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NCLEX Pharm: Lunesta
Generic Name: Eszopiclone
Brand Name: Lunesta
Class: Sedative, Hypnotic, Nonbenzodiazepine
Indication: Sleeping pill, Lunesta is used to treat insomnia.
Side effects: Confusion, clumsiness or unsteadiness (older adults), daytime anxiety and/or restlessness, difficulty with coordination (older adults), mood or mental changes.
Adverse effects: Headache, chest pain, migraine.
Nursing Tips:
- Lunesta may be habit-forming.
- Contraindicated in liver disease; breathing disorder.
- Contraindicated in History of depression, mental illness, or suicidal thoughts.
- Contraindicated in history of drug or alcohol addiction.
- Teach clients to avoid alcohol, it can lead to very serious interactions.
Ref: Roach’s Introductory Clinical Pharmacology
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Pharm: MAOIs and Tyramine Foods
Monoamine Oxidase Inhibitors (MAOI) are
- Best known to be powerful anti-depressants.
- They are effective therapeutic agents for panic disorder and social phobia.
- MAOIs are tried when other antidepressants don’t work, due to side effects.
- MAOIs can cause dangerous interactions with foods and beverages that contain Tyramine. See table below.
Tyramine
- Tyramine is an amino acid that regulates blood pressure
- It occurs naturally in the body, and it’s found in certain foods.
Important: Clients taking MAOIs will need to avoid foods containing high levels of tyramine.
Common side effects of MAOIs include:
- Dry mouth, Headache, Drowsiness
- Nausea, diarrhea or constipation
- Dizziness or light-headedness
- Skin reaction at the patch site
Nursing Implications:
- Monitor for occipital headache, nausea, vomiting, sweating, fever, chest pain.
- Notify the MD quickly, if client complain of any of the signs above.
- Monitor for other drug interactions e.g. sedatives, hypnotics, & analgesics.
- Check if client is taking Herbal products – St John’s wort has a potential for adverse reaction when taken with antidepressants.
To Your Success!
Rophem 🙂
NCLEX Pharm: Dilantin
Generic name: Phenytoin Sodium. Brand name: Dilantin
Class: Antiepileptic, Anticonvulsant, Antiarrhythmic
Indication: Seizures, Cardiac Arrhythmias
Side effects:
- Hematology: aplastic anemia, hematopoietic complications,
- Neuro: ataxia, dizziness, drowsiness, insomnia
- Skin: purpuric dermatitis, Steven-Johnson syndrome.
- GI: gingival hyperplasia, liver damage
Nursing Tips:
- Therapeutic serum level 10-20 mcg/ml
- Do not stop abruptly, to prevent status epilepticus.
- Stop if rash, depressed blood count, enlarged lymph nodes, hypersensitivity reaction, signs of liver damage develop.
- Not for use in pregnancy, it will cause fetal hydantoin syndrome; mental & physical birth defects.
- Phenytoin is occasionally used in the treatment of cardiac arrhythmias, those associated with digitalis intoxication
- Continually monitor cardiac rhythm; check BP frequently.
- Dilantin capsules should be taken by mouth, swallowed whole. Do not open or crush medication.
- Patient should take medication with a full glass (8 ounces) of water unless the doctor directs otherwise.
- Dilantin should be used regularly and all doses taken on time to keep the serum level constant.
- Products that contain calcium (e.g., antacids, calcium supplements) and nutritional tube-feeding products may decrease the absorption of phenytoin. Separate liquid nutritional products at least 1 hour before and 1 hour after phenytoin dose.
To your Success!
Rophem 🙂
Holiday Sales
‘Tis the season of giving 🙂 To bring out the special Christmas spirit and to usher in the new year, we have decided to host a new year sale.
FIRST – Continuing Education Courses are at 15% off for Nurses and Advanced Nurses in the following states: 
- Florida
- Georgia
- South Carolina
- District of Columbia
- Arkansas
- Licensed Midwives.
- Alabama Nurses*
By using the code SAVE15, you can save when you get the course
package for your respective state, and you will be renewal ready.
Course credits post to CE Broker website within 24 hours.
(*Alabama Board of Nursing accepts CE courses that are approved by other BON within the US, see link for reference – http://www.alabamaadministrativecode.state.al.us/docs/nurs/610-X-10.pdf)
SECOND – Two for the price of One! Rophem NCLEX Review for graduate nurses. 
Get your license this New Year 2019 with Rophem and what better way to stay accountable than with a friend. Get one NCLEX review and invite a friend for FREE, or simply split the bill for double the reward! Now you and a friend can do it together – #passNCLEX! Register Now on rophem.com! Seats are limited!
January 7, 8, 9, 10 (Mon to Thur).
January 14, 15, 16, 17 (Mon to Thur) – 9 am each day.
Rophem 🙂
Happy Holidays
Our Team at Rophem Nursing Education wishes you peace, joy and prosperity throughout the coming year. We appreciate your continued support and partnership. We look forward to working with you in the years to come. Wishing you all the joys of the season and happiness throughout the coming year 🙂 🙂
New Nurses – First Year Survival Tips
Congratulations!! You have achieved those things that you really wanted – you’ve finished nursing school, passed the NCLEX and now you probably secured your first job as a nurse or you are waiting to get one. So what’s next, how ready are you for the tasks ahead? There are challenges ahead and most graduates feel overwhelmed and unprepared; as a matter of fact, some new nurses find it hard to keep their first job past their orientation time.
I remember when I finished nursing school, honestly, it was a great achievement to become a nurse but then the reality of this lovely and wonderful profession can be shocking. As a graduate or new nurse, you really do not know everything; yes, you passed every test but you are still learning and now you learn where you work. Note that as a new nurse, you are not expected to have answers to every question. So here are some ideas to help get through your first year as a Nurse.
- Be Patient: Remember you are still learning, you don’t know everything, and there are some questions you may not be to answer right away. Give yourself time to learn and you will surely get there. The same thing applied to the unit you work, it will take some time for you to know all the policies and get used to the unit in general. So do not be harsh on yourself. If there is anything you don’t know, don’t feel bad because it is okay. Be Patient; take one day at a time.
- Don’t be afraid to ask: one of those things that will help you to learn is asking questions. This is a sign that you are ready to learn, and that you do not want to make mistakes. Making assumptions when you don’t know what to do will only lead to mistakes. Remember you are a nurse, and that you are taking care of people – mistakes could be bad, so ask questions. Protect your practice.
- Take care of yourself: this is where you will need to do a head to toe assessment on yourself. Believe me; I do this all the time, even now. Working as a nurse is very demanding and you will be on your feet for longer hours. So it is highly important to look at yourself, assess and plan for the future. You do not want to break down, eat good food, drink adequate amount of fluid exercise and wear comfortable shoes.
- Don’t take it home: just like the employer does not want you to bring your home to work, don’t take work home either. Things will happen but once you give report to the coming nurse; that is the end of your shift. You need to go home rest your body, eat good food and prepare for another day. And when someone wrongs you on the job, remember no one is perfect; don’t take it home.
- Be grateful and believe in yourself: you have come a long way, look back at where you started and see where you are now. Take a look at the nursing curriculum that you’ve learned from, all the exams you took and passed, time to be grateful. Not everyone that started finished. Also belief in yourself, you are a professional nurse, you are licensed and authorized to practice. You can do it, with patience and readiness to learn all you can; it will surely come together.
Welcome to the nursing profession!!!
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
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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
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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
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Dose of Nursing 