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Tag Archives: passnclex

NCLEX Pharm: Heparin

Class: Anticoagulant

Indication:

  • Prevention of clotting in arterial and heart surgery
  • Disseminated Intravascular Coagulation (DIC)
  • Atrial fibrillation with embolization
  • DVT and Pulmonary embolism

Side effects:

  • Hematology: Thrombocytopenia, bleeding, bruising, injection-site reactions,
  • Skin: hair loss,
  • GI: liver enzyme changes

Nursing Tips:

  • Heparin is a High Alert Medication
  • Adjust dose based on lab results.
  • Dosage is considered adequate when the activated partial thromboplastin time (APTT) is 1.5 to 2 times normal
  • Give by deep subcutaneous injections; do not give IM.
  • Have protamine sulfate on hand as antidote.
  • Protect clients from injury, report bleeding gums, black or tarry stools, and severe headache.
  • Avoid intramuscular route of administration because of the frequent occurrence of hematoma at the injection site.
  • Always follow facility’s heparin protocol, whenever working with this medication.

Ref: Roach’s Introductory Clinical Pharmacology

To Your Success!

Rophem 🙂

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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

To Your Success!

Rophem 🙂

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 😊

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 🙂

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. 

 

Don’t Give Up!

With hope and confidence, you can achieve success.

It doesn’t matter how long ago you finished school.

Don’t give up!! #passnclex

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 🙂