Polycythemia Vera

Polycythemia vera is a rare disease in which the body makes too many red blood cells. The excess cells make the blood too thick, this thickness causes blood to flow very slowly. It is a slow-growing cancer of the blood.

A person may have this disease and not know, it may be discovered during a blood test for another reason. A rare disease that can occur at any age, but it is common in people over 60 years. Polycythemia vera can be life-threatening if it is not treated quickly. Survival time may be 10 to 15 years with new treatment.

There are two types:

  • Primary which is a chronic myeloproliferative disorder from chromosomal mutation.
  • Secondary polycythemia can be hypoxia driven. Hypoxia stimulates the kidneys to produce more erythropoietin which then stimulates the production of erythrocytes. The need for more oxygen in the secondary type could be due to multiple reasons: cardiovascular disease, pulmonary disease, or tissue hypoxia.

Sign and Symptoms:

  • Hypertension and Hyperviscosity from polycythemia vera are the cause of circulatory manifestations that are seen in this disorder.
  • Polycythemia vera causes headache, vertigo, tinnitus
  • Pruritus which is exacerbated by hot bath may be a confirmatory symptom.
  • Other sign and symptoms include painful fingers and toes, hyperuricemia, weakness, and easy fatigability.

Complications include abnormal blood clots, which can lead to a heart attack or stroke.

Diagnostic tests:

Blood tests – elevated hemoglobin, increased platelets, uric acid, cobalamin levels. Increased histamine levels. Increased RBCs are noted in Bone marrow examination.

Treatment for polycythemia vera includes administering oxygen, radioisotope therapy, or chemotherapy agents for bone marrow suppression. Phlebotomy is the top treatment, to reduce the percentage of hematocrit; during phlebotomy, about 300ml of blood or more may be removed every other day until hematocrit is down to normal level.

Nursing Interventions

  • Maintain adequate oxygenation. This may prevent secondary polycythemia; primary polycythemia is not preventable.
  • Control of pulmonary diseases, teach client to stop smoking.
  • Educate clients to avoid high altitudes
  • Assist with phlebotomy per orders and facility policies during acute exacerbations
  • Monitor client for complications that may result from phlebotomy
  • Monitor hydration therapy closely to avoid fluid overload.
  • Moderate activities, to decrease the risk of clot formation

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

Rophem Nursing 😊

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Raynaud’s disease

Raynaud’s disease (Raynaud’s phenomenon)

  • Vasoconstrictive disease.
  • Rare condition that affects the arteries – the blood vessels become narrow.
  • The amount of blood that flows to the body is affected
  • It mainly affects blood flow to fingers and toes.
  • More common in women, triggered by cold temperatures and stress.

Symptoms

  • Vasospasm leads to pain and pallor in affected extremities
  • There may be ulceration of the fingers occasionally
  • Color changes of the affected areas,

Causes

  • Causes of Primary Raynaud’s disease is unknown
  • Secondary Raynaud’s disease is more serious.
  • Caused by other health issues, medications, or injuries
  • Related health issues include – rheumatoid arthritis, scleroderma, Sjögren’s syndrome, or lupus, blood disorders, polycythemia vera, pulmonary hypertension.

Diagnostic tests – Cold stimulation test to trigger an episode

Treatment

  • Medication – Vasodilators (e.g. Nifedipine)

Nursing Interventions

  • Teach client to stay warm, avoid cold
  • Teach to wear gloves, warm but nonconstructive.
  • Encourage the client that smoking cessation is very important.
  • Inform client to contact doctor if any sores or ulcers appear on fingers or toes.

References

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

Rophem Nursing 😊

Success Mentality

 

Keep going…
Don’t stop and Don’t quit

Gout (Gouty Arthritis)

A form of arthritis characterized by severe burning pain, redness, tenderness and stiffness in joints. Gout is a kind of arthritis caused by uric acid crystals forming in one or more joints.

Symptoms

  • Usually start at night
  • Very common in the big toe joint but can also occur in other joints
  • Affected joint becomes red, feels hot, and painful.
  • Pain increases when the joint is touched.

Causes & Risk Factors

  • Foods that are rich in purines increase the risk for gout – Salmon, sardines, organ meats, asparagus, mushrooms and herring are examples of foods rich in purines.
  • Gout is hereditary.
  • Overweight, Alcohol, High cholesterol, Diabetes, high blood pressure
  • Men develop gout more often than women.

Treatment

  • Rest
  • Pain relievers & anti-inflammatory medications – Motrin, Advil and Naproxen

Patient teaching – Teach patient to

  • Take all medication as prescribed.
  • Inform the MD before taking any aspirin product because aspirin can interfere with other medications
  • Lose weight if patient is overweight.
  • Seek treatment promptly for high blood pressure, high cholesterol or diabetes
  • Follow diet prescribed – low-salt, & low-fat diet.
  • To avoid alcohol and foods that are high in purines.
  • To drink lots of water to help flush uric acid from the body.

Complications

  • When gout is not treated, a gout attack can last for days or even weeks.
  • Prolong attacks for many years may lead to TOPHI – uric acid crystals that form lumps under the skin.
    • Tophi usually form on the toes, fingers, hands and elbows.
  • Gout may also lead to kidney disease or kidney stones from uric acid crystals that collect in the urinary tract.

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

Rophem Nursing 🙂

Study Tips for the NCLEX – 2

Tip #2 – Develop a Great Study Plan

Study plans are an extremely effective way to prepare for any type of exam, the big NCLEX too. However, they can be tricky, so it’s important to be realistic, understand your routine, and organize yourself and your time. A personal study plan will not only help you to keep track of the topic you’ve studied and keep you more organized, it can also hold you accountable for your learning outcomes.

First, conduct a quick self-evaluation of your current schedule and how you manage your time. For example, what time of day you study better, day or at night? Find days when you have fewer personal commitments and you can commit to studying without distractions.

Second, you want to create a study plan that is reasonable. How much time you set aside for your studies is very important, but try not to plan for too many hours at a time with no break. Long hours, for example 4 to 5 hours without breaks can easily make your study plan feel overwhelming. Include break times in your study plan to prevent failure of the plan. Remember to schedule time for other activities within your daily life; too many days scheduled for study without time for other activities can make you feel discouraged and your study plan won’t hold up.

Lastly, stay true to your study plan. What’s the point of a study plan if you don’t follow it? A great study plan is useless if it isn’t followed, so stick to it; your study plan will work very well if you follow it consistently.

Feel like you need help in putting a study plan together? Don’t worry, we’ve made one for you! At Rophem our proven 42-Day Plan has been specially put together for NCLEX success and is available for all students to use and follow. We understand that you have other obligations and aim to create a flexible study plan to ensure that you aren’t overwhelmed as you study.

Good Luck!
Rophem Nursing 🙂

Systemic Lupus Erythematosus (SLE)

What is SLE?

  • SLE is an autoimmune disease that can affect many parts of the body, like the kidneys, skin, the heart, joints, and lungs.
  • Systemic lupus erythematosus (SLE) is the most common and most serious type of lupus.
  • Discoid lupus erythematosus (DLE) also called cutaneous lupus erythematosus. DLE affects the skin. It does not affect other organs.
  • DLE shows up like a red rash or scaly patch, commonly found on the face or scalp, butterfly rash.
  • Leading cause of death in clients with Lupus – Kidney and Cardiac involvement.
  • Another type of lupus is the Drug-induced lupus, this type is caused by reaction to some prescription drugs.

Triggers of Lupus

  • Sunlight – very specific with Lupus
  • Stress
  • Pregnancy
  • Drugs

Assessment Findings – SLE

  • Joint pain and decreased mobility, Photosensitivity, HTN,
  • Fever, Pericarditis, Nephritis, Pleural effusion

Instructions for the client with SLE

  • Instruct client to avoid prolonged exposure to sunlight.
  • Avoid stress and illness
  • Provide instruction about medications – steroids.

Nursing Care

  • Monitor for Pain, mobility, and fatigue,
  • Vital signs
  • UOP, BUN, & serum creatinine.

Medications

  • Corticosteroids
  • NSAIDs (not for clients who have renal compromise)
  • Immunosuppressant agents
  • Antimalarial

Complications – Lupus nephritis, Pericarditis and myocarditis

References:
Medical-Surgical Nursing, 9th Edition by Lewis, Heitkemper, et all.
Understanding Medical Surgical Nursing by Paula D Hopper

Rophem Nursing. 

 

When you have a difficult Patient

Hello Nurses,

Every day is different, there will be days or times when, no matter what you do or how caring you try to be, you will still have people who are not satisfied with your services. There will always be ungrateful people.

So, what do you do as a nurse when this happen to you?

First, know that it is not personal. Do not think it is because of who you are or how you look, etc. It is important to understand that no one chooses to be sick or be in the hospital or in the healthcare facility where you may be working. Many people who happen to be receiving care may be frustrated for other reasons – not because of the you.

Nursing is a calling, and since you have accepted this calling, you have all that it takes to take great care of every client and every situation you may come across.

  • Remain calm. Remember it is not about you. They may be going through pain or anxiety about their health and they may want to discuss their feelings with you. Whatever the case may be, find the good in each day and appreciate it.
  • Listen and have a conversation with the client, this may not work the first time you try it. Try again. This is how you demonstrate the patience of being a nurse. I am sure you can do it!
  • Greet your patients and introduce yourself with a very big smile. Make it a part of your uniform as a great nurse. You may have received in report that the client is the most difficult on the unit; but your approach with this client will make a big difference. With a big smile and a warm greeting as you introduce yourself, you can successfully gain the trust of the client, and just earn yourself a great shift.
  • Do not get in an argument with the client, this will only make the situation worse. Know when to leave for a moment, then try again when they may have calmed down.

Much love to all of you great Nurses out there, you are doing an awesome job!
Happy Nurses’ Week 🙂

Rophem 🙂

Carbidopa-Levodopa (Sinemet)

Sinemet is used to treat Parkinson’s disease.

  • Classifications: Autonomic Nervous System Agent; Anticholinergic; Antiparkinsonism Agent
  • Available in Capsule & Tablet forms

Geriatric

  • Elderly patients may have increase chance of side effects during treatment due to high sensitivity.

Contraindications

  • Narrow-angle glaucoma
  • Pregnancy (category C)

Caution in

  • Kidney disease
  • Diabetes mellitus
  • Chronic lung disease

Side effects

  • Urine, saliva, and sweat become darker in color than usual.
  • May cause a bitter taste, or a burning sensation of the tongue

Interactions – MAOI, Tricyclic antidepressants, Haloperidol

Nursing Implications

  • Observe for therapeutic effects and report adverse reactions promptly.
  • Monitor vital signs & rhythm, particularly during period of dosage adjustment.

Patient teaching

  • Teach to make position changes slowly, particularly from sitting to upright position.

Reference: Roach’s Introductory Clinical Pharmacology. 

Rophem Nursing 🙂

Weekly Dose of Nursing: Reye’s Syndrome

  • Reye’s syndrome is a rare illness, most common in children.
  • It is a serious illness that can be harmful to the brain and the liver.
  • Usually occurs in children who are recovering from a viral infection; which may include cold, flu, or chickenpox.
  • Reye’s syndrome is commonly associated with the use of aspirin in children.
    • To prevent Reye’s syndrome, aspirin (salicylates) should not be given to children.

Symptoms of Reye’s syndrome

  • Symptoms can be very mild and may not be easily noticed.
  • These symptoms can also can be very serious and may get worsen within few hours.
  • Symptoms of Reye’s Syndrome may lead to death.
    • Common symptoms include:
    • Changes in level of consciousness
    • Vomiting, Diarrhea
    • Irritability and aggressive behavior
    • Tachypnea (in children under 2 years old)
    • Confusion, Lethargy, Seizures & Coma

Causes of Reye’s Syndrome

  • The cause of Reye’s syndrome is not known yet.
  • The use of aspirin to treat children with viral illness increases the chances of developing Reye’s syndrome.

Diagnosis of Reye’s Syndrome

  • Diagnosis usually starts with blood and urine tests.
  • Doctors may also test for metabolic disorders that could affect the liver.
  • Sometimes more invasive tests are needed – lumbar puncture, liver biopsy, MRI, or CT.

Prevention of Reye’s syndrome

  • Education – nurses should teach parents to avoid giving children aspirin
  • Aspirin should not be given to any child under the age of 19
  • Prevent viral illnesses in children, teach parents to make sure the child’s vaccinations are up to date.

Treatment for Reye’s Syndrome

  • There is no cure for Reye’s syndrome.
  • Early diagnosis helps towards successful treatment.
  • A client with Reye’s Syndrome will be treated in the hospital, mostly in the intensive care unit (ICU).
  • Treatments include:
  • Corticosteroids
  • IV fluids and Diuretics
  • Medicines to prevent bleeding
  • Client may also need ventilator

Nursing Interventions – Prevent further complications

  • Monitor vital signs – BP, RR, HR, Temp. Administer oxygen. Maintain airway.
  • Monitor Intracranial Pressure and prevent seizures. Position to decrease ICP.
  • Monitor blood glucose levels closely
  • Intake and output, make sure to prevent fluid overload
  • Assess hemodynamic status; monitor cardiac, respiratory and neurologic status.
  • Administer medications per doctor’s orders, monitor for adverse effects, prevent injury and complications.
  • Provide skin and mouth care, provide range of motion exercise to promote joint mobility.
  • Provide supportive care for the client and the family members.

Reference: Wong’s Essentials of Pediatric Nursing 9th edition

Lisinopril: My Experience!

High Blood Pressure usually has no symptoms.
But as I stared at my enlarged lip in the mirror at 3am yesterday, I have to say I was a bit doubtful. Countless people battle this silent disease on a daily basis, and I’m one of them.
As a cardiac nurse, I can easily state the causes, side effects, and complications that come with high blood pressure and hypertension, but I’m not planning on giving a lecture. For once, I want to look at this problem from the eyes of a woman, not a nurse. The experience I had with treating this ailment can only be regarded as tedious.
They say, “Don’t die before death comes”, but when my son drove me to the emergency room in pitch black darkness, and the triage nurse overdramatized my swollen lip, if I had not been a nurse, a heart attack would’ve been only seconds away.
So how did this problem even start?
Let me just begin by saying that I have not had an easy life, and stress engulfed me far too frequently. This was particularly true about four years ago when I was working a twelve-hour shift and I felt a sudden headache and could hear the blood rushing in my head. To say the least, I knew something wasn’t right. Being a nurse, I could assess my symptoms and so decided to check my blood pressure.
For a minute, I couldn’t believe what I was seeing. I couldn’t believe it. My blood pressure was a high 154/88.
Though blood pressure numbers vary from person to person, I knew those numbers were extremely high for me. Before long, I had talked to my doctor friends and got a prescription for Norvasc. And for a while, it did its job. But as we all know, ALL medications have side effects, some even worse than the problem they’re meant to fix.
Norvasc led a whole other can of worms for me and I developed heartburns less than two months after I started taking it. From there on I switched from medication to medication, each giving me worse side effects than I bargained for, hoping to find something, anything that would fix my problem. Finally, I started taking Lisinopril/HCTZ as prescribed by my doctor.
For a while, it did its job, and I thought I could finally relax and not worry about blood pressure. I had hoped it would be the end of my stressing over blood pressure, but of course I was wrong. Several weeks ago, my daughter bought me an EOS Lip balm ball when I ran out of my usual lip gloss. She was using it well and I figured there was nothing wrong with trying it.
Three hours later, one of my students noticed my upper lip had swelled significantly throughout the day. In the end, I chalked it up to allergies and decided not to use the lip balm again. I didn’t even consider that it might have been my blood pressure medication. Or maybe I just didn’t want to think of the possibilities, after all, the simplest answer is probably correct, right?
It wasn’t. Not in this case. Not having had time to get a new lip gloss still, I tried a Lip Treatment cream to hydrate my lips instead of my usual Vaseline. For a day, everything was fine, and I didn’t think much of the lip balm instance in the past. But then the day after, the swelling began. Slowly but surely, my lip blew up like a balloon at a carnival and I began to get scared.
I tried washing off the balm. I tried icing to reduce the swelling, but it was useless, I decided to take 50 mg of Benadryl to calm down some immune reactions. I was too scared to go to bed, finally, at 3am, I called my son and we went to emergency room.
Through the fear, I began to think of the possible causes. Then it hit me. I had oral Angioedema. A life threatening tissue swelling and fluid accumulation in the lips and throat. As I rode with my son to the emergency room and as the ER doctor gave me Epinephrine and Solu-Medrol intravenously, I knew in my heart that I was really blessed to have not had any swelling in my throat. I remembered all the times I took care of people with the same problem, taking the same medication and I knew I had to change my blood pressure medication again because for all I knew, the next time my lips swell, my throat may swell with it.
I write this a warning to any who may have high blood pressure. Be extremely careful with the medication prescribed to you. Do your research! Just because a doctor says something is good doesn’t mean it’s good for YOU. If you’re not sure, get multiple second opinions. I know it’s hard work and it’s tedious, but I think your health is worth at least that much, don’t you?
Share this, please, you might save someone’s life!
Blessings, RASamuels 🙂