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Category Archives: Nursing/NCLEX

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. 

 

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Pharm: 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. 

To Your Success!

Rophem 🙂

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 🙂

Beauty in the Struggle

Life is full of ups and downs that will test your resilience. But take heart! The lessons you will learn from the ups and downs will only make you stronger.  The deepest pains become our greatest strength.

If you win at everything you do in life, you might be happy, but you may not have developed the strength you need to face any struggles that might come your way. The struggles of our daily life make us strong. The hardship, the pain, and the hurt of everyday life, that you go through and still did not give up; these makes you stronger each day. So, when you’re in the middle of a hardship you think you may not get out of, don’t give up, and look for the lesson in each moment. You are building up the strength for the next day!

Rophem 🙂

Never Give Up

When there is a will, there is a way!!
You truly want to do something; and there are obstacles, you will always find a way to do it.

Set your eyes on the prize; always remember that nothing comes easy in life. If it were to be easy then everyone will have it and it wouldn’t worth that much.
What is the goal that you want to achieve at this time; stay focused, have the strong will and gently find available resources.

Other things will happen at the same time, life has to go on and these things may appear to stand in your way. Try not to pay too much attention to distractions. Stay focused. A person does not fail until they give up. Never give up!!!

With Love
Rophem 🙂