MANAGEMENT PROTOCO L FOR PROBLEM ON INSOMN IJ. \: ADULT PATIENT (Logic Tree No. 16) p LAN A: 3· 6. Determine knowledge of lhe patient anc J/or his companion on the management oftlic problem presented. Based on J. o, advise lhc paticnt to do the following is caused by severe itchjness of the anal area al night (patient is most likely suffering from parasitism): 2. 1 Give/prescribe over-the-counter mc<licinc or herbal medicine 2. for parasilfam specifying accurately the method of preparation (specifically for herbal medicine), the dose,md frequency of intake. 2 Advise p. 1tient to observe cnvin. inmcnlal and 1>crsonal cleanlinesi; to avid r·ccurrencc <Jf purasitism. Based on 1. 0, advise patient to do the following if the insomnia is due to faulty habits (like laking a nap unli J late in t J1e afternoon, going to bed immediately i1f1. cr a heavy rnc,d, going to bed hungry, drinking tea or coffee after diner or indnlging in ment:11 activity after dinner). 3. 1 Change the faulty habit: 3. 1. 1 When te1king an afternoon nap, do not sleep until late in the · afternoon (beyond three o'clock in the afternoon) 3. 1. 2 Avoid drinking coffee, tea (except Chamomile tea or other non-caffe ine containing tea) or cola drinks late in the day cspccial. ly after runner. 3. 1. :1 Do the assignment or any mental activity early preferably before dinner. 3. 1-4 Try to relax both the mind and body after dinner. 3. 1. 5 Avoid watching stressful programs in the evening. 3. 2 Drink a glass of warm milk with or without honey or a glass of chocolate berore going to heel. 3. 3 Take a warm bath bcfoi:e going to bed. Based on 1. 0, if Ulc insomnia is due to some problem or pressure in school, in the office or at home, try to help the patient solve his problem. Refer him the proper authorities if possible. Based on 1. 0, do the following if the insomnia is due to sudden change in the patient's daily routine, like taking ca:re of a newborn, or if the patient just. suffered some adverse life situation, like death of a loved one or loss of a job. 5. 1 Advise patient to take some nap in the afternoon if possible. 5. 2 Give/prescribe over-the-counter multivitamins specifying accurately the <lose and frequency of intake. 5. 3 Give/prescribe medicine for allergy like one containing diphehydramii1-e for a few days. 5. 3. 1 Advice patient to take it after dinner. 5. 3. 2 Advice patient not to drive or operate a machine after intake of medicine. Advise patient to come back for follow-up if there is no improvement after one week or if any of the YELLOW signs and symptoms develop. 409 