Nursing Exam Review Lecture 9 Platelet and RBC

Lecture 9 Platelet and RBC (Continued from Lecture 8) Lab Platelet (PLT) RBC (Red blood cell) Neutropenic Precautions • Strict hand washing • Vital q4 hrs • Dedicated stethoscope, BP cuff • Reverse/protective isolation • Shower BID with microbial soap • Avoid crowds • Private room • Limit staff/visitors • No fresh flowers/potted plants • No raw fruits/veggies/undercooked meat • No water pitcher standing for over 15 minutes • Check WBC daily • No indwelling catheters • Do not reuse cups or disposable plates Range 150,000 to 450,000 4 to 6 million “ABCD” Scheme Level C if <90,000 Level D if <40,000 Level B if abnormal Five Deadly “Ds” • The following are 5 priority pts based on their lab values • The NCLEX exam will not put one of the followings against another o K+ >6 o pH in the 6s o CO2 in the 60s o pO2 <60 o Platelets <40,000 Psychiatric Drugs ALL psychiatric drugs cause low BP and weight changes—usually weight gain Major Classes Phenothiazines • First generation or typical antipsychotics • All end in “ZINE” o Example: Thorazine, Compazine • They don’t cure … They just reduce symptoms • We use ZINEs for the ZANY (Cuckoos) … Antipsychotics • In small doses, they are antiemetics (to treat vomiting) Phenothiozines are major tranquilizers • Major tranquilizers—big guns psych meds—are Antipsychotics • Analogy o Aminoglysoside are to Antibiotics what Phenothiazines are to Antipsychotics • Antipsychotics S/Es = “ABCDEFG” o Anticholinergic (dry mouth, urinary retention) o Blurred vision o Constipation o Drowsiness o EPS (tremors, Parkinson) o Foto sensitivity o aGranulocytosis (low WBC count, immunosuppressed) Teach patient how to recognize and report sore throat and symptoms of infection Question • What is the nursing action when someone presents with a S/E? o Educate Question • What is the nursing action when someone presents with a Toxic effect? o HOLD the drug ! Notify HCP Note • The #1 nursing diagnosis for “ABCDF” S/Es is to teach pt about SAFETY • The #1 nursing diagnosis for “G” S/Es is to teach pt to report signs of infections to HCP Decanoate or “Caprate” form of a medication • The long-acting form of a drug • Sometimes denoted with the letter “D” • IM form given for non-compliance • Often Court-ordered Tricyclic Antidepressants • Grandfathered into the NSSRI (Non-selective serotonin reuptake inhibitor) group • Mood elevators (Happy pills) • Elavil (elevates), Trofranil, Aventyl, Desyrel o Elevates the mood o Side effects of TCA are Anticholinergic (especially, dry mouth) Blurred Vision Constipation Drowsiness Euphoria (happy) • Must take meds for 2 to 4 weeks for beneficial effects • So, after the first week of antidepressant therapy, pt will complain the drug is not working • Teach pt that the medication takes about 2 to 4 weeks to reach therapeutic effects Benzodiazepines Naming of antipsychotics • Anti-anxiety, minor tranquilizers • If you want to put someone asleep, give • Always have ZEP in the name him the ZZzzs • Remember ZZzzs for falling/going to • Zines for the Zany (major antipsychotics) sleep • Zeps for the minor antipsychotics • Many benzodiazepines end in “Pam” or o If you are old enough, you may “Lam” answer that question … What do you • Prototype: Valium, induction of find at a Zeppelin concert? anesthetic, muscle relaxant, alcohol Minors on tranquilizers • Can be used as o Seizures medications o Preop induction of anesthesia o Muscle relaxants o EtOH withdrawal medications o Ventilation—medication to relax and calm down pts on a ventilator • Benzos work quickly … But do not take them for more than 2 to 4 weeks Administer major and minor tranquilizers at the same time. Why? • The major antipsychotics take a long time to start working • The minor antipsychotics start working right away • Both are administered at the same time • Example: pt is usually put on Valium and Elavil at the same time o Valium is discontinued in 2 to 4 weeks once Elavil kicks in Note A similar example for giving major and minor tranquilizers together is the concurrent use of Heparin and Coumadin (warfarin) • Heparin works right away but a pt should not be on it for a long time • Coumadin takes a few days to start working but a pt can be on it for the rest of his life S/Es of Benzodiazepines are “ABCD” • Anticholinergic • Blurred Vision • Constipation • Drowsiness Monamine Oxidase (MAO) Inhibitors • Antidepressant • Depression is thought to be caused by norepinephrine, dopamine, and serotonin in brain • Name of MAOIs starts with • MARplan, NARdil, PARnate the beginnings—all rhyme • S/E of MAOIs o Anticholinergic o Blurred Vision o Constipation o Drowsiness Teaching Points • Avoid tyramine-containing food … May cause Hypertensive Crisis • Food with tyramine o Fruits/Veggies—Avoid salad “BAR”: Bananas, Avocados (guacamole), Raisins (dried fruit) o Grains—Ok to have, except Yeast o Meats—No organs liver, kidney, tripe, heart, no preserved meats (smoked, dried, cured, pickled, hot dogs) o Dairy—No chees except for mozzarella, cottage cheese (no aged cheese) o No EtOH, elixirs, tinctures (iodine/betadine) caffeine, chocolate, licorice, soy sauce Lithium • Used for treating Bipolar disorder—it decreases the mania LI = BI • S/E: Very Unique—acts more like an electrolyte—think: Potassium/Lithium • The 3 Ps as S/Es o Peeing (Polyuria) o Pooping (diarrhea) o Paresthesia (earliest sign of electrolyte imbalance) The earliest sign of electrolyte imbalance is Paresthesias = Numbness and Tingling Toxic effects of lithium • Tremors • Metallic taste • Severe diarrhea Question What is the #1 nursing intervention in a pt on lithium presenting with peeing/pooping all the time? • #1 intervention o Give pt fluids • The above S/Sx are S/Es—expected • Monitor sodium • Low sodium makes lithium toxic • High makes lithium ineffective • Sodium needs to be normal Question What is the #1 nursing intervention in a pt on lithium presenting with metallic taste and severe diarrhea? • #1 intervention o Give pt fluids • Notify the HCP—this is a toxic effect Prozac (fluoxetine) • SSRI, mood elevator • Side effects of Prozac are o Anticholinergic o Blurred Vision o Constipation o Drowsiness o Euphoria (happy) • Causes insomnia so give before noon. If bid, give at 6 a.m. and noon • When changing doses, watch for suicidal risk in adolescents o Must recently change the dose and be an adolescent of young adult HALDOL (haloperidol) • Tranquilizers (basically same as Thorazine) • S/E of Haldol o Anticholinergic (dry mouth, urinary retention) o Blurred vision o Constipation o Drowsiness o EPS (tremors, Parkinson) o Foto sensitivity o aGranulocytosis (low WBC count, immunosuppressed) Teach patient how to recognize and report sore throat and symptoms of infection • First generation antipsychotics • Pts may develop NMS (neuroleptic malignant syndrome) from overdose o Seen in elderly and young white schizophrenic pts o High fever over 105 o Their doses should be about ½ usual adult dose Question A pt is being treated with an antipsychotic medication. Pt becomes anxious and presents with tremors. What is the nurse intervention to differentiate NMS (neuroleptic malignant syndrome) from EPS (extrapyramidal syndrome)? • Measure the pts’ temperature o If temperature is WNL, this is EPS o If temperature is 102 and rising, call the emergency response team and notify HCP … NMS is lifethreatening • NMS presents with anxiety and tremors, and so does EPS Note: With Haltol, there are safety concerns related to the S/Es Clozaril (clozapine) • Atypical antipsychotic • Advantage it does not have A-F side effects • Don’t confuse it with Klonopin/Clonazepam! • S/Es of clozapine o aGranulocytosis! It is worse than cancer drugs and can trash the pt’s bone marrow Note • Geodon (ziprasidone) has a black box warning • Prolong the QT interval, which can cause sudden cardiac arrest • Do not use in pts with cardiac condition Note: Second generation antipsychotics end in “Zapine” Question What is the #1 nursing intervention in a pt taking Clozaril (clozapine) • Monitor the WBC Zoloft (Sertraline) • Antidepressant • Can cause insomnia • Interact with the followings because they are not metabolized in the liver o St. John’s Wort and cause serotonin syndrome o Warfarin and cause bleeding • S/E of serotonin syndrome is “SAD Head” o Sweating o Apprehensive (impending sense of doom) o Dizzyness o Headache Note: The nurse should anticipate lowering the dose of sertraline (Zolof) of a pt on St. John’s Wort and Warfarin