[doctor] next patient is randy gutierrez . date of birth , 8/10/2020 . please use review of symptoms . all text to write . physical exam , auto text uri .
[doctor] hello , how are you doing today ?
[patient_guest] we're okay , thank you .
[doctor] that's good to hear . so , how many days has randy been feeling sick ?
[patient_guest] well , i would say it started around supper time last night .
[doctor] last night , okay , and what's been going on ?
[patient_guest] well , he started to get a runny nose .
[doctor] okay , and is he stuffy too ?
[patient_guest] yeah . yeah .
[doctor] okay , and have you noticed , is his mucous clear right now ?
[patient_guest] it is , it is right now , yes .
[doctor] okay . and , does he also have a cough ?
[patient_guest] yes , but it's not barky .
[doctor] and does he act like he has a sore throat or is he pulling on his ears ?
[patient_guest] well , i know he's been pulling on his ears , yeah .
[doctor] okay .
[patient_guest] you know , he also , he's also been going crazy rubbing at his nose too .
[doctor] okay . and , any fever you've noticed ?
[patient_guest] i checked his rectal temperature and it was 100.3 .
[doctor] okay . so , a little bit of a low-grade fever there , definitely . and , how was his appetite ? did he eat last night ?
[patient_guest] yes , he did . yeah .
[doctor] and how about this morning ? did he eat his breakfast ?
[patient_guest] uh , this morning he ate about seven ounces from the bottle .
[doctor] okay .
[patient_guest] and then he got another bottle , and he barely ate that . um , i offered him cereal and he would n't eat that either .
[doctor] okay .
[patient_guest] so , he varies i guess .
[doctor] how is his energy ? does he seem like he wants to take more naps , or does he have pretty good energy ?
[patient_guest] mmm , it seems like he's irritable .
[doctor] irritable because he is n't feeling good ?
[patient_guest] yeah . he is energetic , but it seems like he ca n't go to sleep , like , he's fighting it really hard .
[doctor] okay , and just for the chart , is there anyone , anybody else exposed to him who has been sick ?
[patient_guest] yes , his older sister's been sick .
[doctor] thank you .
[patient_guest] we also had a play date with my nephew , who i learned later had a sinus infection .
[doctor] and what medication have you tried for him ? anything at all ?
[patient_guest] um , i've been doing the saline mist in his nose .
[doctor] good , good . that's a good choice .
[patient_guest] i did give him tylenol really early this morning because he was warm when i took the sleeper off of him , and we had the ac on in the house , but his whole body was sweating .
[doctor] i see . and , any other medications ?
[patient_guest] we did put some baby vick's on his feet last night to try and help him breathe . and , i also used the humidifier .
[doctor] okay . that's good .
[patient_guest] okay . okay .
[doctor] so , there was another thing i wanted to bring up since we're here . it appears that his cradle cap has gotten a little worse . what are you using on it ?
[patient_guest] i've been using the cradle cap brush , and then i use regular aveno shampoo .
[doctor] is it a dandruff shampoo ?
[patient_guest] no , i do n't think so .
[doctor] okay , thank you . well , let's complete his exam and then we'll talk about the next steps .
[patient_guest] okay , sounds good .
[doctor] can you take a big breath randy .
[patient_guest] where's mama ?
[doctor] do n't forget to breathe little one . okay . let's try the front too .
[patient_guest] yeah , it's okay buddy .
[doctor] excellent . he's doing excellent . next let's- let's check out those ears .
[patient_guest] okay .
[doctor] let's try to make sure you do n't tip all the way over .
[patient_guest] dino , you're doing so good .
[doctor] all right . ears look okay . we're going to slide you forward so you do n't bump your head when i lay you down .
[patient_guest] hey , you're- hey you're okay . you're okay .
[doctor] okay , you can go ahead and sit him back up if you like .
[patient_guest] all right . thank you .
[doctor] all right . so , he's just kind of getting started with this , and i think we're seeing something viral right now . often sinus infections will start out as a virus and then will become bacterial infections if left alone and does n't go away . but , i do n't think he needs any antibiotics , at least not at this point in time . um , keep up with the fluids , rest , and i would watch him very carefully for a barking cough . if he does get a barky cough , then that tends to be a little bit more significant and a little more severe . so , if he develops a barky cough , i want you to give him a half a teaspoon of his sister's medicine .
[doctor] you know , i'm almost tempted to give you some of the medicine because they're probably sharing the same virus .
[patient_guest] okay .
[doctor] actually , i will . i'll go ahead and just give you some as well .
[patient_guest] okay . okay .
[doctor] but , if he does n't become barky , you do n't have to use it . it only works for the barky cough .
[patient_guest] mm-hmm , got it .
[doctor] okay . we'll do the same thing with him , as long as nothing gets worse , and we'll see him back in one week . so , it wo n't get rid of a regular cough . he can use zarbee's , but use the dose for kids under a year of age . so , if you wan na get some of that , you can definitely try that for him , it can help out a little bit with the regular cough .
[patient_guest] i do have a question . do you or do you not give honey to babies ?
[doctor] yes , that's a great question . you do n't give honey to kids under a year , instead , you can give them agave , which is a different type of nectar . um , now you can give honey to his older sister , that is okay , but for him , it would not be very good because his stomach acid's not good enough to break down the botulism spores . so , it'd cause him harm . um , you should look at the package of say , honey nut cheerios . it says right on there to not give it to a baby .
[patient_guest] okay .
[doctor] now , whether that would really hurt a baby , i am unsure , but it has real honey in it . so , no honey for him , but agave is definitely fine .
[patient_guest] okay . so , zarbee's for the stuffy nose .
[doctor] yes , zarbee's .
[patient_guest] and then you said , uh , which medicine to give him just in case ?
[doctor] i'm gon na give him the same medicine as his sister , and just hang onto it , um , just to watch and see . if this was a monday and we had a whole week to watch , i would say to just call us if things got worse , um , but since , um , if it's gon na be the weekend , and things might worsen tonight or tomorrow night , i'd rather you have just what you need on hand .
[patient_guest] okay .
[doctor] right , does that make sense ?
[patient_guest] yeah , yeah . that makes sense .
[doctor] okay , great . and that way you do n't have to share , um , with his sister .
[patient_guest] right , okay .
[doctor] and since he's about half her size , we'll do half the dose , which is a half a teaspoon .
[patient_guest] okay . will this information all be in the papers ?
[doctor] yes . and so , if he ends up starting the medicine , just give him a half a teaspoon for five days .
[patient_guest] okay .
[doctor] yeah , that's the only thing it wo n't say is , " as needed , " or anything like that .
[patient_guest] mm-hmm , understood , thank you .
[doctor] you're welcome .
[patient_guest] and the cradle cap ?
[doctor] what i would do is use something like either head & shoulder's , or selsun blue , or nizoral ad . now , do n't get the extra strength stuff , just use the regular strength . um , cradle cap , it's just basically a fancy way of saying dandruff . so , those shampoos will help get rid of it . it's not an immediate thing 'cause they , um , they are all dead scales , and you still have to brush them off . so , continue to use the soft brush and some baby oil , or something that will help get the scales out , and those shampoos will actually help to prevent it as well . use it two times per week , not every day , but maybe twice a week .
[doctor] so , two days between shampooing , use what you normally use any other time . and then , often , within six weeks or so , you'll notice that the-the cradle cap is just , um , not coming back anymore . but , he has to be careful because it's not ph balanced for eyes . so , just make sure when you're rinsing his hair you avoid his eyes .
[patient_guest] okay . okay .
[doctor] all right . and , if it keeps getting worse , definitely let us know .
[patient_guest] okay . sounds good .
[doctor] good . and , since they do n't have covid-19 , you can go right ahead and check out .
[patient_guest] okay . and both appointments in the week ?
[doctor] correct . we'll see you all then . bye randy , feel better .
[patient_guest] all right , great . thank you so much .
[doctor] you are welcome , and have a good rest of your day .

Medical orders:
description: see him back in one week
order_type: followup
description: zarbee's half a teaspoon for five days
order_type: medication
reason: regular cough stuffy nose