Study Tip: Myxedema Coma

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

Study Tip: Thyrotoxicosis

Thyrotoxicosis (Thyroid Storm) – a form of severe hyperthyroidism that can be precipitated by stress, injury, or infection. It is a life-threatening emergency. Manifestations of thyroid storm include temperature above 102 degrees F (39 degrees C) – with this high temperature, all organ systems will be affected, tachycardia, abdominal pain, systolic hypertension, N/V, confusion, agitation, tremors, and possible seizures. Management of treatment requires careful follow-up by an endocrinologist. Medications include antithyroid medications and radioactive iodine.

Content area: Med-Surg | Endocrine

Study Tip: Status Asthmaticus

Status Asthmaticus – a severe, life-threatening acute exacerbation of asthma attack that is unresponsive to initial treatments and interventions for asthma attack with bronchodilators. Status Asthmaticus places the client at high risk for respiratory failure. The client has acidosis, hypoxemia, hypoxia, and hypercapnia; all of these together with effects of increase lung volume place the client at risk for pneumothorax and cardiac arrest. Status asthmaticus is considered a medical emergency.

Content Area: Med-Surg – Respiratory

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 🙂

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 🙂

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 🙂

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 😊

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 😊