Nursing Rounds is an on-line resource site for nursing students and professional nurses that offers practical tips, new reports, resources, and guidelines, links to on-line presentations, sample NCLEX questions, news and updates, study/handy clinical tools, etc..

Saturday, April 18, 2009

"Energy Drinks" Potentially Harmful to Patients With Cardiovascular Disease

NEW YORK (Reuters Health) Apr 03 - Consumption of energy drinks increases blood pressure and heart rate, and should therefore be avoided by people with hypertension or heart disease, according to results of a small prospective study.

The beverages, marketed to enhance cognitive function and stamina, usually contain caffeine, taurine, sugars, vitamins, and other nutritional supplements, Dr. James S. Kalus, at Henry Ford Hospital in Detroit, and co-authors note in The Annals of Pharmacotherapy for April. The potential hemodynamic or electrocardiographic effects of energy drinks have not been studied.

To look into this, the researchers studied 15 healthy volunteers, 20-39 years of age, who abstained from other dietary sources of caffeine, beginning 48 hours prior to baseline.

The subjects drank 500 mL (2 cans, each containing 100 mg taurine and 100 mg caffeine) of an energy drink over 30 minutes daily for 7 days. On days 1 and 7, blood pressure, heart rate, and electrocardiograms were obtained prior to consuming the drinks and 5 times during the 4 hours afterward.

Mean heart rate increased significantly from baseline by 7.8% on day 1 and by 11.0% on day 7; corresponding increases for systolic blood pressure were 7.9% and 9.6%, and for diastolic blood pressure, 7.0% and 7.8%. EKG parameters did not change significantly.

"Increases in blood pressure and heart rate of the magnitude observed in our study could be significant in persons with known cardiovascular disease," Dr. Kalus and his associates maintain, especially in patients who exhibit impaired baroreflex buffering in response to vasoactive substances. Young individuals with undiagnosed, premature cardiovascular disease could also be at risk.

They advise clinicians that "consumption of these drinks could, theoretically, be a frequently overlooked cause of altered medication effectiveness or even hospital admissions or emergency department visits."

Ann Pharmacother 2009;43.

Copied from http://www.medscape.com/viewarticle/590582?src=mp&spon=24&uac=3980SX

Tuesday, April 14, 2009

How can you avoid this medication error?

See how your staff or students analyze this error--and how they'd avoid it What happened: Jean Watson, a postoperative patient, has a low serum potassium level on her second postoperative day (2.1 mEq/L), and her health care provider orders an additional 20 mEq of KCl to be added to her I.V. bag. Currently, she has 1,000 ml 5% dextrose in 0.45% NaCl with 20 mEq KCl hanging with 200 ml left in the bag and infusing at 125 ml/hour. The nurse draws up the 20 mEq of KCl and adds it to the current infusion without changing the infusion rate. Situation: This could cause hyperkalemia that might be lethal. Adding KCl to an I.V. bag with 200 ml remaining can create a solution too concentrated to administer I.V. What should have been done: The nurse should have discarded the hanging bag, wasting the 200 ml of I.V. fluid, and hung a new 1,000-ml bag with the additional 20 mEq of KCl added. That I.V. would have 40 mEq of KCl per 1,000 ml, which can be safely given at 125 ml/hour. Administering the I.V. solution through an infusion pump would be safest because it avoids a potential sudden infusion of excess I.V. fluid. Source: Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed., AC Abrams, Lippincott Williams & Wilkins, 2006.

Pistachio Recall Expanded

April 7 (HealthDay News) -- A nationwide recall of pistachio products from a California plant was significantly expanded Monday after federal and state health officials found salmonella bacteria in "critical areas" of the Setton Pistachio facility. Investigators didn't provide any more details. The company announced it's now recalling all lots of roasted in-shell pistachios, roasted shelled pistachios and raw shelled pistachios produced from nuts harvested in 2008, the Washington Post reported. Last week, Setton recalled about 2 million pounds, which represents just a small portion of the 2008 harvest. At the time, it was believed the pistachios may have been contaminated by a sanitation problem that affected only one or two production lines. Setton is the second-largest pistachio processor in the United States and supplies about 35 wholesalers and food manufacturers that repackage the nuts for retail sale or use them as ingredients in other products, the Post reported. The U.S. Food and Drug Administration said it could take weeks before there's a complete list of affected products. To help consumers, the pistachio industry created a Web site that lists products not affected by the recall. The Web site address is www.pistachiorecall.org.

Thursday, April 9, 2009

Test Yourself: NCLEX practice questions 3

Worried about passing the National Council Licensure Examination (NCLEX), the test from the National Council of State Boards of Nursing (NCSBN) that your state board of nursing will use to determine whether you’re ready to practice nursing? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX.

  1. A nurse is preparing a teaching plan for a client who was prescribed enalapril maleate (Vasotec) to treat his hypertension. Which of the following instructions should she include in the teaching plan? Select all that apply.
    1. Instruct the client to avoid salt substitutes.
    2. Tell the client that light-headedness is a common adverse effect that he doesn't need to report.
    3. Inform the client that he may have a sore throat for the first few days of therapy.
    4. Advise the client to report facial swelling or difficulty breathing immediately.
    5. Tell the client that blood tests will be necessary every 3 weeks for 2 months and periodically after that.
    6. Advise the client not to change position suddenly to minimize orthostatic hypotension.
  2. A physician prescribes I.V. normal saline solution to be infused at a rate of 150 mL/hour for a client admitted with dehydration and pneumonia. How many liters of solution will the client receive during an 8-hour shift? _____________________
  3. A nurse is caring for a terminally ill client. In which order is she likely to observe the following five stages of death and dying, as described by Elisabeth Kubler-Ross?
    1. bargaining
    2. denial and isolation
    3. acceptance
    4. anger
    5. depression
  4. A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note below, which postpartum complication has the client developed? 6/7/06 1745 Pt.'s 24-hour blood loss is 600 mL. Uterus is soft and relaxed on palpation and pt. has a full bladder. Assisted pt. in emptying bladder and notified Dr. G. McMann of findings. Vital signs stable at present. See graphic sheet for ongoing assessments and perineal pad weights.-----S. Jones, RN
    1. postpartum hemorrhage
    2. puerperal infection
    3. deep vein thrombosis
    4. mastitis
  5. Which nonpharmacologic interventions should a nurse include in the care plan for a client who has moderate rheumatoid arthritis? Select all that apply.
    1. massaging inflamed joints
    2. avoiding range-of-motion exercises
    3. applying splints to inflamed joints
    4. using assistive devices at all times
    5. selecting clothing that has hook-and-loop (Velcro) fasteners
    6. applying moist heat to joints

Answers to NCLEX practice questions

  1. 1,4,6 Rationale: When teaching a client about enalapril maleate, the nurse should tell him to avoid salt substitutes because they may contain potassium, which can cause light-headedness and syncope. He should report facial swelling or difficulty breathing immediately because they may be signs of angioedema, which would trigger his prescriber to discontinue the drug. The client should also be advised to change position slowly to minimize orthostatic hypotension. The nurse should tell the client to report light-headedness, especially in the first few days of therapy, so his dosage can be adjusted. The client should also report signs of infection, such as sore throat and fever, because the drug may decrease his white blood cell (WBC) count. Because this effect is generally seen within 3 months, the WBC count and differential should be monitored periodically.
  2. 1.2 L Rationale: The ordered infusion rate is 150 mL/hour. The nurse should multiply 150 mL by 8 hours to determine the total volume in milliliters the client will receive during an 8-hour shift (1,200 mL). Then she should convert milliliters to liters by dividing by 1,000. The total volume in liters that the client will receive in 8 hours is 1.2 L.
  3. 2,4,1,5,3 Rationale: According to Kubler-Ross, the five stages of death and dying are denial and isolation, anger, bargaining, depression, and acceptance.
  4. 1 Rationale: Blood loss from the uterus that exceeds 500 mL in a 24-hour period is considered postpartum hemorrhage. If uterine atony is the cause, the uterus feels soft and relaxed. A full bladder can prevent the uterus from contracting completely, increasing the risk of hemorrhage. Puerperal infection is an infection of the uterus and structures above; its characteristic sign is fever. Two major types of deep vein thrombosis occur in the postpartum period: pelvic and femoral. Each has different signs and symptoms, but both occur later in the postpartum period (femoral, after 10 days postpartum; pelvic, after 14 days). Mastitis is an inflammation of the mammary glands that disrupts normal lactation and usually develops 1 to 4 weeks postpartum.
  5. 3,5,6 Rationale: Supportive, nonpharmacologic measures for the client with rheumatoid arthritis include applying splints to treat inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Never massage inflamed joints because massage can aggravate inflammation. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises prevent loss of joint function. Use assistive devices only when marked loss of range of motion occurs.

Source: NCLEX-RN 250 New-Format Questions, 2nd ed., Lippincott Williams & Wilkins, 2007.

Monday, April 6, 2009

Bridging the Gap: Basic Spanish keywords

When you're caring for a Spanish-speaking patient, sometimes it isn't necessary to translate an entire sentence. Instead, you may be able to use one keyword or phrase to convey information to your patient.

- please - thank you - yes - no - maybe - sometimes - never - always - date - signature - good-bye

por favor gracias sí no quizás or tal vez a vecas nunca siempre fecha firma hasta luego or adiós

Source: Medical Spanish Made Incredibly Easy!, 3rd edition, Lippincott Williams & Wilkins, 2008.

Test Yourself: NCLEX practice questions 2

Worried about passing the NCLEX? The more practice questions you do, the more confident you'll feel. Try these, then review the answers and rationales that follow. Experts recommend taking many practice questions before the NCLEX, so take advantage of review courses, books, and other products to help you succeed and pass the NCLEX. ANSWERS BELOW.

1. To maintain airway patency during a stroke in evolution, which nursing intervention is appropriate?
1. Thicken all dietary liquids.
2. Restrict dietary and parenteral fluids.
3. Place the client in the supine position.
4. Have tracheal suction available at all times.
2. Primary prevention of osteoporosis includes which measure?
1. Place items within reach of the client.
2. Install bars in the bathroom to prevent falls.
Maintain the optimal calcium intake.
4. Use a professional alert system in the home in case a fall occurs when the client is alone.
3. A client is admitted with right lower quadrant pain, anorexia, nausea, low-grade fever, and an elevated white blood cell count. Which complication is most likely the cause?
1. A fecalith
2. Bowel kinking
3. Internal bowel occlusion
4. Abdominal wall swelling
4. Which nursing intervention should be taken for a client who complains of nausea and vomitus 1 hour after taking his morning glyburide (DiaBeta)?
1. Give glyburide again.
2. Give subcutaneous insulin and monitor blood glucose.
3. Monitor blood glucose closely and look for signs of hypoglycemia.
4. Monitor blood glucose closely and assess for symptoms of hyperglycemia.
5. Which comfort measure can be recommended to a client with genital herpes?
1. Wear loose cotton underwear.
2. Apply a water-based lubricant to the lesions.
3. Rub rather than scratch in response to an itch.
4. Pour hydrogen peroxide and water over the lesions.
Answers to NCLEX practice questions

1. 4 Because of a potential loss of the gag reflex and potential altered level of consciousness, the client should be kept in Fowler's or a semiprone position with tracheal suction available at all times. Thickening dietary liquids isn't done until the gag reflex returns or the stroke has evolved and the deficit can be assessed. Unless heart failure is present, restricting fluids isn't indicated. 2. 3 Primary prevention of osteoporosis includes maintaining optimal calcium intake. Placing items within reach of the client, using a professional alert system in the home, and installing bars in bathrooms are all secondary and tertiary prevention methods to prevent falls. 3. 1 The client is experiencing appendicitis. A fecalith is a fecal calculus, or stone, that occludes the lumen of the appendix and is the most common cause of appendicitis. Bowel wall swelling, kinking of the appendix, and external occlusion, not internal occlusion, of the bowel by adhesions can also be causes of appendicitis. 4. 3 When a client who has taken an oral antidiabetic agent vomits, the nurse should monitor glucose and assess him frequently for signs of hypoglycemia. Most of the medication has probably been absorbed. Therefore, repeating the dose would further lower glucose levels later in the day. Giving insulin will also lower glucose levels, causing hypoglycemia. The client wouldn't have hyperglycemia if the glybluride was absorbed. 5. 1 Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions isn't recommended.

Source: NCLEX-RN Questions & Answers Made Incredibly Easy!, 4th edition, Lippincott Williams & Wilkins, 2007.

Sunday, April 5, 2009

Key Step to Reduce Lawsuits

The Ins and Outs of Patient Abandonment As a nursing student, you know that you should never "abandon" a patient. But what exactly is patient abandonment? And how do you protect yourself from being accused of this type of unprofessional conduct? Source: http://www.accelacommunications.com/microsite/liability_center/

Prostate Test Found to Save Few Lives

The PSA blood test, which measures a protein released by prostate cells, does what it is supposed to do -- indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early actually saves lives. The studies conducted confirm concerns about the wisdom of widespread prostate cancer screening. More From NursingCenter.com

Thursday, April 2, 2009

To: Dr. Nante Payod

The links below are outputs for my PhD course Educ 305 ICT in Education. For those who are interested to view my accomplished requirements, besides my professor Dr. Payod, let me first give you a description of the course. Educ 305 (Information and Communication Technology [ICT] in Education) is a 3 unit subject designed to provide doctoral students with the technical requirements and learning opportunities to develop and update essential skills, knowledge and dispositions for optimal and effective use of of ICT in Education. It is delivered through a combination of lecture and discussion, laboratory and e-learning activities whereby students use and organize technology and web-based resources to create environments that foster stimulating and meaningful learning to meet desired educational outcomes (Source: Syllabus 2nd Sem 08 - 09). Requirements: 1. Reaction Paper on the Generation Y Model 2. Powerpoint presentation of my report (Scope of ICT and Rationale for the Introduction of ICT in Education) 3. Reaction Papers a. Impact of ICT on the Curriculum b. ICT and Cognitive Process 4. Exercise 1: Task 1: Word Processing Task 2: Computating with the use of Excel Task 3: Powerpoint Designing 5. Exercise 2: Task 1: Asynchronous and Synchronous Communication Task 2: The Internet in Education Task 3: Copyright and Intellectual Property You can click on COMMENTS, located below this post (right side) for feedbacks which I would really appreciate..