmicort Respules 0.5/2, 1mg/2ml
Prostaglandin Receptor Antagonists
Acetaminophen 325, 500mg
An-Cholinergics
Spiriva HandiHaler 18mcg
SUPPLEMENTS
Ascorbic Acid 500mg
Calcitriol 0.25mcg
Calcium/Vitamin D 500mg/200IU
Creon 10 (Pancrea3c Enzymes)
Ferrous Gluconate 225mg
Ferrous Sulfate 325mg
Folic Acid 1mg
Magnesium 54mg
Mul3-Vitamins
Potassium Chloride 10mEq
Potassium Chloride 40mEq/15ml Solu3on
Vitamin B-12
Vitamin B-6
57
MISCELLANEOUS
Ancoagulants
Lovenox 80mg/0.8ml
Plavix 75mg
Warfarin (Coumadin) 2, 5mg
An-mitoc
Colchicine 0.6mg
Methotrexate (Check with Dr. Miller before dispensing!)
An-inflammatory
Sulfasalazine 500mg
Bone disorders
Actonel 150mg
Alendronate Sodium (Fosamax) 35, 70mg
Gout
Allopurinol 100mg
Steroid
Dexamethasone 10mg
Megestrol oral suspension 40mg/ml
Prednisone 1, 5, 10mg
Thyroid
Methimazole 10mg
Propylthiouracil 50mg
Synthroid (Levothyroxine) 25, 50, 75, 100,
125mcg
Urinary inconnence
Enablex 7.5, 15mg
Oxybutynin 5mg
Vasodilators
Isosorbide Dinitrate 20, 40mg
Minoxidil 2.5, 10mg
NitroStat 0.4mg
Glaucoma
Cosopt (Dorzolamide / Timolol) Ophthalmic Solu3on
Combigan (brimonidine / 3molol ) Ophthalmic Solu3on
Lumigan Ophthalmic Solu3on
All of the medica3ons available in the Pharmacy at Shade Tree Clinic are available free of charge to all of our pa3ents only. If there is a drug that is needed
for a pa3ent, but is not available in clinic, we will provide the pa3ent a prescrip3on to be filled at a local pharmacy. We cannot cover these costs, but
there is a prescrip3on pad available in the pharmacy to write the prescrip3ons. Please consult with the directors in clinic before making decisions to
write prescrip3ons for pa3ents.
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59
60
Out of Clinic Resources
Available for Patients
61
Referrals
We are lucky at Shade Tree to have the support of the Vanderbilt medical system. We have built up many contacts with physicians over the
years, and are alloed a certain amount of tests, studies, labs, and
hospital referrals per year. When you see a pa3ent in clinic, there are
several op3ons for more detailed follow-up to which you and your
team may want to refer. These op3ons are:
In-Clinic Specialty Consult
To have the pa3ent seen by a specialist in clinic (or to refer them to
one of the morning clinics) simply write which specialty you would like
them to see in the boom right of the Face Sheet under “Referrals.”
Secondly, check the box next to the specialty op3on on the follow-up
form, and the CC’s will schedule that pa3ent for the next designated
clinic for that specialty when the pa3ent checks out. In-Clinic Special3es are elaborated on more in an earlier sec3on of this booklet, but
again, the available In-Clinic Special3es are:
-Cardiology
-Nephrology -Rheumatology -Ob/Gyn
-Psychiatry
-Endocrinology -Neurology
-Dermatology
-Re3nal Exams
Vanderbilt Referrals
These are for tests or more detailed consults that we must do in a
more specialized seSng. These can include everything from a rou3ne
screening mammogram to neurosurgery (it has happened). We are
lucky to have so many services offered to us. For these referrals, just
write the necessary informa3on (indica3on and required test/service/
specialty) in the boom right corner of the face sheet under
“Referrals,” and it will get taken care of. Most include ultrasounds,
chest x-rays, ophthalmology, etc.
For Colonoscopies, all pa3ents need to fill out a form before leaving
clinic as a pre-colonoscopy screening and they need to receive a prep
kit from the pharmacy. So if you are requesng a colonoscopy please
nofy the Execuve Director.
62
Non-Vanderbilt Referrals (Non-medical—See Social Work)
Other referrals include optometry and dental, both of which can be
wrien on the face sheet, or worked out through Social Work
• Optometry
For optometry, the pa3ent needs to fill out a form in clinic so do
not let the pa3ent leave without seeing the Social Worker, otherwise the pa3ent will have to return to clinic. All of our Optometry referrals are completed through Prevent Blindness Tennessee and can provide eye exams, glasses at a reduced cost, glaucoma and cataract surgeries as necessary, and re3nal exams.
Re3nal exams are scheduled in clinic once every three months,
so contact the clinic coordinator and write it on the follow-up
form.
• Mental Health Cooperave
For pa3ents, who are interested in seeking further counseling
and help for any type of mental health issues, we have partnered
with the Mental Health Coopera3ve to provide pa3ents with expert and more personalized psychiatric and psychological care.
However, there are limita3ons of this program, in that they are
required to be ci3zens of the United States to receive care.
• Cayce Dental Clinic
Regular pa3ents of Shade Tree are eligible to receive financial
support for dental care as needed. This is a case by case basis
but Social Work should be no3fied of this need in addi3on to the
Dental Referrals Coordinator. The Dental Referrals Coordinator
will then provide all follow-up care necessary.
• Franklin Road Women’s Health Center
This alliance has allowed Shade Tree Clinic to begin the STEPP
program. This women’s health clinic is a Vanderbilt associated
health center that provides prenatal care for all of our STEPP pa3ents aIer the first trimester. It is also a good referral site for
complex OBGYN issues that may need to be dealt with outside of
Shade Tree. If you think your pa3ent may need these resources,
speak with the Execu3ve Director in clinic.
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64
In Clinic Skills for
Shade Tree Volunteers
65
66
EtiquetteandCulturalCompetency
To ensure that our pa3ents are treated with the utmost respect,
please avoid talking about pa3ents immediately outside of exam
rooms and wai3ng areas. If you are limited to where you can discuss
with your group, please talk soIly to protect pa3ent privacy
Always ask visitors and family to leave the room before discussing sensi3ve issues such as mental illness and sexual history with pa3ents unless the pa3ent requests for them to stay. Please be aware of s3gmas
that unfortunately exist, and do not discuss mental health or social
informa3on with members of the pa3ent’s family unless explicitly allowed to do so.
We see a variety of pa3ents with a variety of problems that oIen extend beyond just the medical issues. The unique aspect to Shade Tree
Clinic compared to other similar student run clinics is that we have a
clinic that addresses all of the issues a pa3ent presents with. These
issues include any social work issues, dental problems, vision exams,
and pharmaceu3cal needs. We also offer smoking counseling, diet
management, nutri3on counseling, and disease specific educa3on.
However, for a pa3ent to receive the benefits of all of these programs,
they need to feel comfortable at Shade Tree Clinic and feel like they
are respected, while at the clinic. It is important to be sensi3ve to the
issues that a pa3ent presents with and understand that you will never
completely understand what the pa3ent is going through. Rather you
should acknowledge what the pa3ent presents with, the problems
they present to you, and provide solu3ons or an open ear to them.
67
TakingaHistoryforaPatient
Taking a history is oIen 3mes undermined when in reality it is THE
most important aspect of your pa3ent encounter. The pa3ent’s history
is impera3ve to guiding aspects of the physical exam, differen3al diagnosis, and lab management.
Your physical exam should complement your history not the other way
around, a misconcep3on among naïve physicians. There are many aspects of “the history” and it should always be performed in its en3rety,
especially as a medical student. In 70% of cases, a diagnosis can be
made from the history alone. A history consists of a chief complaint,
history of present illness, past medical history, past surgical history,
family history, social history, allergies, medica3ons, and the review of
systems.
Chief Complaint also known as “CC:”
Refers to why the pa3ent has come to clinic. A chief complaint must
always be documented in the pa3ent’s words. You will oIen see quota3on marks in this por3on of the history. For example, “I have a bad
cough.” It should also be in regards to their main complaint. Many
3mes pa3ents will list 10 things, including those that are not acute or
have persisted for many years. In this case, you should push the pa3ent to iden3fy the one thing that pushed them over requiring a physician visit.
While it is usually a single symptom, occasionally more than one complaint will be provided, for example, chest pain, palpita3on, and shortness of breath. This por3on can usually be acquired by asking the pa3ent simple open ended ques3ons (“What brings you here? How can I
help you today?”).
68
History of Present Illness:
This por3on of the history allows you to elaborate on the chief complaint in detail. You should gather a history here in sequen3al order
with the goal of puSng together a story. Allow the pa3ent to speak
freely filling in the gaps of their story. Address each chief complaint
separately (if there is more than one) following the story for each
symptom in its en3rety. Common ques3ons include onset of symptoms, dura3on, quality, radia3on, allevia3ng and aggrava3ng factors,
3ming, and severity. Associated posi3ve and nega3ve symptoms
should also be recorded.
Sample Dialogue for History of Present Illness:
CC: Pain
When did the pain start? Where is the pain? Point to it.
What is the quality of the pain? Is it stabbing, burning, dull, achy
Does the pain radiate (is it sta3onary or does it move around?)
Rate the pain using a scale of 1-10 with 1 being minimal and 10
being the worst.
Is the pain always there or does it come and go throughout the
day?
Is there anything that makes the pain worse?
Is there anything that makes the pain beer?
The HPI is difficult to master. Your sense of what cons3tutes important
data will grow exponen3ally as you learn about the pathophysiology of
disease. As this occurs, you will use your differen3al diagnosis to guide
your ques3oning in this por3on of the history. Don’t let this deter you,
however, as you are already in possession of many skills that will aid
you in history taking – listening intently, recording data, and conversing in a respecaul manner. This will take you further than you think.
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Past Medical History:
This sec3on refers to the medical diagnoses the pa3ent already carries.
In this sec3on, start with an open ended ques3on. Do you have any
other medical problems? You may need to ask more specific ques3ons
if they answer no to clarify any miscommunica3on.
You should always know whether or not they have diabetes, hypertension, heart disease (any heart aacks, stents, pacemaker, etc?), and/or
high cholesterol. These are important pathologies that require preventa3ve medica3on and close follow-up. They also lend themselves to
other pathologies/diagnoses.
Past Surgical History:
Has the pa3ent had any surgical procedures? If so, when? You should
also ask about complica3ons associated with these procedures (i.e.
excessive bleeding during dental extrac3ons).
Family History:
This is important as a screening tool. Ask specifically about immediate
rela3ves. Ask about each family member separately. Does your mother
have any health issues or medical diagnoses? How about your father?
Any siblings with medical issues? Always ask about diabetes, heart disease, stroke, hypertension, hypercholesterolemia, and cancer.
Social History:
This por3on of the history addresses the personal lifestyle of the pa3ent. What type of work do you do? Who lives with you at home?
What type of diet do you eat? Do you exercise? This is also the 3me to
ask about a sexual history. What sexual prac3ces is the pa3ent involved in? Men, women, or both? Do they use protec3on? Any history
of STDs? Lastly, you want to address substances. Does the pa3ent
smoke, if so how much? Does the pa3ent drink, if so how much? Any
illicit drug use?
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Allergies:
This is the one piece of informa3on you should NEVER forget. This is
vital to the safe prac3ce of prescribing medica3ons. Specifically, you
need to know allergies to any medica3ons. If they do have an allergy,
ask specifically what reac3on they have. For example, a pa3ent would
tell you they have a rash with penicillin.
Medicaons:
It’s impera3ve you collect a list of medica3ons a pa3ent currently
takes. You want to know the name of the medica3on, how much, and
how frequently they take it. This also serves as a cross-list with the
PMH. Many 3mes, pa3ents will not be aware of their medical diagnoses. The medica3ons allows you as a physician (or soon to be!) piece
together this informa3on. Make sure to compare the pharmaceu3cal
list given to each pa3ent
Review of Systems:
This por3on serves as a systema3c review of each organ system. A card
will be provided to you as a Shade Tree volunteer that addresses common complaints with each organ system. For example, in reference to
GI, I would ask about diarrhea, abdominal pain/upset, cons3pa3on,
blood in stool, etc. It serves as a cross list to ensure you didn’t miss any
important symptoms.
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TakingVitals
Vitals are standard measures performed at every pa3ent visit to gauge
the physiological state of the pa3ent. Abnormal vitals can be the first
sign that adds to your differen3al diagnosis. Remember to WASH
YOUR HANDS before measuring any vitals or touching a pa3ent.
Blood Pressure
• Blood pressure is taken within the pa3ent exam room for every
pa3ent visit and noted on the pa3ent chart. The pa3ent should
be siSng comfortably and relaxed. Sleeves are pushed up as
clothing can interfere with the pressure of the inflated cuff.
• The cuff of the sphygmomanometer is placed on the upper arm.
It is centered over the brachial artery which is located in the
crook of the elbow. It is important that the correct cuff size is
used to get a correct reading, so change the cuff to a smaller or
larger one as necessary.
• Once the cuff is secured, raise the arm to heart level, place your
arm underneath to support it. Ask the person to relax their arm.
• Palpate (feel for) the brachial pulse and place the diaphragm of
the stethoscope over this spot. Place the ear pieces on the stethoscope into your ears. Listen to the brachial pulse.
• Close the valve on the bladder of the cuff and begin to squeeze
the bulb. Con3nue squeezing un3l the needle on the gauge reads
at least 200 mmHg.
• Open the valve slowly and allow the cuff to deflate very slowly
while you listen to the artery.
• The first thumping sound is recorded as the systolic pressure.
• Con3nue defla3ng the cuff un3l you no longer hear the thumping sound. This is the diastolic pressure.
• At this point you can open the valve completely to allow the cuff
to deflate rapidly. If you did not hear clearly, wait one minute
before repea3ng the procedure. Consider trying the other arm.
• The two numbers that measure blood pressure are recorded as a
frac3on: systolic on top and diastolic on the boom. For example, what many people consider normal blood pressure is read
as 120/80.
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Pulse
• Pulse is taken in the exam room for every pa3ent visit and noted
•
•
•
•
•
•
on the pa3ent chart.
The pulse measures the heart rate and is oIen taken at the
wrist, over the radial artery.
The index and middle finger are used for this. You should not use
your thumb as the thumb has a pulse as well and could give false
readings.
Press your index and middle finger into the groove along the inside of the wrist. You may need to move your fingers up or down
the arm a few cen3meters un3l you find the best spot to feel the
pulse.
You may have to press a lile harder if you don't feel it. But don't
press so hard that you obliterate the pulse.
Watch the clock and count the number of beats for at least 15
seconds. Your final number should be the number of beats in 60
seconds. If you count for only 15 seconds, mul3ply the number
by 4. If you feel for 30 sec, mul3ply by 2, etc. Otherwise, you
can count for a full 60 seconds.
A normal pulse can range from 60-100 beats per minute.
Temperature
• Temperature is taken in the exam room for every pa3ent visit. Oral digital thermometers can be found either in the hall with
lab supplies.
• ALWAYS PLACE A THERMOMETER PROTECTIVE SLIP over the
thermometer to protect pa3ents, as we reuse thermometers. Slips can also be found either in the exam room or on the
lab cart..
• Place a thermometer under the pa3ent’s tongue and remove
aIer the thermometer beeps. Record the temperature. In
adults, a fever is anything over 100 °F.
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Measuring Blood Glucose Levels
Blood glucose is not normally checked at every pa3ent visit, but can be
used for hypo/hyperglycemia screening and diabetes monitoring. Therefore, DIABETIC PATIENTS SHOULD HAVE GLUCOSE LEVELS
CHECKED AT EVERY VISIT. This can be checked if labs are being run for
the pa3ent, but in the case the pa3ent does not have labs, then please
make sure to measure their blood glucose.
• One-Touch or other commercially available brands of digital glucometers can be found in the hall with lab supplies.
• First, protect yourself and the pa3ent with exam gloves.
• Turn on the glucometer and place a tes3ng strip in it with the
“piano-key looking side” in first. Ensure that the code that
comes on the screen matches the code on the bole of strips
(Ex. C25).
• Clean a site on the pad of one of the pa3ent’s fingers with an
alcohol swab.
• Prick the pa3ents finger with a NEW, CLEAN lancet.
• It is helpful to have the pa3ent massage his/her finger first or
hold it down by his/her side to have good blood flow. If you
prick the finger and there is not enough blood, massage the finger gently.
• You need a substan3al drop (about 3-4 mm wide) to have
enough blood.
• Place the free end of the strip next to the drop of blood and hold
un3l blood fills the center space in the end of the strip. Record
the number that appears on the glucometer screen. Take note
as to whether or not the pa3ent has been fas3ng.
• A normal blood glucose level is 80-120 mg/dL, but can be adjusted based on fas3ng/non-fas3ng. If an abnormal or unexpected result is obtained, repeat 30-45 minutes later.
74
BasicPhysicalExam
With 3me and prac3ce, you will become familiar with the physical examine and will be able to discern with confidence various signs. This is
no way is meant to subs3tute or will even touch upon what you will
learn in physical diagnosis or during your clerkships. The basic principles will be covered as well as e3quee.
The four principles of physical examina3on:
Inspecon- Look at your pa3ent! While taking your history you
should observe the general appearance of the pa3ent, state
of nutri3on, body habitus, symmetry, posture and gait, and
speech. Always start with inspec3on regardless of organ system.
Palpaon- This refers to the use of tac3le sense to determine
the characteris3c of an organ system. For example, you can
palpate the abdomen to elicit pain if the pa3ent is having abdominal complaints. Just of note, always start in the quadrant
opposite of the pain!
Percussion – Relates to the tac3le sensa3on and sound produced when a sharp blow is struck to an area being examined.
This provides informa3on about the structure of the underlying organ or 3ssue. Ask your third or fourth year to show you
the technique. It is difficult to master, but I guarantee with
prac3ce you will achieve it.
Auscultaon- Involves listening to the sounds produced by internal organs. This should be last and should corroborate the
signs that were suggested by the other techniques. Your
stethoscope should be the last thing you pick up, not the first!
There are various techniques used to examine each organ system that
cannot be covered in this limited space. The best way to learn the
physical exam is to prac3ce. Don’t b be shy to ask your upper level or
aending to show and explain if you do not understand. When someone is listening to the heart ask if you can listen as well. You will only
learn with exposure and prac3ce.
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Pearls of Physical Exam:
1. Always respect the pa3ent. This includes draping the pa3ent
when exposing the body, pulling out the foot rest to ensure
comfort and proper posi3on, etc. This is not a game of Twister
2. Always stand to the right of the pa3ent during the physical exam. This allows you access to the various organ systems and a
comfortable posi3on to examine the pa3ent. For the Neurological and Dermatological exam may find yourself in front of the
pa3ent. It is ok in these instances.
3. Take your 3me! Do not rush as you may miss things.
4. Ask permission before you begin the physical exam.
5. Tell the pa3ent what you are doing prior to performing an aspect of the exam. This puts the pa3ent at ease.
6. WASH YOUR HANDS! Never touch a pa3ent without washing
your hands. This should be the first things you do when you enter the room. If you cough, sneeze, etc, wash your hands again
prior to performing the physical exam.
7. Ask ques3ons. You will only learn as much as you want. Be curious!
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PresentingtoanAttending
Generally speaking, the presenta3on allows you to convey the informa3on you gathered from the pa3ent in an organized and succinct
manner. Each aending will vary in regards to the amount of informa3on and detail they want. As a rule of thumb, develop the story for
the aending as the pa3ent did for you. You don’t have to relay every
detail but those you believe are most important and relevant to the
differen3al. You should also present in order outlined above in “Taking
a History.” As you become more experienced, you will develop your
own style and manner. Be pa3ent, it will come to you.
Presentaon Format:
“Pa3ent is a age, sex with a per3nent past medical history of
_____________________ (only insert relevant medical diagnoses
that may pose as risk factors or be relevant to the current complaint/management) who present to clinic today because of insert
chief complaint. Pa3ent reports that symptoms began --__________ (3me should be in rela3on to clinic visit).”
Then con3nue to develop the story.
Proceed to report the other por3ons of the history emphasizing the
most relevant facts. Your job is to tell a story guiding the aending to
your differen3al diagnosis. When you reach the review of systems, do
not feel pressured to list every symptom. You should report only the
per3nent posi3ves. If the review of systems is nega3ve, you may report a “nega3ve review of systems.”
Order for Presentaon:
1. CC
5. FH
9. ROS
13. Treatment Plan/
2. HPI
6. SH
10. PE
Management
3. PMH 7. Allergies
11. Pernent Labs 14. Follow-up, next
4. PSH
8. Medicaons 12. Paent Sum. / appointment
Differenal
As a first or second year your primary focus should be on the history.
You will develop techniques for physical exam as you enter your clinical clerkships in the 3rd year. Third and fourth year students should
corroborate the history, helping the 1st and 2nd year when needed.
Your primary focus should be on the physical exam, pa3ent summary
and differen3al, and treatment plan. Many aendings like the treatment plan in terms of symptoms/pathologies. Others may prefer it by
systems.
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AdministeringVaccineInjectionstoAdults
We have some common vaccines available in clinic, such as the flu vaccine, pneumococcal, and tetanus vaccines. If you feel that your pa3ent
may need one of these then go to the pharmacy and fill out one of the
pharmacy forms and ask them for a vial and syringe.
Other injec3ons are also given in clinic that are intramuscular or subcutaneous injec3ons. The Depo-Provera shot available is given subcutaneously for example. It is important that the shot is given as directed
as it can affect the dosage of medica3on the pa3ent receives. Ask an
upperclassman, director, or a physician if you are unsure on how to
give a shot.
Intramuscular (IM) Injecons
Administer these vaccines via IM route: Tetanus, diphtheria (Td), or
with pertussis (Tdap); hepa33s A; hepa33s B; human papillomavirus
(HPV); trivalent inac3vated influenza (TIV); and meningococcal conjugate (MCV). Administer polio (IPV) and pneumococcal polysaccharide
vaccine (PPSV) either Intramuscularly or Subcutaneously.
• Injecon site: Give the shot in the central and thickest por3on of
the deltoid—above the level of the armpit and below the acromion as demonstrated in the image below.
• Needle size: 22–25 gauge, 1–1.5" needle
• Needle inseron:
◊ Use a needle long enough to reach deep into the muscle.
◊ Insert the needle at a 90° angle to the skin with a quick
thrust.
◊ Separate two injec3ons given in the same deltoid muscle by
a minimum of 1".
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Subcutaneous (SC) Injecons
Administer these vaccines via SC route: MMR, varicella, meningococcal polysaccharide (MPSV), and zoster (shingles). Administer polio (IPV)
and pneumococcal polysaccharide vaccine (PPSV) either SC or IM.
• Injecon site: Give in fay 3ssue over the triceps
• Needle size: 23–25 gauge, 5/8" needle
• Needle inseron:
◊ Pinch up on the 3ssue to prevent injec3on into the muscle.
Insert the needle at a 45° angle to the skin.
◊ Separate two injec3ons given in the same area of fay 3ssue
by a minimum of 1".
Drawing up vaccines
• Examine vial for color and cloudiness
• Cleanse stopper using circular mo3on with alcohol swab
• Pull back plunger to draw up air equal to dose
• Uncap needle
• Push needle into empty space and empty air in the syringe– not
into vaccine fluid
• Remove all of the vaccine
• Recap needle (do not scoop up cap)
• Tap needle to remove large air bubbles
• Do NOT squirt vaccine out of needle
Reconstung vaccines
• Recons3tu3ng (mixing) vaccine with diluent or other vaccine
◊ Ex. MMR, Varicella, Pentacel
• Use the correct diluent for that vaccine
• Do not change the needle unless it becomes contaminated or
bent
• Cleanse vial stopper with alcohol pad
• Draw up air in syringe equal to dose
• Push needle straight into center of rubber stopper
• Invert vial and syringe to draw up diluent
• Inject diluent directly into vaccine vial
• Mix well
• Withdraw recons3tuted vaccine into syringe
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DrawingLabs
Most of our pa3ent’s that come to Shade Tree will have labs drawn to
check levels of metabolites, cell counts, hormone levels, or similar
measures needed for diagnosis. It is extremely important that each
pa3ent’s labs are drawn correctly. Mistakes lead to labs that cannot be
measured and the pa3ent must return to clinic and have them drawn
again. Please follow these steps as closely as possible to make sure
labs are correctly drawn. Each tube also has a different addi3ve so it is
essen3al that all labs are drawn into the correct colored tubes. The
tests with the respec3ve tube colors are on the following page.
• Always wash your hands properly and put on gloves.
• Assess the pa3ent's vein; choose appropriate site loca3on, size,
•
•
•
•
•
•
and condi3on.
Mark all specimen tubes with the pa3ent’s medical record number, name, and date-of-birth. Labels are available on the front
panel of each chart so that tubes are properly labeled.
Set out all of the tubes you need by the order of the draw and
have any necessary tools (tourniquet and alcohol swabs) nearby.
Draw blood from the most common point--the median cubital
vein--which runs on the inner part of the forearm. This is the op3mum vein because it's close to the skin surface and there aren't
a lot of nerves surrounding it.
Prep the chosen loca3on by placing a tourniquet on the upper
part of the arm, 3ght enough to make the vein bulge. Gently pat
the vein and look at its size. Find the best angle from which to
draw the blood. Your needle should line up with the direc3on
that the vein is running in.
Screw the holder onto the needle collec3on end.
Insert the needle with the beveled edge up into the vein with a
smooth, fast mo3on.
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• Push the vacutainer (blood specimen tube) into the holder,
•
•
•
•
keeping the needle steady. The vacutainer will automa3cally
start filling with the right amount of blood needed for a specific
specimen. If using an old-fashioned syringe and needle system,
manually pull back on the syringe to start filling the tube with
blood.
Pull the needle out at the same angle you inserted it once the
last specimen is collected. Immediately cap the needle using the
appropriate method. For Buerfly needles pull the yellow cover
below the needle over the needle. For straight needles, push the
green cap over the side of the needle.
Dispose of the needle in the proper place and apply gauze to the
site of the needle s3ck.
Ask the pa3ent to hold the gauze and apply pressure.
Mix the specimens thoroughly by gently swishing them around.
Confirm that each specimen is labeled correctly.
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BloodTubeandTestOrderingGuide
Each of the most common tests performed in clinic is listed below. All
of these tests are available on the StarPanel form for Lab Requisi3ons.
If you are ordering a test that is not on this list, then please go to
www.labvu.com and research the test you need to run. Go to the next
page for more informa3on.
Blood Green Tube
Basic Metabolic Panel (BMP)
Calcium (CA)
Complete Metabolic Panel (CMP)
C-Reac3ve Pep3de (CRP)
Crea3nine - Blood (CRE)
Folate Serum (FS)
Glucose (GLU)
Hepa3c Func3on Panel (HFP)
LDL - Direct (LDL)
Lipid/HDL Profile (LIP)
Iron Blood (Fe)
T4, Free (FT4)
Thyroid S3mula3ng Hormone
(TSH)
Total Iron Binding Capacity (TIBC)
Blood Red Tube
Beta Hcg - Blood (HCG)
Hepa33s A An3body Profil (HAV)
Hepa33s B Profile (HBP)
Hepa33s C (HCV)
HIV 1 & 2 An3body (HIV)
An3bodies to Syphilis (RPR)
Prostate Specific An3gen (PSA)
Blood Purple Tube
CBC w/Platelets w/Differen3al (CBD)
Hemoglobin A1C (Hgb A1C)
Sedimenta3on rate (SED)
Blood Purple Tube
CBC w/Platelets w/Differen3al
(CBD)
Hemoglobin A1C (Hgb A1C)
Sedimenta3on rate (SED)
Urine Clear, Blue Cap Centrifuge Tube
Crea3nine - Urine Spot (CRU)
Microalbuminuria - Urine (MA)
Urinalysis (UA1)
Blood Blue Tube
PT/INR (full tube req'd)
PTT
Urine Gray Capped Culture Tube
Urine Culture (UAC)
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Where to find more informaon?
In the case that you need to draw labs in clinic that are not available
on the tes3ng form. You can to find out what tube to use and how
much blood is needed by using a great laboratory resource from the
Vanderbilt Laboratory and Pathology Services.
To check this informa3on, go to www.labvu.com. From there click on
the big black banner that says “Search Our Test Directory”. Then search
for the test you are looking for. In the list it will provide the preferable
tube type and also the appropriate volume of blood needed. If you s3ll
have ques3ons, feel free to ask the Execu3ve Director in clinic for help.
AIer you find the appropriate test enter the full name and the three
leer code on LabVU into the “Other” sec3on of the lab requisi3on
form.
For more informa3on on the StarPanel Lab Requis3on Form, go to the
StarPanel sec3on of the training manual for click by click direc3ons on
how to order labs and print out the appropriate form.
How many different bags to use for different labs?
Since labs are sent to Vanderbilt Laboratory and Pathology Services
from Shade Tree Clinic aIer clinic is over, it is impera3ve that all labs
are correctly collected, labeled, stored, and packaged, so that all of
the labs can be appropriately delivered. Depending on the tests that
are requested, you may need more than one requisi3on and one bag
to order all of the tests you need to treat or diagnose your pa3ent.
There should be ONE FORM in ONE BAG for each of the following
groups of labs run.
Blood and Urine
GC Probes
Pap Smear
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WritingaNote
During clinic, it should be determined within your group who will be
responsible for comple3ng the pa3ent note and entering it into StarPanel. Notes must be wrien and entered into StarPanel no later than
48 hours aIer clinic ends.
AIer you see a pa3ent and hand in the chart to the front desk, the
Clinic Coordinators will make a copy of the facesheet for you and anyone else on your team. Therefore, make sure to take your exam notes
in enough detail on the face sheet, as the rest of the forms will be kept
by clinic.
The note template is located under "StarNotes" on StarPanel, and is
labeled "Shade Tree Clinic Visit Note", see the StarPanel sec3on for
step by step direc3on on how to find the note template. The template
is already set up, so all you need to do is replac the text under each
sec3on.
Make SURE to amend the date/3me of visit when you are wri3ng your
note (usually you will not be wri3ng your note in clinic, although try to
write it that night or the day aIer, so the pa3ent encounter is s3ll
fresh in your mind).
Clinical students will typically save straight to StarPanel, by clicking on
the blue "Ac3ons" text in the top leI of the note window, and then
clicking "Save to StarPanel" (in large text). This will make the note visible to everyone, and will allow a physician to aest the note. Some
internet browsers save notes in a more readable format than others,
try to use Internet Explorer to write the note.
Once a note is saved to StarPanel, email the physician with whom you
saw the pa3ent with the pa3ent MRN as a friendly reminder. Go back
aIer a couple days to make sure the physician aested your note.
Preclinical students may choose to prac3ce wri3ng notes as well. If this
is the case, instead of saving directly to StarPanel when finished,
choose "Save as DraI" under the aforemen3oned blue "Ac3ons" text.
You can then email your partnered clinical student mentor to look it
over and give you advice before saving it as final for the physician.
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To view notes saved as draIs (they will not appear under the normal
pa3ent summary communica3ons sec3on), click on the "StarNotes"
tab for the pa3ent, and then click "Show all DraIs" on the top right in
blue. All saved draIs by anyone should show up in the boom third of
the window, for your clinical mentor to review, modify, and then save
as final for aesta3on by the physician.
Tips for wring a good note
All clinical students should have experience in this, and the format of
the face sheet and the format of the note outline should provide a
good guideline.
Try to keep your notes succinct, with a clear, delineated plan of ac3on
at the end. This is important as Shade Tree sacrifices con3nuity of care
for the educa3on of its students. If your pa3ent needs a referral elsewhere, or specific follow-up, or you want the physician next visit to
consider a new medica3on, and these points are not Clearly, Concisely, or Completely listed in the end of the note (3 C's), then that pa3ent's follow-up or details of care are at risk of falling through the
cracks. Remember that many teams will see the pa3ent, very poten3ally for the first 3me at the pa3ent’s next visit, so your note is all they
have to go off of.
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86
Community Outreach
Information for Shade
Tree Volunteers
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CommunityOutreachOverview
The Community Outreach branch of Shade Tree is focused on providing medical care and resources for the greater East Nashville Community. We collaborate with many community organiza3ons to provide
free vaccina3ons, health screenings, social work, and community enrichment ac3vi3es to the underserved. To date, we have vaccinated
more than 1,000 individuals and provided health screenings for an addi3onal 500 people. The majority of our pa3ents are homeless, uninsured, or recent immigrants. By providing our services at sites convenient to our target at-risk popula3ons, we are able to reach some of
Nashville’s most vulnerable individuals. While the Shade Tree Clinic
may be limited to a maximum number of pa3ents it may see, the Outreach program can have wide-reaching effects in the community and
provide care to a great number of addi3onal individuals in need. Our
projects include but are not limited to vaccine outreach programs, an
Annual Shade Tree Health fair, a Caldwell Enrichment Program, and
Preventa3ve Health Clinics.
Throughout the year, the Outreach Program is ac3ve in helping local
organiza3ons and individuals with their projects and visions. We oIen
provide health screenings and informa3on at local health fairs organized by partnering organiza3ons. We also help individuals plan their
outreach projects and serve as a source of community contact and rela3ons.
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CommunityOutreachPrograms
Vaccine Outreach
Poor nutri3on and unstable living condi3ons oIen place uninsured and
homeless individuals at a greater risk for infec3ous diseases. Without
transporta3on or funds, these individuals are less likely to seek medical aen3on and are at a greater risk for developing severe secondary
complica3ons. Too oIen, the Emergency Room serves as the primary
care for these individuals. The vaccine outreach program was established to address the issue of accessibility to healthcare through preven3ve medicine. From October to March, we provide weekly/ bimonthly free seasonal flu, booster TDaP, and Pneumovax vaccines to
various sites in the community, such as local churches, homeless shelters, and community centers.
Preventave Health Outreach Clinics
In tandem with our vaccina3on site visits, we provide free diabetes
and hypertension screenings, social work informa3on, proper footcare
educa3on, and chronic care referrals. We also distribute informa3on
on upcoming site-specific events that we organize such as specialty
nights in endocrinology, psychology, medicine, etc. Our clinic sites are
staffed by students, physicians/nurse prac33oners, and undergraduate
volunteers.
Annual Shade Tree Health Fair
Each Fall, we organize a large health fair in East Nashville. The fair
serves as a one-stop source of referral and informa3on. Services provided include health screenings in diabetes, hypertension, and vision,
HIV tes3ng, vaccina3ons, social work, employment help, healthcare
coverage informa3on, nutri3on educa3on, and other resources.
Caldwell Enrichment Program
In collabora3on with VMS Dance, the Caldwell Enrichment program
provides aIer-school enrichment ac3vi3es for elementary school kids.
Lessons include dance, music, nutri3on, and visual art. The goal is to
promote healthy habits among young kids as well as to provide a fostering environment to keep them off the streets.
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EtiquetteandCulturalCompetency
Professional EqueHe
Our Community Outreach sites follow the same expecta3ons in professionalism, respect, and e3quee as our regular clinic. You should always dress professionally, arrive on 3me, and budget appropriately for
travel 3me.
Addi3onally, all students are expected to follow the same pa3ent care
e3quee as expected of them in clinic. Every pa3ent should get your
full aen3on and you should respect the issues that they present. This
is of utmost importance especially at our Community Outreach clinics
as the pa3ents come from diverse backgrounds presen3ng with even
more diverse complaints.
Socio-cultural Competence
The La3no/Hispanic popula3on is the largest-growing minority in the
U.S. With numbers exceeding 50 million, they form an important part
of the pa3ent pool. It is cri3cal to understand language barriers and
cultural differences when working with the minority popula3on. To
ensure that our pa3ents receive the most appropriate care, please use
interpreter services!
Also, understand that percep3on of medicine is different in different
cultures. For example, certain cultures are less trus3ng of physicians,
par3cularly those who do not speak their na3ve tongue. Certain people also have supers33ons about the origin of chronic illness and may
wrongly gauge the prognosis of illness based on the number of medica3ons prescribed (ie, more pills = geSng worse) and are, thus, less
compliant. It is important that, as healthcare providers, we take the
3me to explain the cause of illness and disease management to resolve
misunderstandings, distrust, and cultural differences.
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Socio-cultural Competence (connued)
In caring for the homeless and low-income popula3on, we must be
understanding of their unique needs. Many of these pa3ents are hardened, malnourished, and alone. They are faced with a much greater
barrier to disease management and treatment due to financial instability, unstable housing, and lack of transporta3on.
Pa3ence and understanding are important virtues in caring for these
individuals. Please be considerate of their feelings and understand that
they may not have the opportunity to maintain proper hygiene nor
ea3ng habits. Many homeless individuals are distrusaul of wellmeaning volunteers and are reluctant to receive help. In par3cular,
many homeless individuals have weathered such environmental extremes that they do not believe in receiving recommended vaccina3ons. One of our goals will be to help this incredibly vulnerable popula3on understand the benefits of vaccina3on and preven3ve medicine
by pa3ently and respecaully correc3ng their misconcep3ons.
Regardless of race, religion, gender, or social background, all pa3ents
deserve respect and the highest standard of care. We trust that you
will be mindful of these differences and will provide great care in the
community while gaining many invaluable insights that will hugely enhance the quality of your medical training.
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DiabetesandHypertensionEducation
During the Shade Tree Outreach events, you will be asked to help administer diabetes and hypertension screenings. OIen 3mes, you will
need to explain the findings to your pa3ents and consult them on the
significance of the readings. Below, you will find a brief overview of
diabetes and hypertension to enhance your role as a service provider
in the community.
What is Diabetes?
Diabetes is a group of diseases marked by high levels of blood glucose
resul3ng from defects in insulin produc3on, insulin ac3on, or both.
For many people who have diabetes, target levels are:
• Fasng at least eight hours (fasng blood sugar level) — be-
tween 90 and 130 milligrams per deciliter (mg/dL)
• Before meals — between 70 and 130 mg/dL
• One to two hours aGer meals — lower than 180 mg/dL
Remember that target blood sugar range may differ between individuals, especially they are pregnant or develop diabetes complica3ons.
The target blood sugar range may change with age too.
Different Types of Diabetes
Type I Diabetes (formerly called juvenile diabetes)
Type I Diabetes happens when the body’s immune system aacks and
destroys its own insulin-producing beta cells in the pancreas. People
with type I diabetes must have insulin delivered by injec3on or a
pump. Symptoms of type I diabetes – increased thirst and urina3on,
constant hunger, weight loss, blurred vision, and extreme fa3gue –
usually develop over a short period of 3me. If type 1 diabetes is not
diagnosed and treated, a person can lapse into a life-threatening coma. Type I diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes.
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Type II Diabetes, (formerly called adult-onset diabetes)
Type II Diabetes happens when the body does not make enough insulin or cannot use the insulin it makes effec3vely. This form of diabetes
usually develops in adults over the age of 40 but is becoming more
prevalent in younger age groups – including children and adolescents.
The symptoms of type II diabetes – feeling 3red or ill, unusual thirst,
frequent urina3on (especially at night), weight loss, blurred vision, frequent infec3ons, and slow-healing wounds – may develop gradually
and may not be as no3ceable as in type 1 diabetes. Some people have
no symptoms. Type II diabetes accounts for about 90 to 95 percent of
all diagnosed cases of diabetes.
A person is more likely to develop type II diabetes if they:
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•
•
•
•
•
•
•
•
•
•
have a family history of diabetes
are a member of an ethnic group like Hispanics/La3nos
are overweight or obese
are 45 years old or older
have had diabetes while pregnant (gesta3onal diabetes)
have high blood pressure
have abnormal cholesterol (lipid) levels
are not geSng enough physical ac3vity
have polycys3c ovary syndrome (PCOS)
have blood vessel problems affec3ng the heart, brain or legs
have dark, thick and velvety patches of skin around the neck and
armpits (This is called acanthosis nigricans.)
Gestaonal Diabetes
Gesta3onal Diabetes develops during pregnancy. Women who have
had gesta3onal diabetes have a 40 to 60 percent chance of developing
diabetes, mostly type 2, in the next five to 10 years.
Hispanics/La3nos are twice as likely as whites to develop diabetes.
They also have an earlier onset for diabetes and up to 50% higher
death rate due to diabetes than non-Hispanic whites. The Hispanic
popula3ons, likewise, experience greater complica3ons from diabetes
(ie re3nopathy, nephropathy, lower-extremity amputa3ons).
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Cardiovascular Disease and Diabetes
• Cardiovascular disease is the leading cause of death for people
•
•
•
•
with diabetes – about two out of three people with diabetes die
of heart disease or stroke.
Adults with diabetes have heart disease death rates about two
to four 3mes higher than adults without diabetes.
The risk for stoke is two to four 3mes higher for diabe3cs.
About 75% of adults with diabetes also have hypertension.
Smoking doubles the risk for heart disease in diabe3cs.
Prevenng Type II Diabetes
Type II Diabetes can be prevented or onset can be delayedwith certain
measures:
• Weight loss/management
• Exercise (at least 30minutes, five days per week)
• Make healthier food choices and limit the amount of calories
and fat in diet.
Hypertension
Hypertension (HTN) is the term used to describe high blood pressure.
• Normal blood pressure: below 120/80 mmHg
• Prehypertension:
Systolic blood pressure between 120 and 139 on mul3ple readings
and/or
Diastolic blood pressure between 80 and 89 on mul3ple readings
• If you have pre-hypertension, you are more likely to develop
high blood pressure.
• Hypertension:
Systolic pressure consistently over 140
and/or
Diastolic pressure consistently over 90.
• Either or both of these numbers may be too high.
A single health screening cannot be used to diagnose hypertension
but can idenfy paents that may need follow up.
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Treatment of HTN
In addi3on to medica3ons, lifestyle changes can help control HTN:
• Weight loss. Excess weight adds to strain on the heart. In some
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•
•
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•
cases, weight loss may be the only treatment needed.
Regular exercise. If possible, exercise for 30 minutes most days.
Eat a diet rich in fruits, vegetables, and low-fat dairy products
while reducing total and saturated fat intake.
Avoid smoking.
If you have diabetes, keep your blood sugar under control.
Do not consume more than 1 or 2 alcoholic drinks per day.
Try to manage your stress.
Who is at risk for HTN?
• High blood pressure can affect all types of people.
• Those with a family history are at a higher risk.
• HTN is more common in African Americans.
• HTN is more prevalent in the Southeastern U.S.
• Smoking, obesity, and diabetes are all risk factors for HTN.
• The prevalence of hypertension in the U.S. reached 29% in 2004.
• HTN is greater in the southeastern United States.
• Hypertension is more prevalent in men and those of low socioeconomic status.
Blood Pressure and Blood Glucose Screening at Local Health Fairs
When discussing HTN or Diabetes and risks with members of the community at local health fairs, be cognizant of sensi3ve issues involving
weight, lifestyle, and ethnicity. Recognize that it is very difficult to
change dietary and exercise habits, especially with the stress of working, family obliga3ons, etc.
Also note that you cannot determine if someone has pre-HTN, HTN,
pre-diabetes, or diabetes from a single reading at a health fair – you
can only report that the paent has an abnormal reading and encourage him/her to visit a doctor because he/she may be at risk.
Diagnoses of hypertension and diabetes can only be made by a physician. We provide handouts with a list of local clinics and their pay
scales at every health fair. We will also try to have a resident or physician volunteer at local health fairs when their schedules allow.
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