Important Update: Remedial Course & NCLEX Review Courses
All Remedial Course groups & NCLEX Review schedules will be Online due to changes regarding the COVID-19 Pandemic. Theory online self study, or face to face via video conferencing; Clinical Training via Simulation and Skills practice. Schedules remains the same. We continue to practice social distancing and follow updates from the CDC & WHO.
For questions or clarification – contact us at 727-656-0077
Myxedema coma – a rare life-threatening form of hypothyroidism. It is a disorder characterized by hypoventilation, hypoglycemia, and hypotension. The client with myxedema presents with severe metabolic disorders, generalized nonpitting edema, puffy face, weakness, hypothermia, cardiovascular collapse, and coma.
Diagnostic tests: blood gases, electrolyte levels, ECG, blood sugar, and thyroid hormone levels. Intravenous fluid, electrolyte replacement, intravenous cortisol or other adrenal cortical hormone are used in the treatment. Warm blanket for low body temperature, glucose supplements for hypoglycemia.
Content area: Med-Surg | Endocrine
Work hard for what you want because it won’t come to you without a fight. You have to be strong, courageous, and know that you can do anything you put your mind to. If somebody puts you down or criticizes you, just keep on believing in yourself and keep pushing. Don’t give up! #Ambition #Success #youcanpassnclex!
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 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
- 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!
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 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.
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.
- 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 😊