Many nurses are faced with the task of creating standing orders for the camp practice environment. This is challenging for nurses with limited experience in camp, or who have not worked with standing orders extensively before. Here is an example of standing orders, please feel free to use them as a starting point for your camp health service.
General Standing Orders for Camp Environments
OTC Medications Available on Location
- Acetaminophen (Tylenol) 325mg tabs
- Acetaminophen Liquid (Tylenol) 160mg/5ml
- Ibuprofen (Advil) 200mg tabs
- Ibuprofen Liquid (Advil) 100mg/5ml
- Diphenhydramine (Benadryl) 25mg tabs
- Diphenhydramine Liquid (Benadryl) 12.5mg/5ml
- Dextromethorphan (Delsym)15mg/5ml
- Ranitidine (Zantac)75mg tab
- Calcium carbonate chewable (TUMS)
- Cetirizine (Zyrtec) 10mg tabs
- Phenylephrine HCL (Suphedrine PE) 10mg tabs
- Guaifenesin Liquid 100mg/ml
- Cough Drops (generic)
- Polyethylene Glycol (MiraLAX)
- Psyllium fiber (Metamucil)
- Phenol spray (Chloraseptic spray)
- Meclizine HCL (Bonine) 25mg tab
- Triple antibiotic ointment (neosporin)
- Hydrocortisone cream 1%
- Tolnaftate cream 1%
These medications will be given, at the discretion of the onsite nurse, and with parental permission, as directed on the labeling instructions.
Prescription Medications Available on Site
Epinephrine 1:1000 0.3mg auto injector
To be given in cases of suspected severe allergic reactions where any of the following symptoms are present:
Difficulty breathing or swallowing
Tight throat, or obstructive tongue swelling
Pale skin, week pulse, or other signs of poor profusion.
Note time epinephrine is administered. Call 911 immediately. Give oral diphenhydramine. (Benadryl) liquid dose as appropriate for age. If symptoms persist or recur five minute or more after the first dose give a second dose of epinephrine.
Medical Orders for Specific Problems
Abdominal Pain: Check temperature. Palpate for location, softness, rebound, distention, or tenderness. Assess for constipation, and stool frequency/qualities. Nothing by mouth except small sips of water until resolved. If pain is severe or persistent, refer to MD. If pain is severe, or associated with rebound tenderness, call MD, transport to ED, or call 911 if needed.
Abrasions and Lacerations: Wash area with soap and water. Cover with triple antibiotic ointment (with parental permission) and dry dressing. Change dressing and follow up using nursing judgement. Refer to MD if signs and symptoms of infection develop. For large or deep wounds requiring suturing, cover with dry dressing, and refer to MD or ED as appropriate.
Asthma: Students with their own inhalers should use them as directed in their action plan, for symptoms of asthma, and may require restriction of activities until symptoms improve. If wheezing persists or becomes severe, or if more than three doses of Albuterol are needed for an episode, refer to MD. If episode is severe, persistent, or not responsive to prescribed medications call MD, transport to the ED, or call 911 as appropriate to the situation. In cases of severe wheezing where inhaler not available, give epinephrine auto injector, and call ambulance.
Bites from animals or humans: Wounds should be cleaned with soap and water. If animal can be safely caught, it should be determined if at risk for rabies. All bite wounds should be evaluated by physician. Call MD, transport to the ED, or call 911 as appropriate to the situation
Blisters: Wash with soap and water. Do not break blisters. Apply dry dressing. If blister is broken apply triple antibiotic. If signs of infection are present refer to MD
Bruise and Contusions: Ice pack off and on for first 48 hours for no longer 20 minutes at a time. May apply warm compress if tender after 48 hours. Limit activities involving the injured part. All significant traumatic injuries should be evaluated by a physician to rule out fracture.
Burns: Thermal burns, apply cold water until pain subsides for 1st and 2nd degree burns. Than cover with dry dressing. All 3rd degree and extensive 2nd degree burns should be referred to a physician for evaluation, call MD, transport to the ED, or call 911 as appropriate to the situation
Colds: Check temperature, and if febrile (temperature greater then 100° F) isolate form the general population and refer to MD. May give acetaminophen, ibuprofen, or phenylephrine HCL as directed (with parental permission), for symptom relief. Encourage fluids and rest.
Constipation: If patent reports no bowel movement in three days, assess bowel sounds and palpate for abdominal trendiness. If bowel sounds are absent or abdominal tenderness is present notify MD. If bowel sounds are present and no tenderness is noted the nurse may administer Polyethylene Glycol (MiraLAX) or Psyllium fiber (Metamucil) as directed (with parental permission).
Convulsions: Place patent on side to prevent aspiration and restrain only enough to prevent injury. Follow action plan if applicable. If no action plan available, call 911.
Cough: Check temperature, and if febrile (temperature greater then 100° F) isolate form the general population and refer to MD. May give Guaifenesin as directed (with parental permission),for congestion. If cough is bothersome at night, may give Dextromethorphan (Delsym), as directed (with parental permission). Patent may be provided with cough drops to self administer as needed, if the nurse deems them able to do so safely.
Diarrhea: Check temperature, and if febrile (temperature greater then 100° F) isolate form the general population and refer to MD. If having bloody diarrhea, or vomiting ref to MD. if not febrile have student rest until feeling better. Encourage clear liquids. Avoid fruit, and fruit juices.
Ear Ache: Check temperature and external ear canal. If very painful or discharge refer to MD. May give acetaminophen, or ibuprofen as directed.
Eye Drainage: Copious, crusty drainage of one or both eyes, may be accompanied by redness or irritation of the conjunctiva. Isolate form general population until evaluated by MD. Remove, or do not insert contact lenses. Do not administer any OTC eye drops.
Fever: For temperature greater then 100° F, isolate form the general population and refer to MD. May give acetaminophen or ibuprofen as directed (with parental permission). Encourage rest and fluids. Check temperature every four hours, and as needed. Must remain afebrile for 24 hours before returning to activities.
Foreign Bodies and Splinters:
- Splinter: may remove if able to do so easily with tweezers. Wash area with soap and water. Cover with triple antibiotic ointment and dry dressing. Change dressing and follow up using nursing judgement. Refer to MD if signs and symptoms of infection develop.
- Ear: do not attempt to remove it object does not come out easily by tilting head to side, call MD, transport to the ED, or call 911 as appropriate to the situation.
- Eye: do not rub. Flush gently. Close eye and cover with a patch. transport to the ED, or call 911 as appropriate to the situation.
- Throat: if obstructing, use abdominal thrust and call 911. If not obstructed do not attempt to remove call 911.
Fracture, Dislocations, Sprains, and Strains: Do not move if fracture of the leg, back, or neck is suspected call 911. All suspected fractures should be evaluated in the ED. Sprains and stains should be iced and ace wrapped as appropriate. May give acetaminophen or ibuprofen as directed (with parental permission). Refer to MD for evaluation if pain is severe or is not improved in 24 hours.
Headache: Check temperature and evaluate mental status. If headache is mind, diffuse, and without fever, give acetaminophen or ibuprofen as directed (with parental permission). Rest with ice pack and encourage clear liquids. If headache associated with trauma, or fever, stiff neck, altered mental status, vomiting, or focal abnormality are present call MD, transport to the ED, or call 911 as appropriate to the situation.
Head Injury: A camper involved in contact sports, who sustains a blow to the head, regardless of protective equipment, be removed from activities for 15 minutes, and evaluated, by a designated trained individual, for any of the following symptoms.
Nausea or vomiting
Double vision or other visual disturbances
Dizziness or balance problems
Drowsiness or odd behavior
If none of the above are present, the camper may return to activities. If any of the above are found the camper will immediately be escorted to the health center, for observation by the health staff. The camper will not be permitted to resume normal activities until cleared to do so by the camp doctor. A student hit in the face will likely suffer some swelling and brushing. Use an ice pack to minimize swelling. Any head laceration, eye injury, a possible broken nose, or chipped tooth should be evaluated. Call MD, transport to the ED, or call 911 as appropriate to the situation.
Heat Exhaustion: If presenting with weakness, cramps, headache, dizziness, but still with moist skin should rest in a cool room with forced thin liquids, and ice packs until comfortable. If dry skin, fever, altered mental status, vomiting, or fainting occurs sponge with water and call 911.
Hives: Cold compress and hydrocortisone cream may be applied. May administer Diphenhydramine, or Cetirizine as directed (with parental permission).
Impetigo, Boils, and Pimples:
- Impetigo: cleanse with soap and water and cover with dry dressing. Refer to MD for evaluations and treatment instruction. Avoid sharing of towels, or close personal contact.
- Boils and pimples: cleanse with soap and water and apply warm compress. If skin around lesion is red and swollen, refer to MD. no squeezing of boils and pimples or poking with a needle. Swelling more than 1cm should be seen by MD. No swimming with open or draining lesions. Avoid sharing of towels, or close personal contact.
Neck Injury: Any trauma involving the neck should be evaluated by the MD. If trauma is acute or severe do not move the victim, call 911.
Nose Bleed: If from injury, check for deformity and refer to MD or ED as appropriate. Apply pressure to the lower part of the nose for three to five minutes. Keep patient sitting up while bleeding is active. Refer to MD if bleeding does not stop in a reasonable amount of time.
Poisoning: Refer to material safety data sheet, or consult poison control for specific treatment instructions. Call MD, transport to the ED, or call 911 as appropriate to the situation.
Rash: If associated with fever, refer to MD. If no fever, but itching, if permitted administer hydrocortisone ointment. May also administer Diphenhydramine, or Cetirizine as directed (with parental permission). If suspected fungal rash administer Tolnaftate cream (with parental permission). Refer to MD if rash is persistent or unusual.
Sore Throat: Check temperature, and if febrile (temperature greater then 100° F) isolate form the general population and refer to MD. If patent is unable to swallow or drooling do no further examination, transport to the ED, or call 911 as appropriate to the situation. Examine throat for presence of viral patches, if present refer to MD. May provide cough drops (with parental permission), salt water gargle, or Phenol spray (Chloraseptic spray) as directed (with parental permission)
Ticks: Remove tick with tweezer, taking care not to squeeze the body of the tick. Refer to MD If rash or illness develop. Advise parents to follow up with physician if any illness develops.
Toothache/Tooth Injury: Refer any injury or painful tooth to a dentist via parent. Severe injury should be evaluated by the ED. May give acetaminophen or ibuprofen as directed (with parental permission).
Vomiting: Check temperature and abdomen for softness and focal pain. If febrile, or if abdominal or focal discomfort is present, transport to the ED, or call 911 as appropriate to the situation. Encourage sips of clear liquid as tolerated. Isolate from general population until vomiting has stopped. Monitor for symptoms of dehydration and notify MD if needed.
This document authorizes RN's and LPN's tasked, or employed for the purpose of providing health services to ___________________ to follow my written care directives. The nurses must implement these orders as written and stay within the confines of the direction outlined. If unable to follow these orders, or unsure of any situation, the nurse may contact me via phone at _____-_____-________. If I am unable to be contacted the nurse on duty should arrange transport to the ED, notify parents, or call 911 as appropriate to the situation.
Signature _______________________________________ Title____________
Printed Name ____________________________________ Date____/_____/________