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Wednesday, September 10, 2008

Nclex Made Incredibly Easy: Nclex Review Course Module

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Surface foreign bodies are often removed simply by irrigating the eye with sterile normal saline. The nurse would not use clamps because this action will risk causing further injury to the eye. Applying an eye patch would not provide relief for the problem. Visual acuity tests are not the priority at this time, and might not be feasible because the client most likely has excessive blinking and tearing as well at this time.

Keratoplasty is done by removing damaged corneal tissue and replacing it with corneal tissue from a human donor (live or cadaver). Preoperative preparation of the recipient’s eye can include obtaining a culture and sensitivity with conjunctival swabs, instilling antibiotic ophthalmic medication, and cutting the eyelashes. Some ophthalmologists order a medication such as 2% pilocarpine to constrict the pupil before surgery.

Discharge instructions to a client after a keratoplasty includes telling the client that sutures are usually left in place for as long as 6 months. After the sutures are removed and complete healing has occurred, prescription glasses or contact lenses will be prescribed.

Enucleation is removal of the eye, leaving the eye muscles and remaining orbital contents intact.

Topical glucocorticoids can be absorbed in sufficient amounts to produce systemic toxicity. Primary concerns are growth retardation (in children), and adrenal suppression in all age groups. Systemic toxicity is more likely under extreme conditions, such as with prolonged therapy in which extensive surfaces are treated with high doses of high potency agents in conjunction with occlusive dressings.

Isotretinoin (Accutane) is prescribed for a clietn to treat severe cystic acne. It is usually administered two times daily for a period of 15 to 20 weeks. The usual adult dosage is 0.5 to 1 mg/kg/day. If needed, a second course may be administered, but not until 2 months have elapsed after completing the first course.

Saquinavir (Invirase) is an antiviral medication. It is administered within 2 hours after a full meal. If the medication is taken without food in the stomach, it may result in no antiviral activity.

Anastrozole (Arimidex) is prescribed for a postmenopausal client with breast cancer. The most dangerous adverse reaction to anastrozole is thromboembolism. Common reactions include nausea, chest pain, edema, and shortness of breath. A variety of gastrointestinal tract or nervous system effects may also occur.

Cytarabine (Cytosar-U) is being prescribed to a nonlymphocytic anemia patient. The major toxic effect of cytarabine is bone marrow depression, resulting in hematologic toxicity. Signs of hematologic toxicity include fever, sore throat, signs of local infection, easy bruising, or unusual bleeding from any site. If these signs occur, the physician is notified. Anorexia, nausea, and a transient headache can occur as side effects of the medication but do not necessarily warrant physician notification, unless they are persistent in nature.

Docetaxel (Taxotere) is an antineoplastic medication. Frequent side effects include alopecia, hypersensitivity reaction, fluid retention, nausea, vomiting, diarrhea, fever, myalgia, and nail changes. Before receiving docetaxel, the client is premedicated with an oral corticosteroid (dexamethasone (Decadron) 16 mg per day for 5 days, beginning day 1 before docetaxel therapy) to reduce the severity of fluid retention or prevent a hypersensitivity reaction.

Paclitxel is being prescribed to a client with ovarian cancer. Side effects of paclitaxel (Taxol) include alopecia, pain in the joints and muscles, diarrhea, nausea, vomiting, peripheral neuropathy, hypotension, mucositis, pain and redness at the injection site, cardiac disturbances (bradycardia), and an abnormal electrocardiogram. Fatigue is an occasional side effect.

Stavudine (Zerit) is prescribed for a client with advanced human immunodeficiency virus. Peripheral neuropathy, characterized by numbness, tingling, or pain in the hands or feet can occur frequently with this medication and is an adverse reaction.

Ritonavir (Norvir) oral solution is prescribed to a client with HIV virus. The drug is preferably administered with food. It may be mixed with chocolate milk or a dietary supplement to improve the taste. The client is also instructed to consume the dose within 1 hour of mixing.

Propofol (Diprivan) is an anesthetic agent that is used to provide continuous sedation for a client receiving mechanical ventilation. An adverse effect of the medication is hypotension. It can also cause respiratory depression and bradycardia. Facial flushing can occur as an occasional side effect.

An adverse reaction of gemcitabine hydrochloride, an antineoplastic medication, is severe bone marrow depression, evidenced by anemia, thrombocytopenia, and leukopenia. The medication may be discontinued or the dosage may be modified if bone marrow depression occurs. The normal platelet count is 150,000 to 450,000/mm3. The nurse would contact the physician if a platelet count of 90,000/mm3 were noted. The normal range for the total bilirubin is 8.4 to 10.2 mg/dL. The normal BUN is 7 to 25 mg/dL. The normal range for the alkaline phosphatase is 42 to 128 units/L.

IGIV is an immune serum that increases antibody titer and antigen-antibody reaction, providing passive immunity against infection. Anaphylactic reactions, although rare, can occur, and so the nurse ensures that epinephrine is readily available when administering this medication. Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for oral anticoagulants. Acetylcysteine is used to treat acetaminophen overdose.

Lepirudin (Refludan) is an anticoagulant used for clients with heparin-induced thrombocytopenia and associated thromboembolitic disease to prevent additional thromboembolitic complications. For the postoperative client, the initial dose is administered as soon as possible after surgery but not more than 24 hours after surgery.

Letrozole (Femara) is an aromatase inhibitor that is used to treat advanced breast cancer in postmenopausal women whose disease has progressed after antiestrogen therapy. The most frequent side effects include skeletal pain, and back, arm, and leg pain. Less frequent side effects include nausea, headache, fatigue, constipation, vomiting, and dyspnea.

Amprenavir (Agenerase) is an antiretroviral agent, classified as a protease inhibitor, used to treat HIV infection.

Indinavir (Crisxivan) is an antiretroviral agent. This medication can cause kidney stones; therefore, the client is instructed to increase fluid intake to at least 1.5 liters per day. The client is also instructed to report sharp back pain or the presence of blood in the urine. The client is instructed to take the medication 1 hour before or 2 hours after a large meal. If the medication needs to be taken with food, the client should consume a light meal, such as dry toast, juice, or a bowl of cereal with milk. Unexplained weight loss needs to be reported to the physician.

Lamivudine is an antiretroviral agent that is administered in combination with zidovudine to delay the appearance of zidovudine resistance. Lamivudine is well absorbed orally either with or without food. Peripheral neuropathy can occur with its use, and the client is instructed to notify the physician if burning, numbness, or tingling of the hands, arms, feet, or legs occurs. Pancreatitis, evidenced by nausea, vomiting, and abdominal pain is also an adverse reaction to the medication, requiring physician notification.

Levalbuterol (Xopenex) is a bronchodilator. This medication stimulates the beta receptors in the lungs, relaxes bronchial smooth muscle, increases vital capacity, and decreases airway resistance. Central nervous system (CNS) stimulation can occur with the use of this medication. The client is instructed to avoid caffeine-containing products such as coffee, tea, colas, and chocolate, because these products can cause further CNS stimulation.

Moxifloxacin (Avelox) is a fluoroquinolone. Increased sensitivity of the skin to sunlight can occur, and the client is instructed to avoid excessive sunlight and artificial ultraviolet light. The client should wear sunscreen and protective clothing when outdoors. The client should also drink fluids liberally and avoid the use of antacids, because antacids will decrease absorption of the medication. The medication can cause inflamed and ruptured tendons, so that the client is instructed to notify the physician if inflammation or tendon pain occurs.

Nelfinavir (Viracept) is an antiviral medication used in the treatment of HIV infection when antiretroviral therapy is warranted. It is available in both tablet and powder form. The powder form is prepared by mixing the dose with a small amount of water, milk, formula, soy milk, or dietary supplements. The powder is not mixed with acidic foods or juices such as apple juice or applesauce, orange juice, or grapefruit juice.

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