3-29
Patient Education
General: Discuss the level of injury with the patient but do not give prognosis in diseases that should be
managed at a higher level of care.
Activity: Tailor activity level to severity of injury.
Diet: Keep patient NPO for obvious and occult globe ruptures and lid lacerations that will be evacuated.
Prevention and Hygiene: All eye patients should maintain a high level of hygiene while recovering from
their injury.
Wound Care: Keep eye patched, clean and dry. Change dressings daily.
Follow-up Actions
Return evaluation: Follow patients closely on daily basis for signs of improvement or worsening.
Evacuation/Consultation Criteria: Evacuate patients as indicated in Treatment above and any patient who
does not show improvement within 24-48 hours. Consult with an ophthalmologist if available prior to using
steroids in the eye.
Symptom: Fatigue
CPT Brooks Morelock, MC, USAIntroduction: Fatigue is a nonspecific complaint for which no precise diagnosis may be found. The patient
must be detailed in describing their fatigue. Broadly assess body systems when taking a history because
fatigue may be due to an underlying endocrine disorder, systemic illness, sleep disorder, drug side effect
(recreational or prescribed), or psychiatric disorder. If the patient’s history does not yield a specific etiology,
a careful psychiatric history for depression should be performed. Expect to find more psychiatric illness
(usually depression) than organic disease if the patient has a primary complaint of fatigue rather than fatigue
as part of a clustering of symptoms.
Subjective: Symptoms
Focused History: Sleeping: Have you had trouble with sleeping or had a change in your sleep pattern?
(Fatigue may be a presenting symptom for undiagnosed COPD.) Early awakening/difficulty getting to sleep?
(associated with depression—see below.) Snoring? (may indicate Obstructive Sleep Apnea [OSA] if coupled
with Chronic Fatigue. See Respiratory: Apnea) Told they stop and start breathing when they sleep? (hallmark
sign of OSA) Wake up with headache on most days? (secondary symptom of OSA due to nocturnal
hypoxemia) Shift work? (disordered circadian rhythm) Sleep during the day? (Daylight lowers secretion of
melatonin, a hormone that regulates the sleep cycle.) Medication: Do you take any medication? (Starting or
stopping many medications can cause fatigue. Starting an antihypertensive or stopping thyroid replacement
are the most common.) Drugs/Alcohol: Do you drink alcohol, use tobacco or use any other type of
recreational drugs? (Alcohol, drugs can alter normal sleep patterns.) Weight: Have you lost weight? (may
indicate occult malignancy or systemic illness) Duration: How long have you had fatigue? (6 months to be
Chronic Fatigue) Night sweats: Do you have night sweats? (can be symptom of tuberculosis, lymphoma,
malaria, others) Exposure: Have you had any known exposure to HIV, hepatitis, or mononucleosis? (all can
have fatigue as presenting complaint) Have you been flying or diving recently? (possible decompression
sickness–see Dive Medicine) Muscle/Joint Pain: Do you have muscle or joint pain? (seen in connective
tissue disorders such as rheumatoid arthritis and lupus) Depression: Does the patient have any symptoms
related to depression? Difficulty with getting to sleep or early awakening? Lost interest in activities that
he/she used to enjoy? Does patient feel guilty about things that they could not control? Decreased energy?
Does the patient have difficulty with concentration? Absent appetite? Does the patient feel like their thoughts
are slower than usual, or seem to be fleeting? Has the patient had a decrease in libido? Has the patient
contemplated suicide? (All of these questions try to elicit symptoms of depression, although none are
comprehensive. The more symptoms the patient has, the more likely he has depression. Any time the
diagnosis of depression is entertained, screen the patient for suicidal or homicidal ideation.)
Objective: Signs (See Fatigue: Table 3-3)