Care UK reveals five-week delay on staff coronavirus testing

The government has failed to keep its promise to provide weekly coronavirus tests for staff working in care homes, according to a leading provider of health and social care and care homes. Care UK has been told there will be a five-week wait before another…

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Nursing Research Quiz Series - 19

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New concerns suggest students ‘may have to pay extra fees’ for course delays

Fresh concerns have been raised that student nurses in England who have to delay completing their programmes due to the coronavirus pandemic may have to pay additional fees for the duration of their course extension. It comes after the government told Nursing Times this week…

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Nurses no longer exempt from overseas self-isolation measures

Nurses travelling to the UK from high-risk countries will now have to self-isolate for 14 days the government has confirmed, after a review ruled health and care professionals should no longer be exempt from the national requirement. At the beginning of June, an exemption was…

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New NHS People Plan focuses on ‘culture and leadership’ changes needed

A new plan to help retain and support the NHS workforce has today been launched - though unions are frustrated and concerned it falls short of addressing nurse shortages and pay. NHS England and NHS Improvement has today published its latest phase of the NHS…

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Students ‘will be financially supported’ if studies are extended due to Covid-19

Student nurses in England who may be forced to extend their courses beyond three years because of the coronavirus pandemic will be given access to financial support to help them graduate, the government has confirmed. The outbreak of Covid-19 has caused significant disruption to nurse…

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Nursing Education Quiz Series - 15

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NMC postpones launch of new test of competence in wake of Covid-19

The Nursing and Midwifery Council has postponed the launch of its new test of competence until next year because of the coronavirus pandemic, it has been announced. The nursing regulator was due to implement an updated version of the test, which assesses the skills and…

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UK study to investigate impact of Covid-19 on BAME nurses

A major £2.1m research study has been launched to investigate why UK health workers from black, Asian and minority ethnic (BAME) groups have been disproportionally affected by Covid-19. Academics at the University of Leicester are set to follow a group of BAME health workers for…

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Public back early pay rise for nurses, poll reveals

The vast majority of the public think nurses deserve a pay rise, and most think it should be in pockets before the end of this financial year, according to a new poll carried out on behalf of Unison. It found that 85% of 2,000 UK…

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Survey shows 60% of health visiting teams affected by Covid-19 redeployment

The redeployment of health visitors to support the national coronavirus response has left remaining staff with increased workloads, worsened mental health and fears that the needs of children are being missed, a new survey has revealed. In the wake of Covid-19, University College London (UCL)…

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Child Health Nursing Quiz Series - 15

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Social media nurse army set to protest for early pay rise

Nurses across England are preparing to protest to demand a significant pay rise this year, as part of a grassroots movement born on social media. Within just one week, the ‘NHS workers say NO! to public sector pay inequality’ Facebook group has exploded to garner…

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Obstetric and Gynecological Nursing Quiz Series - 14

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Prioritising nurses for Covid-19 vaccines ‘the right thing to do’, says ICN

Nurses and other health workers must be first in the queue for any Covid-19 vaccine that is discovered, the International Council of Nurses (ICN) has urged. The race to develop a vaccine is moving with pace with the World Health Organization (WHO) currently tracking more…

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Significant drop in registered nurses working in adult social care

The number of jobs in adult social care for registered nurses has reduced by a third in England since 2012-13, new data reveals. The body behind the figures said a possible explanation for the significant drop was that organisations were employing nursing assistants to take…

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Government announces new measures to tackle obesity

Nurses have welcomed the publication of the government’s new obesity strategy and described the measures as “long overdue”. The plan comes in the wake of evidence showing that being overweight puts people at greater risk of severe complications and death from Covid-19. ‘Clear link’ between…

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Mental Health Nursing Quiz Series - 17

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‘COVID-NURSE’ trial to create standard model for nursing Covid-19 patients

A new project has been launched to design a new best practice model of nursing care for Covid-19 patients based on the most effective innovations of UK nurses so far during the pandemic. The “COVID-NURSE” study has been granted £430,000 in government funding to develop…

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‘Clear link’ between Covid-19 complications and obesity

Being overweight puts people at greater risk of severe complications and death from Covid-19, a new review of UK and international evidence has found. The risks appeared to grow substantially as weight increased above what is considered to be the healthy body mass index (BMI)…

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Community Health Nursing Quiz Series - 15

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Pharmacology Quiz Series - 16

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Trust pays tribute to rising star palliative care nurse after sudden death

A “passionate” nurse who was building a reputation both nationally and internationally for her trailblazing work in the field of palliative care has died unexpectedly at the age of 32. Kimberley St John was a palliative care specialist nurse at Guy’s and St Thomas’ NHS…

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Health committee launches inquiry into maternity safety ‘failings’

MPs have launched a new inquiry into the safety of maternity services in England amid what it described as “recurrent failings” in the care of mothers and babies. The Health and Social Care Committee is set to examine evidence relating to ongoing concerns at maternity…

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Covid-19 testing ‘much slower’ in community, says Welsh RCN

The Royal College of Nursing in Wales has called for an investigation into why coronavirus tests in the community seem be taking longer to process than those in hospitals and regional centres. Based on its own analysis over the last four weeks, RCN Wales warned…

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Medical-surgical Nursing Quiz Series - 19

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Plans revealed for ‘most comprehensive flu jab campaign in UK history’

The government has today revealed details of what it claims to be the most comprehensive flu vaccination programme in the UK’s history, with a doubling in the number of people eligible for the jab. Under the plans, new groups, including those shielding from coronavirus and…

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Study predicts 3,000 extra cancer deaths as result of coronavirus pandemic

Disruption to diagnostic services and patients avoiding healthcare because of Covid-19 could see around 3,500 potentially avoidable deaths from the four main cancers in England, warn researchers. They said urgent policy interventions were needed to deal with the backlog of patients awaiting routine diagnostic services…

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Nurse leader to retire after almost four decades at specialist hospital

The assistant chief nurse at a specialist orthopaedics hospital is hanging up her uniform after almost four decades spent at the organisation. Julie Roberts has nursed on six wards and cared for thousands of patients during her 37 years at the Oswestry-based hospital, noted The…

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New asbestos-related cancer nurse specialist for East Kent

A new specialist nurse has been appointed to part of the country with a high proportion of patients with cancer related to exposure to asbestos, following charity funding. Toni Fleming has been appointed as a new Mesothelioma UK clinical nurse specialist for East Kent Hospitals…

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MPs call for action on ‘significant failings’ around NHS staff testing

Immediate action must be taken to undo “significant” failings to introduce routine testing for NHS staff and to address the needs of patients left in “limbo” during the coronavirus pandemic, an influence group of MPs have said. The Commons health select committee has written to…

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NMC launches new principles for preceptorships

The Nursing and Midwifery Council has released a new set of common principles to help employers build an “effective model” of preceptorship for all newly registered nurses, midwives and nursing associates in the UK. The newly updated principles aim to help organisations aim to “achieve…

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Consider ‘targeted pay solutions’ to support nursing workforce, says report

“Targeted pay solutions” must be considered to help boost the supply of nurses and stamp out workforce shortages, a report on health service pay has suggested. Proposals included the use of pay supplements to attract nurses into locations or specialties that usually faced higher vacancy…

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NHS England urged to prioritise nurse wellbeing in virus recovery plans

Protecting nurse wellbeing must be kept “at the heart” of plans to restore health and care services in the aftermath of the Covid-19 peak, NHS England boss Sir Simon Stevens has been urged. In an open letter to Sir Simon, he was also asked to…

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Fundamental of Nursing Quiz Series - 16

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Care home visits to resume in England following new guidance

Care homes in England have been given the go-ahead to reopen to visitors if they can meet conditions laid out in new coronavirus guidance. The government announced today that family and friends will be able to once again visit their loved ones in social care…

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Nottingham nurses claim Covid-19 unit was ‘more like a prison camp’

A hospital trust has launched an investigation into claims that nurses on its coronavirus end-of-life ward had been redeployed without adequate support or protection and were bullied into silence by their superiors. The union Unison has lodged a collective grievance on behalf of more than…

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Senior nurse ‘given second chance at life’ after 40-day coronavirus coma

A senior nurse who spent more than two months in hospital with Covid-19 including 41 days in intensive care said the experience had helped her appreciate the importance of being "patient with your patients". Ayesha Orlanda, 52, was cheered and clapped out of the hospital…

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International nursing body releases new ‘nurse anthem’

The International Council of Nurses has released a new song that it hopes will become the “anthem for nurses everywhere”, featuring vocals from real nurses around the world. The lyrics of ‘I am a Nurse’ aim to reflect both the challenging realities and the joyous…

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Psychology Quiz Series - 15

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Charity raises concern over spike in diabetes deaths in community

The “devastating impact” Covid-19 is having on people with diabetes must be better recognised and mitigated by the government, as the pandemic moves into the next stage, a charity has warned. Diabetes UK issued the call to action in response to what it called “harrowing”…

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Public sector pay pledge sparks renewed calls for early nurse uplift

Making nurses wait until next year to be considered for a new pay rise is “not acceptable”, unions have warned, following the announcement of a wage increase for other public sector professions. The chancellor has today confirmed an above-inflation uplift for nearly 900,000 workers in…

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Nutrition and Biochemistry Quiz Series - 13

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Two thirds of nurses who contracted Covid-19 ‘still experiencing fatigue’

Around 65% of nurses who have recovered from Covid-19 are still experiencing post-viral fatigue and many continue to report symptoms, according to a survey carried out by a nursing union in Ireland. The majority of nurses who responded to the survey reported a negative impact…

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Patients urged to ‘phone first and book’ before going to A&E, under pilot

Patients in part of Wales are to be asked to phone first and potentially book an appointment at accident and emergency, as part of an attempt to remodel services in the wake of coronavirus. The move, announced today by the Welsh Government, is an attempt…

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Government urged to ‘properly invest’ in student nurses in England

The Royal College of Nursing has issued fresh calls on the government to invest in the student nursing workforce, by reimbursing and abolishing tuition fees in England. It also wants to see the introduction of a living maintenance grant that reflects “actual student need”. “There…

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Call to prioritise healthcare staff after ‘exciting’ Covid-19 vaccine results

Health and care staff must be a priority when a Covid-19 jab becomes available, a body representing NHS managers has said in the wake of latest results from the UK coronavirus vaccine trial. It was announced today that, according to preliminary results, the UK’s vaccine…

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Specialist elective trust fully adopts end-of-life memory box initiative

End-of-life memory boxes have been placed in all wards at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in order to bring comfort and support to families. As a result, families who lose a loved one at the trust’s Oswestry-based hospital are…

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Call to prioritise healthcare staff after ‘exciting’ Covid-19 vaccine results

Health and care staff must be a priority when a Covid-19 jab becomes available, a body representing NHS managers has said in the wake of latest results from the UK coronavirus vaccine trial. It was announced today that, according to preliminary results, the UK’s vaccine…

The post Call to prioritise healthcare staff after ‘exciting’ Covid-19 vaccine results appeared first on Nursing Times.

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Specialist elective trust fully adopts end-of-life memory box initiative

End-of-life memory boxes have been placed in all wards at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in order to bring comfort and support to families. As a result, families who lose a loved one at the trust’s Oswestry-based hospital are…

The post Specialist elective trust fully adopts end-of-life memory box initiative appeared first on Nursing Times.

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Workbook to help people with learning disabilities who experience psychosis

Clinicians at a trust in the South West have developed a new workbook designed to help people with learning disabilities who experience psychosis. The group has developed a set of resources to help clinicians working with people who experience psychosis and who also have a…

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CNO confirms being ‘dropped’ from government Covid-19 briefing

Chief nursing officer for England Ruth May has confirmed to MPs that she was “dropped” from a government press briefing in June. Ms May did not verify it was because she refused to back the actions of the prime minister’s chief advisor, Dominic Cummings, as…

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New 24/7 mental health helpline launched for nurses in Scotland

Nurses in Scotland will now have “around the clock” mental health support, following the launch today of a national helpline as part of the country’s response to Covid-19. The new service will be available for all health and social care workers in the country and…

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Hospital trust aiming to test all 9,000 staff for Covid-19 within five days

A trust in the South East of England has committed to testing its entire workforce for Covid-19 in the next few days, to help “identify and isolate” asymptomatic staff, as services that were previously suspended begin to re-open. East Kent Hospitals University NHS Foundation Trust…

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Microbiology Quiz Series - 13

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Covid-19 has ‘exacerbated’ challenges faced by young people with epilepsy

The cancelation of clinical procedures and a rise in seizures and stress are among the challenges faced by young people with epilepsy during the coronavirus pandemic, a leading charity has found. A new study from Young Epilepsy has uncovered the difficulties experienced by young people…

The post Covid-19 has ‘exacerbated’ challenges faced by young people with epilepsy appeared first on Nursing Times.

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How a pandemic affects the mental health of the nursing workforce

International research on the experiences of nurses during outbreaks of infectious diseases highlights how their mental and wellbeing is affected by caring for patients in stressful and challenging situations

The post How a pandemic affects the mental health of the nursing workforce appeared first on Nursing Times.

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Anatomy and Physiology Quiz Series - 13

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Nursing Management Quiz Series - 15

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‘More nurses needed’ to address learning disability health inequalities

Greater recognition is needed of the part learning disability nurses can play in addressing health inequalities among vulnerable people and understanding early signs of health deterioration, to reduce the number of avoidable deaths, a leading nurse has said. Learning disability nurse consultant Jim Blair told…

The post ‘More nurses needed’ to address learning disability health inequalities appeared first on Nursing Times.

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Flu jab programme set for ‘massive’ expansion ready for winter with Covid-19

The flu vaccination programme in the UK will be "massively" expanded this winter to help the NHS cope with the ongoing coronavirus pandemic, the government has said. At what is already traditionally a challenging time of the year for clinicians, prime minister Boris Johnson said…

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New training for school nurses helping pupils return after lockdown

A new bespoke training course has been launched to help equip school nurses with the skills and knowledge they need to best support children and young people in their return to school amid the coronavirus pandemic. The free resource will be provided by the School and…

The post New training for school nurses helping pupils return after lockdown appeared first on Nursing Times.

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Nurse secures new job through coronavirus redeployment

A mental health nurse who was left feeling “totally gutted” when she was selected for deployment as part of the coronavirus response has since secured a job in the team she was moved to. Kim Carter was working as a clinical nurse lead on an…

The post Nurse secures new job through coronavirus redeployment appeared first on Nursing Times.

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‘Prediabetes’ link to increased risk of heart disease prompts call for screening

Prediabetes is associated with an increased risk of cardiovascular disease and death in both the general population and in patients with a history of heart problems, according to researchers. They suggested the screening and proper management of prediabetes may help to prevent cardiovascular disease in…

The post ‘Prediabetes’ link to increased risk of heart disease prompts call for screening appeared first on Nursing Times.

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A&E patients often overestimate CPR success, warn researchers

Patients and the public appear to significantly overestimate the success of cardiopulmonary resuscitation (CPR), potentially affecting issues around consent, according to US researchers. In contrast, people tend to underestimate the negative impact CPR can have on health of those who have received it, said study…

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‘Even more’ nurses considering quitting the profession, survey reveals

There has been a sharp rise in the number of nurses considering quitting the profession compared to this time last year, suggest results from a new survey. The research also found that “existing tensions” among the workforce appeared to have been “exacerbated” by the Covid-19…

The post ‘Even more’ nurses considering quitting the profession, survey reveals appeared first on Nursing Times.

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Nursing Research Quiz Series - 18

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Funding offer announced for local maternity support worker training

Health Education England (HEE) has launched a £1m fund for maternity support worker education and training. HEE is inviting local maternity services from the across the country to bid for funding to support the education, training and development of maternity support workers in their area.…

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Former RCN chief exec and community nurse leader honoured by college

A well-respected community nursing charity leader and one of the Royal College of Nursing’s former chief executives are among those honoured today for their contribution to the profession. The RCN has announced the recipients of its annual awards, including seven new fellowships, an honorary fellowship…

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Recently created mental health trust reveals new chief nurse

Black Country Healthcare NHS Foundation Trust has announced the appointment of a new chief nurse to replace the current incumbent who is set to retire this summer. Dean Howells will join the new trust as chief nurse from his present post in London, where he…

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‘Worrying increase’ in number of learning disabilities inpatients during lockdown

The number of people with a learning disability and/or autism in inpatient facilities has seen a “worrying increase” during the coronavirus lockdown, a leading charity has warned. Figures published by NHS Digital today showed at least 2,085 people with a learning disability and/or autism were…

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Nurses in Rotherham set to benefit from online group service amid Covid-19

Nurses and midwives in Rotherham are being offered a series of online sessions, where they can access additional mentoring and peer support from colleagues, to help them through the coronavirus pandemic. The initiative comes from the Florence Nightingale Foundation, which launched a group video calling…

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Government’s Covid-19 inquiry must hear experiences of all nurses, says RCN

An independent inquiry into Covid-19 must be done urgently and with the input of nurses across all settings and sectors, according to the Royal College of Nursing. The RCN warned that an investigation into the coronavirus crisis and the way it has been handled in…

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Nursing Education Quiz Series - 14

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Cyclobenzaprine Hydrochloride

Drug Name

Generic Name : cyclobenzaprine hydrochloride

Brand Name: Apo-Cyclobenzaprine (CAN), Flexeril, Novo-Cycloprine (CAN)

Classification: Skeletal muscle relaxant (centrally acting)

Pregnancy Category B

Dosage & Route

Adults

• 5 mg PO tid, 10 mg PO tid (range 20–40 mg/day in divided doses); do not exceed 60 mg/day; do not use longer than 2 or 3 wk.

Pediatric Patients

• Safety and efficacy in patients < 15 yr not established.

Therapeutic actions

• Precise mechanism not known; does not directly relax tense skeletal muscles but appears to act mainly at brain stem levels or in the spinal cord.

Indications

• Relief of discomfort associated with acute, painful musculoskeletal conditions, as adjunct to rest, physical therapy
• Unlabeled use: Adjunct in the management of fibrositis syndrome

Adverse effects

• Antimuscarinic effects, neurological adverse effects, GI disorders, orthostatic hypotension, tachycardia, hypersensitivity reactions. Rarely, cholestatic jaundice and blood disorders. Endocrine effects, sexual dysfunction, changes in blood sugar. Increased appetite with wt gain, sweating.

Contraindications

• Contraindicated with hypersensitivity to cyclobenzaprine, acute recovery phase of MI, arrhythmias, heart block or conduction disturbances, CHF, hyperthyroidism.
• Use cautiously with urinary retention, angle-closure glaucoma, increased IOP, lactation, mild hepatic impairment.

Nursing considerations

Assessment

• History: Hypersensitivity to cyclobenzaprine, acute recovery phase of MI, arrhythmias, CHF, hyperthyroidism, urinary retention, angle-closure glaucoma, increased IOP, lactation
• Physical: Orientation, affect, ophthalmic examination (tonometry); bowel sounds, normal GI output; prostate palpation, normal voiding pattern; thyroid function tests

Interventions

• Arrange for analgesics if headache occurs.

Teaching points

• Take this drug exactly as prescribed. Do not take a higher dosage.
• Avoid alcohol, sleep-inducing, or over-the-counter drugs; these may cause dangerous effects.
• You may experience these side effects: Drowsiness, dizziness, blurred vision (avoid driving or engaging in activities that require alertness); dyspepsia (take drug with food; eat frequent small meals); dry mouth (suck sugarless lozenges or ice chips).
• Report urinary retention or difficulty voiding, pale stools, yellow skin or eyes.

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Installing lights in hospital mortuary helping bereaved families, say nurses

Nurses at a hospital in Middlesbrough have helped transform the corridor that leads to its mortuary viewing room in a bid to make visits for bereaved families “more bearable”. A series of scenic light boxes have been installed at the James Cook University Hospital to help…

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Warning that nursing is ‘missing’ from new primary care networks

Nurses are missing from influential roles at a swathe of new primary care networks (PCNs), designed to connect GP practices and boost integrated care in England, a year after they were set up, Nursing Times has been told. The clinical director of one of the new…

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Exclusive: Working conditions contributing to poor nurse wellbeing

A new workplace culture is needed that “explicitly recognises” how the very nature of the work carried out by nurses and midwives can strain their mental health, researchers have warned. They called for action to tackle the “organisational causes” of stress that increase the burden…

The post Exclusive: Working conditions contributing to poor nurse wellbeing appeared first on Nursing Times.

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Nursing academics develop new hand-washing training course amid Covid-19

A team of nursing academics has created a new online training course for fellow health and care professionals about the importance of hand hygiene and how it helps combat coronavirus. The new e-learning platform is on offer to all health and care professionals but is…

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Coronavirus NHS death in service scheme extended in Scotland

A one-off payment of £60,000 will be provided to families of all health and social care workers in Scotland who died in service because of Covid-19, it has been announced. The offer is an extension to the NHS Scotland Coronavirus Assurance Scheme that was launched…

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Child Health Nursing Quiz Series - 14

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International nurses ‘now exempt’ from immigration health surcharge

The promised exemption to the immigration health surcharge for overseas health and care staff will come into force immediately and be backdated to 31 March, the government has finally confirmed. Ministers today offered further details about the scheme after coming under pressure from unions, opposition…

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Government promises new national guidance on DNACPR orders

Updated guidance is to be rolled out in England for patients and staff on the use of do not attempt cardiopulmonary resuscitation (DNACPR) orders, following reports of poor practice during the coronavirus pandemic. NHS England and NHS Improvement are putting together “system and patient-facing guides”…

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Tributes flood in for ‘exemplary’ school nurse after shock death

A school nurse who died unexpectedly this month at the age of 44 has been remembered as a tireless advocate for children and young people whose passion for her speciality was “infectious”. Friends and colleagues have paid tribute to Caroline Lowton, who worked across nine…

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Obstetric and Gynecological Nursing Quiz Series - 13

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RCN launches new resource to help nurses ’embrace’ digital tools

A new online resource has been launched to help nurses lead the use of emerging digital tools across health and social care. The Royal College of Nursing has created the new online platform to help demystify the role of digital technology in the profession and show…

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Plans confirmed for ‘fast-track’ nurse visas under new immigration system

Overseas nurses who want to come and work in the UK from 2021 will be eligible for reduced fees and fast-track entry, as part of a new health and care visa scheme, the government has confirmed. Home secretary Priti Patel today revealed more details about…

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Heart abnormalities found in half of scanned Covid-19 patients

Heart scans could prove crucial for improving some patients' Covid-19 recovery and preventing potential long-term damage, according to a new study which found half of coronavirus patients who had a heart scan in hospital showed abnormalities. Researchers from the British Heart Foundation Centre of Research…

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Amnesty International raises concern over UK nurse deaths from Covid-19

The number of deaths among British health and care workers during the coronavirus pandemic has been highlighted as a concern by Amnesty International in a new report. Analysis from the global human rights organisation found that the UK had recorded the second-highest number of deaths…

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Mental Health Nursing Quiz Series - 16

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Community Health Nursing Quiz Series - 14

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Pharmacology Quiz Series - 15

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Return redeployed neurology nurse specialists ‘as soon as possible’

Specialist neurology nurses redeployed due to Covid-19 must be returned to their substantive roles as soon as possible to pull patients with complex conditions out of “limbo”, experts have warned. They told Nursing Times that the mass redeployment of more than 2,000 neurology specialist nurses…

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Exclusive: Spring students must wait extra academic year for new grant

Student nurses who are part of a spring cohort will have to wait until the start of their next academic year to benefit from a new maintenance grant that is being introduced in September, it has emerged. Those affected have told Nursing Times that they felt…

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Medical-surgical Nursing Quiz Series - 18

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Codeine Phosphate

Drug Name

Generic Name :codeine phosphate

Classification: Opioid agonist analgesic, Antitussive

Pregnancy Category C (during pregnancy)
Pregnancy Category D (during labor)
Controlled Substance C-II

Dosage & Route

Adults

Analgesic

• 15–60 mg PO, IM, IV or subcutaneously q 4–6 hr; do not exceed 360 mg/24 hr.

Antitussive

• 10–20 mg PO q 4–6 hr; do not exceed 120 mg/24 hr.

Pediatric Patients

• Contraindicated in premature infants.

Analgesic

• >1 yr: 0.5 mg/kg or 15 mg/m2 IM or subcutaneously q 4–6 hr.

Antitussive

• 2–6 yr: 2.5–5 mg PO q 4–6 hr; do not exceed 30 mg/24 hr.
• 6–12 yr: 5–10 mg PO q 4–6 hr; do not exceed 60 mg/24 hr.

Geriatric Patients or Impaired Adults

• Use caution; respiratory depression may occur in elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.

Therapeutic actions

• Codeine provides relief by blocking the ascending pain pathways by binding to opiate receptors found in the CNS. It also helps suppress cough by direct action in the medulla.

Indications

• Relief of mild to moderate pain in adults and children
• Suppression of coughing induced by chemical or mechanical irritation of the respiratory system

Adverse effects

• Dependence, withdrawal symptoms; nausea, vomiting, constipation; drowsiness, confusion; difficulty in micturition, ureteric or biliary spasms, urinary retention; dry mouth, dizziness, sweating, facial flushing, headache, vertigo, bradycardia, tachycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood changes, decreased libido or potency, hallucination, miosis; raised intracranial pressure, muscle rigidity.
• Potentially Fatal: Respiratory depression and hypotension, with circulatory failure and deepening coma (larger doses). Convulsions (especially in children and infants). Rhabdomyolysis.

Contraindications

• Respiratory depression, obstructive airway disease, asthma. Acute alcoholism, convulsive disorders, head injuries, comatose patients, raised intracranial pressure. Pregnancy (prolonged use or high doses at term).

Nursing considerations

CLINICAL ALERT! Name confusion has occurred between codeine and Cardene (nicardipine) and Lodine (etodolac); use caution.

Assessment

• History: Hypersensitivity to codeine, physical dependence on an opioid analgesic, pregnancy, labor, lactation, bronchial asthma, COPD, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic impairment
• Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse, auscultation, BP; R, adventitious sounds; bowel sounds, normal output; LFTs, renal function tests

Interventions

• Give to nursing women 4–6 hr before scheduled feeding to minimize drug in milk.
• WARNING: During parenteral administration, ensure that opioid antagonist and facilities for assisted or controlled respirations are readily available.
• Use caution when injecting subcutaneously into chilled body areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored.
• WARNING: Do not use IV in children.
• Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex.
• Monitor bowel function, arrange for laxatives (especially senna compounds—approximate dose of 187 mg senna concentrate per 120 mg codeine equivalent), bowel training program if severe constipation occurs.

Teaching points

• Take drug exactly as prescribed.
• Do not take any leftover medication for other disorders, and do not let anyone else take it.
• You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving and performing other tasks that require alertness); nausea, loss of appetite (lie quietly; eat frequent small meals); constipation (use a laxative).
• Report severe nausea, vomiting, palpitations, shortness of breath or difficulty breathing.

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