Non-pharmacological counseling points

Question 1

Migraine

Answer 1

Avoid substances (food, caffeine, alcohol, and medications) or situations (stress, fatigue, oversleeping, fasting, and missing meds) that you know can trigger a migraine
Avoid foods or food additives known to trigger migraines, including red wine, aged cheese, aspartame, monosodium glutamate, coffee, tea, cola beverages, and chocolate
Avoid foods to which you are allergic
Eat regularly to avoid hunger and low blood sugar
Consider taking magnesium supplements
Apply an ice bag or cold pack to the forehead or temples

Question 2

Fever

Answer 2

Do not use isopropyl or ethyl alcohol for body sponging - alcohol poisoning can result from skin absorption or inhalation
For all levels of fever, wear lightweight clothing, remove blankets, and maintain room temperature of 68 degrees
Unless advised otherwise, drink or provide sufficient fluids to replenish body fluid losses

Question 3

Musculoskeletal injuries (once they’ve occurred)

Answer 3

For pain related to muscle or joint injuries, begin treatment with RICE therapy
For periodic muscle cramps, stretch and massage the affected area immediately then rest or reduce activity of the muscle to allow it to loosen
For stiffness, apply heat to the affected area in the form of a warm wet compress, a heating pad, or a hot water bottle
For osteoarthritis, try a combination of nondrug measures, including applying heat or cold to the affected area, supporting the area with splints, and doing range of motion and strength-maintenance exercises

Question 4

Preventing musculoskeletal injuries

Answer 4

To prevent muscle or joint strains and sprains, do warm-up and stretching exercises before playing sports or exercising, and wrap injured muscle or joint with protective bandage or tape.
To prevent repetitive strain, exercise the muscles that are vulnerable to the injury, and use ergonomic controls to adjust posture, stresses, motions, and other damaging physical factors.
To prevent tendonitis and cramps, warm up and stretch muscles before physical activity, drink sufficient fluids, and do not exercise to the point of exhaustion. To help prevent nocturnal leg cramps, raise the foot of the bed. For achilles tendonitis, wearing better-fitting shoes with heel lifts may help reduce the symptoms.
To prevent or reduce the occurrence of osteoarthritis, avoid a sedentary lifestyle, keep joints active, lose weight (if overweight), and use assistive devices if needed.

Question 5

Vulvovaginal candidiasis

Answer 5

If significant irritation of the vulva is present, use a sodium bicarbonate sitz bath to provide relief and give the antifungal medication time to become effective (1tsp of sod bicarb to 1 pint of water then 2-4tbsp to 2 inches of water)
For recurrent infections try eating yogurt and decreasing dietary sugar and refined carbohydrates

Question 6

Primary dysmenorrhea

Answer 6

If effective, apply topical heat to the abdomen, lower back, or other painful area
Stop smoking cigarettes and avoid second hand smoke
Consider eating more fish high in omega 3 fatty acids or taking a fish oil supplement
Participate in regular exercise if it lessens the symptoms

Question 7

Premenstrual syndrome

Answer 7

Try to avoid stress, develop effective coping mechanisms for managing stress, and learn relaxation techniques
If possible, participate in regular aerobic exercise
During the 7-14 days before your menstrual period, reduce intake of salt, caffeine, chocolate, and alcoholic beverages. Eating foods rich in carbohydrates and low in protein during the premenstrual interval may also reduce symptoms.

Question 8

Colds

Answer 8

To prevent: frequently wash your hands with soap for at least 20 seconds, cover your nose and mouth when coughing or sneezing, use antiviral products to clean surfaces
To provide relief or speed up recovery: get adequate rest, drink fluids and use a humidifier or vaporizer, suck on hard candy, gargle salt water, or drink fruit juice or hot tea with lemon to soothe a sore throat.

Question 9

Allergic rhinitis

Answer 9

Avoidance of allergens
For symptoms that develop mostly outdoors: frequently check local pollen counts and air quality index, keep house and car windows shut, avoid yard work and outdoor sports on days with high levels of pollen/mold/pollution
For symptoms that occur mainly when indoors: try to remove the symptom triggers, lower the humidity in the house to reduce molds, wash bedding in hot water every week, and encase mattresses and pillows in coverings resistant to house-dust mites.
Nasal saline solutions may relieve nasal irritation and dryness and aid in the removal of dried, encrusted, or thick mucus from the nose.

Question 10

Cough

Answer 10

Stay well hydrated
Reduce throat irritation by slowly dissolving nonmedicated lozenges and candies in the mouth, use humidifiers and vaporizers to increase the moisture in the air and possibly soothe irritated airways
Treat the underlying cause of the cough

Question 11

Heartburn and dyspepsia

Answer 11

Avoid food, beverages, and activities that may precipitate or increase the frequency and severity of symptoms
If possible, avoid the use of medications that may aggravate heartburn or dyspepsia
Avoid eating large meals
Stop or reduce smoking
Lose weight if overweight and not pregnant
Wear loose-fitting clothing
If nocturnal symptoms are present: avoid lying down within 3 hours of a meal, elevate the head of the bed using 6-8” blocks or use a foam pillow wedge

Question 12

Intestinal gas

Answer 12

If possible, avoid foods known to cause intestinal gas

Avoid activities known to introduce gas into the digestive system, such as drinking carbonated beverages

Question 13

Constipation

Answer 13

To promote regular bowel movements, use nondrug strategies such as a high fiber diet (slowly increase intake to 25-35 grams per day), plenty of fluid intake, and regular exercise
Increase dietary fiber by eating foods with whole grains, oats, fruits, and vegetables.
Avoid constipating foods, such as processed cheeses and concentrated sweets
Drink plenty of fluids to help soften your stool and move food through your GI tract
Develop and maintain a routine exercise program
Establish a regular pattern for bathroom visits. Do not delay in responding to the urge to use the bathroom; allow adequate time for elimination in a relaxed, unhurried atmosphere
Maintain general emotional well-being and avoid stressful situations

Question 14

Diarrhea for less than 5yo

Answer 14

Mild-moderate diarrhea is 3-5 unformed bowel movements per day. Give ORS at 50-100mL/kg over 2-4 hours. Continue to give the solution until the child is rehydrated
If the child is vomiting, give 1tsp of ORS every few minutes
If the child is not dehydrated,give 10mL/kg for every episode of diarrhea and 2mL/kg for every episode of vomiting
After the child is rehydrated, reintroduce food appropriate for the child’s age while also continuing to administer ORS
If breast-feeding, continue. If bottle feeding, contact the pediatrician about switching to a lactose free formulation
Give children complex carbohydrate rich foods, yogurt, lean meats, fruits, and vegetables. Do not give them fatty or sugary foods.
Do not withhold food for more than 24 hours

Question 15

Diarrhea for older than 5yo

Answer 15

For mild-moderate dehydration, indicated by a 3-9% drop in body weight or 3-5 unformed stools per day, drink 2-4 liters of ORS over 4 hours
If not dehydrated, drink 1/2- 1 cup of ORS or fluids after each unformed bowel movement
If no medical conditions exist, sports drinks, diluted juices, soups, and broths may be consumed until the diarrhea stops
Do not withhold food for more than 24 hours

Question 16

Anorectal disorders

Answer 16

Maintain hydration and a healthy diet. If experiencing hard stools, straining, or constipation, increase the amount of fiber and fluids in the diet to reduce or prevent straining during bowel movements
Avoid medications that cause constipation if possible
Clean anorectal area after each bowel movement with a moistened, unscented, white toilet tissue or wipe
Use a sitz bath or soak in a bathtub two to four times a day
Avoid the use of soaps, salts, and oils

Question 17

Pinworm infection

Answer 17

Educate in person hygiene, particularly the need to wash hands before eating or preparing food and after using the toilet. Encourage keeping fingernails short to prevent harboring of eggs and autoinoculation; discourage biting nails and scratching anal area
Eggs are destroyed by sunlight and ultraviolet rays, so ensure blinds or curtains are open in the affected room to enhance cleaning of the environment
Wash bed linens, underwear, bedclothes, and towels of the entire family in hot water daily
Shower (rather than bathe) daily in the morning
Change underwear, nightclothes, and bed sheets daily
Clean and vacuum (do not sweep) house for several days after treatment

Question 18

Nausea and vomiting

Answer 18

To prevent NVP, eat small, frequent meals that are low in fat content. Sleep in a room with fresh air. Also, try eating crackers before getting up in the morning. Try lying down to relieve the symptoms once they occur
To prevent motion sickness in young children, place them in a car seat that allows them to look out the windows. Try acupressure wristbands to prevent motion sickness in adults or older children.
To prevent nausea associated with overeating, avoid foods or beverages known to cause nausea; consume foods and beverages in moderation

Question 19

Excessive/Impacted cerumen

Answer 19

Use a washcloth draped over a finger to remove earwax from the outer canal
Do not insert objects in the ear to remove earwax. Such attempts may injure the ear canal or push the wax further into the canal

Question 20

Water clogged ears

Answer 20

Tilt the affected ear down, and gently manipulate it to help drain the water from the ear. Immediately after swimming or bathing, use a blow dryer on low head and speed setting to help dry the ear canal. Do not blow air directly into the ear canal.

Question 21

Recurrent aphthous stomatitis

Answer 21

If a deficiency of iron, folate, or vitamin B12 is diagnosed as a contributing factor, increase consumption of foods high in these nutrients, or take nutritional supplements.
Avoid spicy or acidic foods until the lesions heal.
Avoid sharp foods that may cause increased trauma to the lesion.
If desired, apply ice directly to the lesions in 10 minute increments but not longer than 20 minutes in a given hour.
Do not use heat (if infection is present, it will cause it to spread)

Question 22

Minor oral mucosal injury or irritation

Answer 22

Rinse with a sodium bicarb solution to remove injured tissue and cleanse the affected area. Add 1/2 - 1tsp of sodium bicarbonate to water. Swish the solution in the mouth over the affected area for at least 1 minute, then spit out the solution. This can be done up to 4 times per day.
Use saline rinses to cleanse and soothe the affected area. Add 1-3tsp of salt to 4-8oz of warm tap water. This can be done up to 4 times per day.
For bruised lips or cheeks, apply ice in 10 minute increments to reduce swelling. Do not apply ice longer than 20 minutes in a given hour.

Question 23

Teething

Answer 23

Massage the gum around the erupting tooth to provide relief.
Give the baby a cold teething ring or cold wet cloth, or food (toast or teething cookies) to chew.
The ADA recommends regular dental check ups beginning 6-12mo

Question 24

Herpes Simplex Labialis

Answer 24

Keep labial or extraoral lesions clean by gently washing them with mild soap solutions.
Wash hands frequently to prevent contaminating the lesions and to avoid spreading the virus.
Avoid factors believed to delay healing such as stress, injury to the lesions, wind, excessive sun exposure, and fatigue
If outbreaks are related to sun exposure, use a lip and face sunscreen, with appropriate SPF protection, routinely.

Question 25

Dry mouth

Answer 25

To prevent reduced levels of saliva, avoid use of cigarettes and smokeless tobacco
Do not drink or use products that contain alcohol or medications that cause depletion of salivary flow
Avoid food or drinks that contain caffeine
Avoid hot spicy foods
To prevent tooth decay, limit consumption of sugary, starchy, and acidic foods. Do not suck on hard candy or lozenges sweetened with sugar
If desired, chew gum sweetened with sugar alcohols, such as xylitol, to help increase flow of saliva
If possible take medications 1 hour before meals so that natural saliva flow caused by food can counteract mouth dryness
To help prevent tooth decay, use a very soft toothbrush to reduce abrasion of the teeth
Drink water
Use a humidifier at home

Question 26

Atopic dermatitis

Answer 26

Avoid factors that trigger allergic reactions. Do not wear tight clothing. Remain in areas that have a moderate temperature and low humidity.
Bathe or shower every other day, if possible. Take short showers or baths using tepid water and a nonsoap cleanser.
If possible, substitute sponge baths for full body bathing.
Pat dry after a bath or shower.
To dry weeping lesions, apply cool tap water compresses for 5-20 minutes, 4-6 times daily.
To prevent injury to the affected area caused by scratching, keep your fingernails short, smooth, and clean. At night, wear cotton gloves or socks on your hands to lessen scratching.

Question 27

Dry skin

Answer 27

Avoid excessive bathing; take brief full body baths 2-3 times per week and take sponge baths on other days using warm water to maintain skin hydration.
Pat dry after bathing or showering.
Drink plenty of water daily.
Moisturizer should be generously applied 3-4 times daily and continued as long as dry skin persists.
Moisturizers should be applied withing 3 minutes after bathing, plus an additional 3 times per day
Although getting rid of dry skin completely may be difficult, initial improvement should be seen within 24 hours
Avoid caffeine, spices, and alcohol because they can contribute to dehydration
Keep the room humidity higher than normal to minimize evaporation from the skin

Question 28

Irritant contact dermatitis

Answer 28

Avoid or limit contact with common skin irritants, such as detergents, soaps, and solvents
Change clothing, diapers, and gloves used for cleaning more frequently
Wash the affected area gently to remove the skin irritant

Question 29

Preventative measures against poison ivy/oak/sumac

Answer 29

learn the physical characteristics and usual habitat of toxicodendron plants. Survey the area when outdoors and assess potential risk for exposure.
Eradicate toxicodendron plants near your residence either by mechanically removing the plant and its roots or by applying an herbicide recommended by the government. Do not burn the leaves of plants.
Apply bentoquatam on exposed areas of the body to reduce the risk of contamination before visiting an outdoor site with high likelihood of contact with poison ivy/oak/sumac. Repeat application every 4 hours.

Question 30

Protective measures against poison ivy/oak/sumac

Answer 30

Wear protective clothing to cover exposed areas
Cover your nose and mouth with a protective mask when removing or eradicating toxicodendron plants.
Remove all clothing worn during exposure, and place the clothing directly into the washing machine, separate from other clothes.
If thorough washing is not possible, rinse with water as soon as possible.
At the earliest convenience, take a shower.
Clip fingernails and keep clean.
Clean the fur of contaminated pets.

Question 31

Insect bites

Answer 31

Apply ice pack promptly to reduce swelling, itching, and pain.
Avoid scratching affected area; keep fingernails trimmed.
Remove ticks with tweezers by grasping the tick’s head and gently pulling, the head should be removed.
Do not wear rough, irritating clothing over the bite area.

Question 32

Insect stings

Answer 32

For honeybee stings, removing the honeybee stinger immediately is important. Scraping the stinger away with the edge of a credit card is effective. Try to not squeeze or rub the stinger.
Apply an ice pack or a cold compress promptly to the sting site to help slow absorption of the venom. This will reduce the itching, swelling, and pain.
Avoid scratching the affected area; keep fingernails trimmed. Gloves or mittens may help children not scratch.
When outside, do not wear perfume, scented lotions, and brightly colored clothes; control odors in picnic and garbage areas; change children’s clothing if it becomes contaminated with summer foods such as fruits; wear shoes when outdoors; and destroy nests of stinging insects near homes.
If you are hypersensitive, carry identification of the allergy.

Question 33

Lice

Answer 33

Wash hairbrushes, combs, and toys of infected patients in hot water for 10 minutes.
Objects or clothing that can’t be washed should be sealed in a plastic bag for 2 weeks.
Avoid close physical contact with an infested patient; do not share combs, brushes, towels, caps, and hats.
Vacuum living areas thoroughly and regularly during treatment period.
Visually inspect the hair and scalp before, during, and after treatment.

Question 34

Acne

Answer 34

Cleanse the skin thoroughly but gently twice daily to produce a mild drying effect that loosens comedones. Use a mild, oil-free cleanser and warm water.
To prevent or minimize acne flare-ups, avoid or reduce exposure to environmental factors such as dirt, dust, petroleum products, cooking oils, or chemical irritants.
To prevent friction or irritation that may cause acne flare-ups, do not wear tight fitting clothes, headbands, or helmets; avoid resting the chin on your hand
To minimize acne related to cosmetic use, do not use oil-based cosmetics and shampoos.
To prevent excessive hydration of the skin, avoid areas of high humidity.
Avoid stressful situations when possible and practice stress management techniques.
Do not pick or squeeze pimples, which can further irritate skin and lead to scarring.

Question 35

Avoiding/minimizing sun exposure

Answer 35

Avoid exposure to the sun and other sources of ultraviolet radiation, such as tanning beds/booths and sunlamps
The sun’s rays are the most direct and damaging between 10am and 4pm. Avoid sun exposure as much as possible between those hours
Sunburn can occur on a cloudy or overcast day
Wear protective clothing (long sleeves, long pants, wide-brimmed hat). Tightly woven fabrics are best
Use a beach umbrella or other protection to reduce UVR
Time spent in the water is time spent in the sun