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Sixth Edition
FAMILY
Editor
JILL C. CASH
PRACTICE
GUIDELINES
FAMILY PRACTICE GUIDELINES
Jill C. Cash, MSN, APRN, FNP-BC, a family nurse practitioner (FNP) for over 27 years, currently
practices at Vanderbilt University Medical Center for the Vanderbilt Medical Group at Westhaven
Family Practice in Franklin, Tennessee. She is a faculty member of the School of Nursing at
Vanderbilt University. She has been a clinical preceptor for nurse practitioner students for a variety
of programs over the past several years. She also serves as a clinical preceptor for the Vanderbilt
Program in Interprofessional Learning, which includes students from other disciplines, including the Vanderbilt Medical School, Nurse Practitioner, Pharmacy, and Social Work programs. Her
previous experience includes high-risk obstetrics as a clinical nurse specialist in maternal–fetal
medicine, as well as practicing as an NP in women’s health, family practice, and rheumatology. In
2017, Ms. Cash was awarded the 2017 American Association of Nurse Practitioners State Award
for Excellence in Illinois. Ms. Cash has authored several chapters in a variety of nursing and NP
textbooks. She is the coauthor of Family Practice Guidelines (rst, second, third, fourth, and fth editions), Adult-Gerontology Practice Guidelines (rst, second, and third editions), and the rst edition
of Canadian Family Practice Guidelines. Ms. Cash is an active member of the American Association
of Nurse Practitioners and Sigma Theta Tau International Honor Society.
FAMILY PRACTICE GUIDELINES
SIXTH EDITION
Jill C. Cash, MSN, APRN, FNP-BC
EDITOR
Copyright © 2024 Springer Publishing Company, LLC
https://t.me/med1917
All rights reserved.
First Springer Publishing edition 978-0-8261-1812-7 (2011); subsequent editions 2014, 2017, 2021
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer
Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance
Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, info@copyright.com or on the
Web at www.copyright.com.
Springer Publishing Company, LLC
11 West 42nd Street, New York, NY 10036
www.springerpub.com
connect.springerpub.com/
Executive Acquisitions Editor: Joseph Morita
Director, Content Development: Taylor Ball
Production Manager: Kris Parrish
Compositor: diacriTech
ISBN: 978-0-8261-7354-6
ebook ISBN: 978-0-8261-6605-0
DOI: 10.1891/9780826166050
23 24 25 26 / 5 4 3 2 1
Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge,
in particular our understanding of proper treatment and drug therapy. The authors, editors, and publishers have
made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time
of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for any errors or
omissions or for any consequence of application of the information in this book and make no warranty, expressed or
implied, with respect to the content of this publication. Every reader should examine carefully the package inserts
accompanying each drug and should carefully check whether the dosage schedules therein or the contraindications
stated by the manufacturer differ from the statements made in this book. Such examination is particularly important
with drugs that are either rarely used or have been newly released on the market.
LCCN: 2022049728
Publisher’s Note: New and used products purchased from third-party sellers are not guaranteed for quality,
authenticity, or access to any included digital components.
Printed in the United States of America.
This book is dedicated to my children, Kaitlin and Carsen, for their support and love.
https://t.me/med1917
“Be fearless in the pursuit of what sets your soul on re.”
—Unknown
https://t.me/med1917
List of Client Teaching Guides xiii
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Contributors xv
Preface xvii
Acknowledgments xix
Instructor Resource xxi
CONTENTS
SECTION I: GUIDELINES
1. HEALTH MAINTENANCE GUIDELINES 3
Jill C. Cash and LaDawna Goering
Cultural Diversity and Sensitivity 3
Health Maintenance During the Life Span 4
Other Collaborating Providers 7
Adult Risk Assessment Form 7
Adult Preventive Healthcare 7
Client Teaching Guides
Adolescent Nutrition 11
Childhood Nutrition 12
Exercise 13
Infant Nutrition 14
2. PUBLIC HEALTH GUIDELINES 17
Doncy J. Eapenand Jill C. Cash
Homelessness 17
Obesity 21
Postbariatric Surgery Long-Term Follow-Up 27
Substance Use Disorders 33
Violence: Children 46
Violence: Intimate Partner 49
Violence: Older Adults 55
3. PAIN MANAGEMENT GUIDELINES 59
Kathleen Siders
Acute Pain 59
Chronic Pain 61
Lower Back Pain 65
Client Teaching Guides
Back Stretches 69
Chronic Pain 70
4. DERMATOLOGY GUIDELINES 71
Jill C. Cash and Amy C. Bruggemann
Acne Rosacea 71
Acne Vulgaris 72
Animal Bites, Mammalian 74
Benign Skin Lesions 77
Candidiasis 78
Contact Dermatitis 79
Eczema or Atopic Dermatitis 81
Erythema Multiforme 83
Folliculitis 84
Hand, Foot, and Mouth Syndrome 86
Herpes Simplex Virus Type 1 87
Herpes Zoster or Shingles 88
Impetigo 90
Insect Bites and Stings 91
Lice (Pediculosis) 93
Lichen Planus 94
Pityriasis Rosea 95
Precancerous or Cancerous Skin Lesions 96
Psoriasis 98
Scabies 100
Seborrheic Dermatitis 102
Tinea 103
Tinea Versicolor 105
Warts 106
Wound Care: Lower Extremity Ulcer 107
Wound Care: Pressure Injuries/Ulcers 109
Wound Care: Wounds of The Skin 111
Wound Healing: High-Protein Nutrition 113
Xerosis (Winter Itch) 114
Client Teaching Guides
Acne Rosacea 117
Acne Vulgaris 118
Dermatitis 119
Eczema 120
Erythema Multiforme 121
Folliculitis 122
Herpes Zoster or Shingles 123
Insect Bites and Stings 124
Lice (Pediculosis) 126
Lichen Planus 127
Pityriasis Rosea 128
Psoriasis 129
Ringworm (Tinea) 130
Scabies 131
Seborrheic Dermatitis 132
Skin Care Assessment 133
Tinea Versicolor 135
Warts 136
Wound Care: Lower Extremity Ulcers 137
Wound Care: Pressure Injuries/Ulcers 138
Wound Care: Wounds 139
Xerosis (Winter Itch) 140
viii
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CONTENTS
5. EYE GUIDELINES 141
Jill C. Cash and Nancy Pesta Walsh
Amblyopia 141
Blepharitis 142
Cataracts 143
Chalazion 144
Conjunctivitis 145
Corneal Abrasion 147
Dacryocystitis 149
Dry Eyes 150
Excessive Tears 152
Eye Pain 153
Glaucoma 154
Hordeolum (Stye) 156
Strabismus 157
Subconjunctival Hemorrhage 158
Uveitis 159
Client Teaching Guides
Conjunctivitis 163
Eye Medication Administration 164
6. EAR GUIDELINES 165
Jill C. Cash and Emily Y. Brignola
Cerumen Impaction (Earwax) 165
Hearing Loss 166
Otitis Externa 168
Otitis Media 169
Tinnitus 172
Client Teaching Guides
Acute Otitis Externa (Swimmer’s Ear) 175
Acute Otitis Media 176
Otitis Media with Effusion 177
Cerumen Impaction (Earwax) 178
Tinnitus 179
7. NASAL GUIDELINES 181
Jill C. Cash and Sarah Hendershott Taylor
Allergic Rhinitis 181
Epistaxis 183
Nonallergic Rhinitis 185
Sinusitis 187
Client Teaching Guides
Allergic Rhinitis 191
Nosebleeds 192
Sinusitis 193
8. THROAT AND MOUTH GUIDELINES 195
Jill C. Cash
Avulsed Tooth 195
Dental Abscess 196
Epiglottitis 197
Oral Cancer 198
Pharyngitis 200
Stomatitis, Minor Recurrent Aphthous
Stomatitis 203
Thrush 204
Client Teaching Guides
Aphthous Stomatitis 207
Oral Thrush in Children 208
Pharyngitis 209
9. RESPIRATORY GUIDELINES 211
Audra Malone Cave
Asthma 211
Bronchiolitis: Child 217
Bronchitis, Acute 218
Bronchitis, Chronic 220
Chronic Obstructive Pulmonary Disease 222
Common Cold/Upper Respiratory Infection 226
Cough 228
Croup, Viral 230
Emphysema 232
Obstructive Sleep Apnea 235
Pneumonia (Community-Acquired Pneumonia) 237
Pneumonia (Viral) 240
Respiratory Syncytial Virus Bronchiolitis 241
Shortness of Breath 243
Tuberculosis 245
Client Teaching Guides
Asthma 249
Asthma: Action Plan and Peak Flow
Monitoring 250
Asthma: How to Use a Metered-Dose
Inhaler 252
Bacterial Pneumonia: Adult 253
Bacterial Pneumonia: Child 254
Bronchiolitis: Child 255
Bronchitis, Acute 256
Bronchitis, Chronic 257
Chronic Obstructive Pulmonary Disease 258
Common Cold 259
Cough 260
Croup, Viral 261
Emphysema 262
Pneumonia, Viral: Adult 263
Pneumonia, Viral: Child 264
Respiratory Syncytial Virus 265
Shortness of Breath 266
Sleep Apnea 267
10. CARDIOVASCULAR GUIDELINES 269
Jill C. Cash, Debbie A. Gunter, and Laura Petty
Acute Myocardial Infarction 269
Arrhythmias 271
Atherosclerosis and Hyperlipidemia 273
Atrial Fibrillation 278
Chest Pain 281
Chronic Venous Insufciency and Varicose
Veins 286
Deep Vein Thrombosis 288
Heart Failure 291
Hypertension 298
Lymphedema 303
Murmurs 304
Palpitations 307
Peripheral Arterial Disease 309
Supercial Thrombophlebitis 312
Syncope 314
Client Teaching Guides
Atrial Fibrillation 317
Atherosclerosis and Hyperlipidemia 318
Chronic Venous Insufciency 319
Deep Vein Thrombosis 320
CONTENTS
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ix
Lymphedema 322
Peripheral Arterial Disease 323
Supercial Thrombophlebitis 324
Varicose Veins 325
11. GASTROINTESTINAL GUIDELINES 327
Audra Malone Caveand Doncy J. Eapen
Abdominal Pain 327
Appendicitis 331
Celiac Disease 334
Cholecystitis 337
Colic 339
Colorectal Cancer Screening 341
Constipation 344
Crohn’s Disease 348
Cyclosporiasis 356
Diarrhea 357
Diverticulosis and Diverticulitis 359
Elevated Liver Enzymes 361
Gastroenteritis, Bacterial and Viral 365
Gastroesophageal Reux
Disease 368
Giardiasis Intestinalis 371
Hemorrhoids 373
Hepatitis A 376
Hepatitis B 380
Hepatitis C 384
Hernias, Abdominal 388
Hernias, Pelvic 390
Hirschsprung Disease or Congenital Aganglionic
Megacolon 393
Hookworm 395
Irritable Bowel Syndrome 397
Jaundice 401
Malabsorption 404
Nausea and Vomiting 407
Peptic Ulcer Disease 410
Pinworm 414
Roundworm 415
Ulcerative Colitis 417
Client Teaching Guides
Abdominal Pain: Adults 423
Abdominal Pain: Children 424
Celiac Disease 425
Cholecystitis 426
Colic: Ways to Soothe a Fussy Baby 427
Constipation Relief 429
Crohn’s Disease 430
Diarrhea 432
Gastroesophageal Reux Disease (Gerd) 434
Hemorrhoids 435
Irritable Bowel Syndrome 436
Jaundice and Hepatitis 437
Lactose Intolerance and Malabsorption 439
Roundworms and Pinworms 440
Ulcer Management 441
12. GENITOURINARY GUIDELINES 443
Kristina Pottsand Nancy Pesta Walsh
Benign Prostatic Hypertrophy 443
Chronic Kidney Disease in Adults 447
Epididymitis 451
Hematuria 453
Hydrocele 456
Interstitial Cystitis 457
Prostatitis 459
Proteinuria 464
Pyelonephritis 467
Renal Calculi or Kidney Stones
(Nephrolithiasis) 470
Sexual Dysfunction Male: Erectile Dysfunction 473
Sexual Dysfunction Male: Premature
Ejaculation 478
Testicular Torsion 479
Undescended Testes or Cryptorchidism 481
Urinary Incontinence 482
Urinary Tract Infection (Acute Cystitis) 488
Varicocele 492
Client Teaching Guides
Epididymitis 495
Kidney Disease: Chronic 496
Prostatic Hypertrophy/Benign 501
Prostatitis 502
Testicular Self-Examination 503
Urinary Incontinence: Females 504
Urinary Tract Infection (Acute Cystitis) 505
13. OBSTETRICS GUIDELINES 507
Penny Wortman and Jill C. Cash
Prepregnancy Counseling: Identifying Clients at
Risk 507
Prenatal Care: Initial Prenatal Visit 509
Prenatal Care: First Trimester Overview 510
Prenatal Care: Second Trimester Overview 511
Prenatal Care: Third Trimester Overview 512
Postpartum Overview 513
Anemia, Iron-Deciency 515
Gestational Diabetes Mellitus 517
Hypertensive Disorders 520
Preterm Labor 523
Pyelonephritis in Pregnancy 526
Vaginal Bleeding: First Trimester 528
Vaginal Bleeding: Second and Third
Trimesters 530
Postpartum Breast Engorgement 533
Endometritis 534
Mastitis 535
Postpartum Depression 536
Secondary Postpartum Hemorrhage 540
Wound Infection 542
Postpartum Exam 543
Client Teaching Guides
Endometritis 545
Gestational Diabetes 546
Insulin Therapy During Pregnancy 547
Iron-Deciency Anemia (Pregnancy) 549
Mastitis 550
Postpartum: Breast Engorgement and Sore
Nipples 551
Preterm Labor 553
Pyelonephritis: Urinary Tract Infection During
Pregnancy 555
Vaginal Bleeding: First Trimester 556
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