Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

Funded places for student nurses in Scotland to increase for 10th year

The Scottish Government has said it will increase the number of places it funds on nursing and midwifery courses for the 10th year in a row. Recommended undergraduate student nurse and midwife intake for 2022-23 has been set at 4,837 – a rise from 4,449…

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Redeploying specialist nurses is a false economy, warn Parkinson’s leaders

Health charity leaders have stressed the importance of keeping non-Covid-19 services “intact” amid the latest surge of the pandemic, warning that redeploying specialist nurses creates a “false economy”. In a letter to Nursing Times, Dr Rowan Wathes, associate director of the UK Parkinson’s Excellence Network,…

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Reduced isolation period: Nurses may be redeployed for three days

Nurses looking to take advantage of the newly reduced Covid-19 isolation period may still have to be redeployed for a few days if they work with vulnerable people. This week the government announced that people with Covid-19 will now be able to leave isolation after…

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Omicron: NMC takes action to address nursing workforce gaps

The Nursing and Midwifery Council has reopened its emergency Covid-19 register to internationally trained nurses, in light of the “increasingly severe pressures” being caused by the Omicron wave. Employers can now nominate overseas recruits in their workplaces who are on the pathway to NMC registration,…

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Chief nurses pay special thanks to profession as 2021 draws to a close

Nursing leaders from across the UK have expressed their gratitude for the continued efforts and dedication of the profession during another difficult year amid Covid-19. Ahead of the festive period and what is expected to be “one of the toughest winters in recent times”, chief…

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‘It was like a tumour growing’: Nurse survivor of domestic abuse tells her story

A nurse who was abused by her partner for almost a decade has shared her story with Nursing Times and set out her thoughts on the increased support that could be brought into the workplace to help others in her former situation. From monitoring the mileage…

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Obstetric and Gynecological Nursing Quiz Series - 18






Call for caution over plans to treat more Covid-19 patients at home

Community nursing leaders have responded to new national plans in England to urgently increase the number of Covid-19 patients who are treated at home on “virtual wards”. NHS England has set a new target for a “minimum” of 15% of would-be hospital patients with Covid-19…

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RCN confirms it will now begin application to re-join international group

The Royal College of Nursing has said it will now proceed with its application to re-join the International Council of Nurses. The announcement comes nearly eight months after members voted in favour of the move during the RCN’s annual general meeting in May 2021. Of…

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Obstetric and Gynecological Nursing Quiz Series - 17






Enduring pandemic pressures ‘taking a toll’ on health staff, warns union

Around two thirds of health staff have experienced burnout and feel overwhelmed due to the pressures of the pandemic, a new survey reveals. The union Unison surveyed more than 10,000 health workers across England, Wales and Northern Ireland, 90% of whom work for the NHS, between…

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Covid-19 isolation period reduced to seven days to ‘help public services’

The self-isolation period for people who test positive for Covid-19 has been reduced from 10 to seven days in England. Following the latest evidence from the UK Health Security Agency (UKHSA), the government has announced an update to self-isolation guidelines. The change means that, from…

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Northern Ireland confirms appointment of interim CNO

An interim chief nursing officer has been appointed for Northern Ireland, following the departure of Professor Charlotte McArdle. Professor McArdle’s former deputy, Linda Kelly, has stepped up into the CNO role, the country’s department of health has confirmed. Ms Kelly has been registered as a…

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Filipino nurse in UK describes feeling ‘hopeless’ in typhoon aftermath

A nurse who moved from the Philippines to work in the UK more than 15 years ago has told of the worry and hopelessness she felt when she was unable to make contact with her family back home during the aftermath of a devastating typhoon.…

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RCN announces new council leaders and flags hopes for ‘stability’

The Royal College of Nursing has announced the election of a new chair and vice chair of its governing council. Carol Popplestone has been selected as chair of RCN Council, and Mel Kerr as vice chair. “I look forward to working together to provide stability…

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Nursing student jailed for causing girl’s death by dangerous driving

A second-year nursing student has been found guilty of causing the death of a 13-year-old girl by dangerous driving. In addition to her nursing studies, which included a placement at a London hospital, Gardene De Carvalho was also working two paid full-time jobs at the…

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Professor warns of UK’s ‘increasing reliance’ on overseas nurses

The coronavirus pandemic is seeing the UK become “increasingly reliant” on internationally trained nurses, a leading nursing workforce expert has warned. Writing for Nursing Times today, Professor James Buchan, visiting professor at University of Edinburgh, puts forward data highlighting the “rapid” increase in new overseas…

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Petra Srncova: Vigil held as police confirm nursing assistant was not murdered

A candlelit vigil has been held for Petra Srncova in the London park where the senior nursing assistant's body was found earlier this month. The service came as police released an update confirming that no evidence had been found to suggest that Ms Srncova had…

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Fundraiser to support NHS Filipino nurses affected by ‘super typhoon’

A fundraising campaign has been launched to support Filipino nurses working in the NHS who have been affected by a devastating 'super typhoon' in their native country. Louie Horne, deputy associate director of nursing at East Suffolk and North Essex NHS Foundation Trust, is raising…

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Warning against further redeployment of heart failure specialists

It is “imperative” that heart failure specialists remain in place during the latest surge of Covid-19 and are not redeployed as they were in previous waves, a leading nurse at a UK charity has warned. The newly appointed chair of the British Society for Heart…

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Omicron: Staff absences intensifying pressures for London nurses

Nurses in London are being “pushed past the point of exhaustion” due to soaring Covid-19 cases and existing gaps in the workforce being worsened by rising numbers of staff absences, Nursing Times has been told. The situation led London mayor Sadiq Khan to declare a…

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England’s CNO urges student and retired nurses to join booster jab workforce

The chief nursing officer for England has made a direct plea to former and future nurses to help support the Covid-19 booster vaccination programme, as Omicron cases soar across the country. Ruth May has today paid tribute to NHS staff and volunteers who were “going…

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RCN provides pay campaign update after strike ballots fail to achieve turnout

The Royal College of Nursing has provided an update on its fair pay for nursing campaign, after its proposals for industrial action failed to attract enough engagement from members. The college's position is that nurses across the UK need a 12.5% pay increase to bring…

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‘Significant’ levels of distress among nurses during pandemic first wave

Surveys conducted with thousands of UK nursing and midwifery staff during the early stages of Covid-19 have revealed “extremely concerning” levels of psychological distress among the workforce. The team behind the ongoing Impact of Covid-19 on the Nursing and Midwifery workforce (ICON) have this week…

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Many nurses ‘lack confidence’ in responding to violence against women

More training is needed at both pre- and post-registration level to ensure nurses feel “confident” to ask about and recognise the signs of violence against women, a specialist nurse has urged. Leanne Patrick, specialist nurse in domestic abuse and sexual violence in Scotland, has written…

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WHO Europe launches new nursing and midwifery ‘roadmap’

A new “roadmap” for strengthening nursing and midwifery across Europe has been launched by the regional branch of the World Health Organization for the continent. The framework encourages European countries to place nurses and midwives “firmly on political agendas”, as they look to maintain, rebuild…

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Campaign to protect ‘nurse’ title continues as petition comes to close

The petition calling for protection of the ‘nurse’ job title in UK law has now officially closed with more than 33,000 signatures. The nurse behind the #ProtectNurse campaign, Professor Alison Leary, said work to secure the required changes in legislation was pushing ahead. It comes…

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Mandatory vaccination for NHS staff in England voted through by MPs

MPs have given the green-light to making Covid-19 vaccination mandatory for all patient-facing health and social care workers in England including nurses. The move was passed by 385 votes to 100 during a session in the House of Commons last night when other measures proposed…

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Nurses respond to letter from PM with reality check on workforce challenges

Nurses and colleagues have warned that workforce constraints mean it is currently not possible to “safely” deliver latest targets for the Covid-19 booster vaccination programme alongside maintaining other services. They accused the government of ignoring calls to address workforce shortages and said working throughout the…

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Pandemic sees NHS cervical screening coverage drop by 2%

Cervical screening coverage in England has declined by 2% during the coronavirus pandemic, new data has revealed. Those behind the latest statistics for 2020-21 suggested that disruption caused by Covid-19 was “likely to have had an effect on activity” within the NHS cervical screening programme.…

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Student Nursing Times Awards 2022 now open for entries

The only national awards dedicated to celebrating student nurses and nursing education across the UK have opened for 2022 entries. The Student Nursing Times Awards 2022 is accepting nominations across 21 categories designed to recognise outstanding early career nurses and those going above and beyond…

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Preceptorship survey: Is support for newly registered nurses good enough?

The extent to which newly registered nurses across the UK are being supported as they start their careers is the subject of a new survey launched today by Nursing Times in partnership with Unison and the Florence Nightingale Foundation. The survey is seeking to find…

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‘Running on empty’: Concern for nursing workforce amid Omicron wave

Already burnt out and exhausted nurses are feeling anxious and fearful of the weeks to come amid an incoming “tidal wave” of the new Omicron Covid-19 variant, Nursing Times has been told. Nurse leaders have warned that many among the profession would “rather retire” or…

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Analysis: Student nursing numbers in the devolved UK countries

The nurse training situation in the devolved UK nations has been analysed by Nursing Times following the release of final 2021 data by the Universities and College Admissions Service (UCAS). While health leaders in England heralded a record increase in acceptances to nursing and midwifery…

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Interim Scotland CNO appointed to role on substantive basis

The nurse leader who has been carrying out the role of Scotland’s chief nursing officer (CNO) on an interim basis since October has now been appointed to the position permanently. Professor Alex McMahon was previously the executive director of nursing, midwifery and allied health professionals…

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Body found in search for missing nursing assistant from London children’s hospital

Police searching for a missing senior nursing assistant in London have confirmed a body has been found. Petra Srncova, 32, who is from Camberwell and works at Evelina London Children’s Hospital, was reported missing on Friday 3 December by a concerned colleague. “This is extremely…

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Nursing course leader appeals for former nurses to return to practice

Nurses whose registration has lapsed are being encouraged to do a short training course that will allow them to return to practice and ease some of the workforce pressures on the NHS. Janet Wilson, course leader for nursing at CU Scarborough, which is part of…

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Hospital hoping to overcome nurse staffing challenge with new ’emergency village’

A hospital that was forced to suspend paediatric inpatient care due to nurse shortages has announced hopes to reintroduce these services under plans to create a new “emergency village”. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust has received £17.6m to fund an expanded emergency…

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Race and health experts call for greater vaccine equity to fight Omicron

Race and health experts have stressed the importance of vaccine equity so that more nations can benefit and be protected, in light of the emergence of the Omicron variant of covid-19. The latest call for vaccines to be allocated equally across all countries, regardless of…

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Sheffield nurse charged with multiple sexual offences against staff and patients

An operating theatre nurse has been charged with a series of sexual offences against staff and patients at the hospital where he worked in Sheffield. Paul Neil Grayson, 51, has been charged with a total of 20 offences, of which 13 were allegedly committed at…

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Mental health nurse numbers ‘not meeting national targets’

The number of mental health nurses in the English NHS has not grown in line with national targets promised by the government, a new report has revealed. Those behind the newly published report therefore warned that the government’s efforts around increasing the mental health workforce…

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Chief nurse appointed for new south west London hospitals group

Arlene Wellman has been appointed the group chief nursing officer at the newly formed St George’s Epsom and St Helier hospitals group. She is one of the executive team that will take over leadership of the hospitals group from 10 January 2022. "I remain committed…

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Temporary register playing ‘vital’ role but many nurses still awaiting job offer

More than a quarter of trained nursing and midwifery professionals who joined a temporary register to practise during the pandemic were never given an offer of employment, a snapshot survey shows. However, those who have been given an opportunity to help have made "vital contributions",…

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Final UCAS data for 2021 confirms record rise in student nurses in England

End of cycle data from the Universities and Colleges Admissions Service (UCAS) has confirmed a record number of student nurses and midwives have been accepted onto courses in England this year. UCAS today released its final figures for the nursing and midwifery intake in 2021…

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Nursing leaders welcome ‘Plan B’ measures to tackle Omicron threat

“Plan B” measures to slow down the spread of the Covid-19 pandemic are being implemented in England to prevent the NHS being overwhelmed by a surge of cases related to the Omicron variant. The booster vaccine campaign is also being expanded to provide extra protection…

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NHS Scotland releases ‘worrying’ nursing and midwifery vacancy numbers

Nursing unions in Scotland have expressed worry over new NHS data showing nursing and midwifery vacancies have increased by 1,000 posts over the last quarter. On 30 June, quarterly NHS Scotland workforce data recorded 4,845.4 whole time equivalent (WTE) nurse and midwife vacancies and by…

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May Parsons praises ‘stellar efforts’ of NHS staff on Covid-19 jab anniversary

Marking a year to the day since she administered the first Covid-19 vaccine outside a clinical trial, matron May Parsons has paid tribute to the “stellar” efforts of NHS staff who she said had made the UK’s vaccination programme a success. Speaking to Nursing Times…

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Lord Stevens backs drive for better NHS workforce planning

The former chief executive of NHS England has joined calls to amend the new Health and Care Bill to improve workforce planning. Lord Simon Stevens said previous workforce plans for education and training had been “muzzled” and that changes to the bill could address this.…

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Op cancellation data sparks call for ‘sustainable’ nurse workforce strategy

The nursing regulator has said health leaders need to "collaborate on a sustainable strategy" to bolster nursing and midwifery recruitment and retention, amid concerns about service pressures. New data released this week by the the Royal College of Emergency Medicine (RCEM) showed that more than…

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Calls for student nurses to support vaccine roll out amid Omicron

Student nurses are being encouraged to take on non-registered roles in the NHS alongside their studies to support the expansion of the Covid-19 vaccination programme, in wake of the new Omicron variant. It was announced last week that a booster dose of the Covid-19 vaccine…

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Diltiazem Hydrochloride

 Drug Name


Generic Name : diltiazem hydrochloride

Brand Name: Apo-Diltiaz (CAN), Cardizem, Cardizem CD, Cardizem LA, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Gen-Diltiazem (CAN), Gen-Diltizaem CD (CAN), Novo-Diltiazem (CAN), Novo-Diltiazem CD (CAN), Nu-Diltiaz (CAN), ratio-Diltiazem (CAN), Tiazac

Classification: Calcium channel blockerAntianginalAntihypertensive

Pregnancy Category C

Dosage & Route
  • Evaluate patient carefully to determine the appropriate dose of this drug.
ADULTS
  • Initially, 30 mg PO qid before meals and hs; gradually increase dosage at 1- to 2-day intervals to 180–360 mg PO in three to four divided doses.
Extended-release
  • Cardizem CD and Cartia XT: 180–240 mg PO for hypertension; 120–180 mg daily PO for angina.
  • Cardizem LA: 120–540 mg daily PO for hypertension; 180–360 mg/day PO for chronic, stable angina. May be given with nitroglycerine or nitrate therapy.
  • Dilacor XR and Diltia XT: 180–240 mg daily PO as needed; up to 480 mg has been used.
  • Tiazac: 120–240 mg daily PO for hypertension—once daily dose; 120–180 mg PO once daily for angina.
IV
  • Direct IV bolus: 0.25 mg/kg (20 mg for the average patient); second bolus of 0.35 mg/kg.
  • Continuous IV infusion: 5–10 mg/hr with increases up to 15 mg/hr; may be continued for up to 24 hr.
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
Therapeutic actions
  • Diltiazem relaxes coronary vascular smooth muscles by inhibiting influx of calcium ions during depolarisation of the vascular smooth muscles and myocardium. It increases myocardial O2 delivery in patients with vasospastic angina and inhibits cardiac conduction, particularly at the SA and AV nodes.
Indications
  • Angina pectoris due to coronary artery spasm (Prinzmetal’s variant angina)
  • Effort-associated angina; chronic stable angina in patients not controlled by beta-adrenergic blockers, nitrates
  • ER form: Essential hypertension
  • Parenteral: Paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter
Adverse effects
  • Headache, ankle oedema, hypotension, dizziness, fatigue, flushing, nausea, GI discomfort, gingival hyperplasia, rashes, erythema multiforme, exfoliative dermatitis, photosensitivity, occasionally hepatitis.
  • Potentially Fatal: AV block, bradycardia, asystole, sinus arrest.
Contraindications
  • Sick-sinus syndrome; 2nd or 3rd ° AV block; porphyria. Severe congestive cardiac failure; marked bradycardia. Pregnancy and lactation.
Nursing considerations
Assessment
  • History: Allergy to diltiazem, impaired hepatic or renal function, sick sinus syndrome, heart block, lactation, pregnancy
  • Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, normal output; LFTs, renal function tests, urinalysis
Interventions
  • Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to therapeutic dose; dosage may be increased more rapidly in hospitalized patients under close supervision.
  • Monitor BP carefully if patient is on concurrent doses of nitrates.
  • Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.
  • Ensure patient swallows ER preparations whole; do not cut, crush, or chew.
Teaching points
  • Swallow extended-release and long-acting preparations whole; do not cut, crush, or chew; do not drink grapefruit juice while using this drug.
  • You may experience these side effects: Nausea, vomiting (eat frequent small meals); headache (regulate light, noise, and temperature; medicate if severe).
  • Report irregular heart beat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

Guidance published to help mental health settings implement new restraint law

The government has today published long-awaited guidance to support the implementation of new legislation which seeks to prevent inappropriate use of physical force against mental health patients. Seni’s Law, also known as the Mental Health Units (Use of Force) Act 2018, will officially come into…

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Exclusive: Labour nurse advisor asked to work directly with party leader

Labour Party leader Keir Starmer has appointed former health minister and district nurse Ann Keen as his nursing advisor, Nursing Times can exclusively reveal. Since May, Ms Keen had been working as nursing advisor to shadow health and social secretary Jonathan Ashworth until his recent…

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Government confirms community transmission of Omicron now happening in UK

The new Covid-19 variant is now being transmitted between people in the UK, the government has confirmed in an update branded "concerning" by health service groups. In a statement to the House of Commons yesterday, health and social care secretary Sajid Javid said that there…

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‘Day in the life of’ film series to showcase newly-registered nurses

A series of short films documenting the experiences of newly-registered nurses is to be launched today, in the hope of showcasing “what a great profession nursing” is. The Royal College of Nursing is this evening holding a premiere viewing of six films starring members of…

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Child Health Nursing Quiz Series - 22

New isolation gowns aim to be ‘safer, more comfortable and sustainable’

New isolation gowns, that academics say could be “safer, more comfortable and sustainable” than existing types, as well as potentially helping to protect nurses against Covid-19, are being developed by UK researchers. The prototypes have been developed through a collaboration between Nottingham Trent University (NTU)…

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New archive of memorabilia on WWI nurse Edith Cavell launched

A new archive celebrating Edith Cavell, a British nurse who saved the lives of British, French and Belgium soldiers and civilians in Brussels during World War 1, has been launched in Norfolk, the county of her birth. The launch of the collection took place on…

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Health visitors face ‘biggest workforce challenge yet’ amid soaring demand

More than one in four health visitors across England are accountable for triple the recommended number of children, while just 9% are working within advised ratios, latest data has revealed. Findings from an Institute of Health Visiting’s (IHV) survey has laid bare the pressures on…

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Student nurse course places to increase by almost 200 in Wales

A £260m funding package for training health professionals in Wales will see almost 200 additional pre-registration nurse training places created, it has been announced. The Welsh Government has approved Health Education and Improvement Wales’ (HEIW) education and training plan for NHS Wales in 2022-23, which…

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Collection of Florence Nightingale personal letters to be auctioned

A collection of original letters written and signed by nursing pioneer Florence Nightingale are set to be auctioned on Saturday. The letters, which date from between 1820 and 1910, are addressed to Ms Nightingale’s retired housekeepers, a couple called Mary and John Bratby, living in…

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Fundamental of Nursing Quiz Series - 20

Child Health Nursing Quiz Series - 21

Convulsion

 Description

convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body.Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure. However, not all epileptic seizures lead to convulsions, and not all convulsions are caused by epileptic seizures. Convulsions are also consistent with an electric shock.

Epilepsy – Symptom complex characterized by attacks of unconsciousness that may or may not be associated with convulsions, sensory phenomenon or abnormalities in behaviour.

Predisposing FactorsConvulsion
  1. Head injury due to birth trauma
  2. Genetics
  3. Presence of brain tumor
  4. Toxicity from
    • Lead
    • carbon monoxide
  5. Nutritional and Metabolic deficiencies
  6. Physical and emotional stress
  7. Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam, Valium)
Signs and Symptoms
I. Generalize
Primarily generalized seizures can be sub-classified into a number of categories, depending on their behavioural effects:
  • Petit mal Seizures (Absence seizures) involve an interruption to consciousness where the person experiencing the seizure seems to become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight muscle twitching may occur.
  • Myoclonic seizures involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky movements of muscles or muscle groups.
  • Clonic seizures are myoclonus that are regularly repeating at a rate typically of 2-3 per second. in some cases, the length varies.
  • Tonic–clonic seizures (Grand Mal Seizures) involve an initial contraction of the muscles (tonic phase) which may involve tongue biting, urinary incontinence and the absence of breathing. This is followed by rhythmic muscle contractions (clonic phase). This type of seizure is usually what is referred to when the term ‘epileptic fit’ is used colloquially.
  • Atonic seizures involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes called ‘drop attacks’ but should be distinguished from similar looking attacks that may occur in cataplexy.
II. Partial or Localized Seizures

Partial seizures (also called focal seizures and localized seizures) are seizures which affect only a part of the brain at onset.The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parietal and occipital lobes. In partial seizures the seizure is generated in and affects just one part of the brain – the whole hemisphere or part of a lobe. .

Partial seizures can be further characterized as:

  • Simple — not affecting awareness or memory
  • Complex — affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior

Jacksonian (focal Seizure)

  • Jacksonian seizure (or Jacksonian march) is a phenomenon where simple partial seizure spread from distal part of limb to face ipsilaterally (on same side of body). They involve a progression of the location of the seizure in the brain, which leads to a “march” of the motor presentation of symptoms.

Complex partial seizures (AKA Psychomotor Seizure and focal motor seizure)

  • A complex partial seizure is an epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. alteration of consciousness.
  • Complex partial seizures are often preceded by a seizure aura.The seizure aura is a simple partial seizure. The aura may manifest itself as a feeling of déjà vu, jamais vu, fear, euphoria or depersonalization.The seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia).Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing.There may also be loss of memory (amnesia) surrounding the seizure event. The person may still be able to perform routine tasks such as walking. Witnesses may not recognize that anything is wrong.
  • Complex partial seizures might arise from any lobe of the brain.Complex partial seizures most commonly arise from the mesial temporal lobe, particularly the amygdala, hippocampus, and neocortical regions. A common associated brain abnormality is mesial temporal sclerosis. Mesial temporal sclerosis is a specific pattern of hippocampal neuronal loss accompanied by hippocampal gliosis and atrophy.Complex partial seizures occur when excessive and synchronous electrical brain activity causes impaired awareness and responsiveness.The abnormal electrical activity might spread to the rest of the brain and cause a secondary generalized tonic–clonic seizure.
III. Status Epilepticus
  • A continuous uninterrupted seizure activity, if left untreated can lead to hyperpyrexia and lead to coma and eventually death.
  • Drug of choice: Diazepam, Valium and Glucose
Diagnostic Procedures
  1. CT Scan – reveals brain lesions
  2. EEG – reveals hyper activity of electrical brain waves
Nursing Management
  1. Maintain patent airway and promote safety before seizure activity
    • clear the site of blunt or sharp objects
    • oosen clothing of client
    • maintain side rails
    • avoid use of restrains
    • turn clients head to side to prevent aspiration
    • place mouth piece of tongue guard to prevent biting or tongue
  2. Avoid precipitating stimulus such as bright/glaring lights and noise
  3. Administer medications as ordered
    • Anti convulsants (Dilantin, Phenytoin)
    • Diazepam, Valium
    • Carbamazepine (Tegretol) – Trigeminal neuralgia
    • Phenobarbital, Luminal
  4. Institute seizure and safety precaution post seizure attack
    • administer O2 inhalation
    • provide suction apparatus
  5. 5. Document and monitor the following
    • onset and duration
    • types of seizures
    • duration of post ictal sleep may lead to status epilepticus
    • assist in surgical procedure cortical resection
Nursing Care Plan

Nursing Diagnosis
  • Risk for Trauma
  • Risk for Suffocation

Risk factors may include

  • Weakness, balancing difficulties; reduced muscle, hand or eye coordination
  • Poor vision
  • Reduced sensation
  • Cognitive limitations or altered consciousness
  • Loss of large or small muscle coordination
  • Emotional difficulties

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
  • Verbalize understanding of factors that contribute to the possibility of trauma and or suffocation and take steps to correct the situation.
  • Identify actions or measures to take when seizure activity occurs.
  • Identify and correct potential risk factors in the environment.
  • Demonstrate behaviors, lifestyle changes to reduce risk factors and protect self from injury.
  • Modify environment as indicated to enhance safety.
  • Maintain treatment regimen to control or eliminate seizure activity.
  • Recognize the need for assistance to prevent accidents or injuries.
Nursing Interventions
  • Determine factors related to individual situation, as listed in Risk Factors, and extent of risk.
    • Rationale: Influences scope and intensity of interventions to manage threat to safety.
  • Note client’s age, gender, developmental age, decision-making ability, level of cognition or competence.
    • Rationale: Affects client’s ability to protect self and others, and influences choice of interventions and teaching.
  • Ascertain knowledge of various stimuli that may precipitate seizure activity.
    • Rationale: Alcohol, various drugs, and other stimuli (loss of sleep, flashing lights, prolonged television viewing) may increase brain activity, thereby increasing the potential for seizure activity.
  • Review diagnostic studies or laboratory tests for impairments and imbalances.
    • Rationale: Such may result in or exacerbate conditions, such as confusion, tetany, pathological fractures, etc.
  • Explore and expound seizure warning signs (if appropriate) and usual seizure pattern. Teach SO to determine and familiarize warning signs and how to care for patient during and after seizure attack.
    • Rationale: Enables patient to protect self from injury and recognize changes that require notification of physician and further intervention. Knowing what to do when seizure occurs can prevent injury or complications and decreases SO’s feelings of helplessness.
  • Use and pad side rails with bed in lowest position, or place bed up against wall and pad floor if rails not available or appropriate.
    • Rationale: Prevents or minimizes injury when seizures (frequent or generalized) occur while patient is in bed. Note: Most individuals seize in place and if in the middle of the bed, individual is unlikely to fall out of bed.
  • Educate patient not to smoke except while supervised.
    • Rationale: May cause burns if cigarette is accidentally dropped during aura or seizure activity.
  • Evaluate need for or provide protective headgear.
    • Rationale: Use of helmet may provide added protection for individuals who suffer recurrent or severe seizures.
  • Avoid using thermometers that can cause breakage. Use tympanic thermometer when necessary to take temperature.
    • Rationale: Reduces risk of patient biting and breaking glass thermometer or suffering injury if sudden seizure activity should occur.
  • Uphold strict bedrest if prodromal signs or aura experienced. Explain necessity for these actions.
    • Rationale: Patient may feel restless or need to ambulate or even defecate during aural phase, thereby inadvertently removing self from safe environment and easy observation. Understanding importance of providing for own safety needs may enhance patient cooperation.
  • Do not leave the patient during and after seizure.
    • Rationale: Promotes safety measures.
  • Turn head to side and suction airway as indicated. Insert plastic bite block only if jaw relaxed.
    • Rationale: Helps maintain airway patency and reduces risk of oral trauma but should not be “forced” or inserted when teeth are clenched because dental and soft-tissue damage may result. Note: Wooden tongue blades should not be used because they may splinter and break in patient’s mouth.
  • Support head, place on soft area, or assist to floor if out of bed. Do not attempt to restrain.
    • Rationale: Supporting the extremities lessens the risk of physical injury when patient lacks voluntary muscle control. Note: If attempt is made to restrain patient during seizure, erratic movements may increase, and patient may injure self or others.
  • Note preseizure activity, presence of aura or unusual behavior, type of seizure activity (location or duration of motor activity, loss of consciousness, incontinence, eye activity, respiratory impairment or cyanosis), and frequency or recurrence. Note whether patient fell, expressed vocalizations, drooled, or had automatisms (lip-smacking, chewing, picking at clothes).
    • Rationale: Helps localize the cerebral area of involvement.
  • Provide neurological or vital sign check after seizure (level of consciousness, orientation, ability to comply with simple commands, ability to speak; memory of incident; weakness or motor deficits; blood pressure (BP), pulse and respiratory rate).
    • Rationale: Documents postictal state and time or completeness of recovery to normal state. May identify additional safety concerns to be addressed.
  • Reorient patient following seizure activity.
    • Rationale: Patient may be confused, disoriented, and possibly amnesic after the seizure and need help to regain control and alleviate anxiety.
  • Allow postictal “automatic” behavior without interfering while providing environmental protection.
    • Rationale: May display behavior (of motor or psychic origin) that seems inappropriate or irrelevant for time and place. Attempts to control or prevent activity may result in patient becoming aggressive or combative.
  • Investigate reports of pain.
    • Rationale: May be result of repetitive muscle contractions or symptom of injury incurred, requiring further evaluation or intervention.
  • Detect status epilepticus (one tonic-clonic seizure after another in rapid succession).
    • Rationale: This is a life-threatening emergency that if left untreated could cause metabolic acidosis, hyperthermia, hypoglycemia, arrhythmias, hypoxia, increased intracranial pressure, airway obstruction, and respiratory arrest. Immediate intervention is required to control seizure activity and prevent permanent injury or death. Note: Although absence seizures may become static, they are not usually life-threatening.

Carry out medications as indicated: Specific drug therapy depends on seizure type, with some patients requiring polytherapy or frequent medication adjustments.

  • Antiepileptic drugs (AEDs): phenytoin (Dilantin), primidone (Mysoline), carbamazepine (Tegretol), clonazepam (Klonopin), valproic acid (Depakene), divalproex (Depakote), acetazolamide (Diamox), ethotoin (Peganone), methsuximide (Celotin), fosphenytoin (Cerebyx);
    • Rationale: AEDs raise the seizure threshold by stabilizing nerve cell membranes, reducing the excitability of the neurons, or through direct action on the limbic system, thalamus, and hypothalamus. Goal is optimal suppression of seizure activity with lowest possible dose of drug and with fewest side effects. Cerebyx reaches therapeutic levels within 24 hr and can be used for nonemergent loading while waiting for other agents to become effective. Note: Some patients require polytherapy or frequent medication adjustments to control seizure activity. This increases the risk of adverse reactions and problems with adherence.
  • Topiramate (Topamax), ethosuximide (Zarontin), lamotrigine (Lamictal), gabapentin (Neurontin);
    • Rationale: Adjunctive therapy for partial seizures or an alternative for patients when seizures are not adequately controlled by other drugs.
  • Phenobarbital (Luminal);
    • Rationale: Potentiates and enhances effects of AEDs and allows for lower dosage to reduce side effects.
  • Lorazepam (Ativan);
    • Rationale: Used to abort status seizure activity because it is shorter acting than Valium and less likely to prolong post seizure sedation.
  • Diazepam (Valium, Diastat rectal gel);
    • Rationale: May be used alone (or in combination with phenobarbital) to suppress status seizure activity. Diastat, a gel, may be administered rectally, even in the home setting, to reduce frequency of seizures and need for additional medical care.
  • Glucose, thiamine.
    • Rationale: May be given to restore metabolic balance if seizure is induced by hypoglycemia or alcohol.
  • Monitor and document AED drug levels, corresponding side effects, and frequency of seizure activity.
    • Rationale: Standard therapeutic level may not be optimal for individual patient if untoward side effects develop or seizures are not controlled.
  • Monitor CBC, electrolytes, glucose levels.
    • Rationale: Identifies factors that aggravate or decrease seizure threshold.
  • Prepare for surgery or electrode implantation as indicated.
    • Rationale: Vagal nerve stimulator, magnetic beam therapy, or other surgical intervention (temporal lobectomy) may be done for intractable seizures or well-localized epileptogenic lesions when patient is disabled and at high risk for serious injury. Success has been reported with gamma ray radio surgery for the treatment of multiple seizure activity that has otherwise been difficult to control.

Nursing Diagnosis
  • Risk for Ineffective Airway Clearance
  • Risk for Ineffective Breathing Pattern

Risk factors may include

  • Neuromuscular impairment
  • Tracheobronchial obstruction
  • Perceptual or cognitive impairment

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
  • Maintain effective respiratory pattern with airway patent or aspiration prevented.
Nursing Interventions
  • Ensure patient to empty mouth of dentures or foreign objects if aura occurs and to avoid chewing gum and sucking lozenges if seizures occur without warning.
    • Rationale: Lessens risk of aspiration or foreign bodies lodging in pharynx.
  • Maintain in lying position, flat surface; turn head to side during seizure activity.
    • Rationale: Helps in drainage of secretions; prevents tongue from obstructing airway.
  • Loosen clothing from neck or chest and abdominal areas.
    • Rationale: Aids in breathing or chest expansion.
  • Provide and insert plastic airway or soft roll as indicated and only if jaw is relaxed.
    • Rationale: If inserted before jaw is tightened, these devices may prevent biting of tongue and facilitate suctioning or respiratory support if required. Airway adjunct may be indicated after cessation of seizure activity if patient is unconscious and unable to maintain safe position of tongue.
  • Suction as needed.
    • Rationale: Reduces risk of aspiration or asphyxiation. Note: Risk of aspiration is low unless individual has eaten within the last 40 min.
  • Supervise supplemental oxygen or bag ventilation as needed postictally.
    • Rationale: May lessen cerebral hypoxia resulting from decreased circulation or oxygenation secondary to vascular spasm during seizure. Note: Artificial ventilation during general seizure activity is of limited or no benefit because it is not possible to move air in or out of lungs during sustained contraction of respiratory musculature. As seizure abates, respiratory function will return unless a secondary problem exists (foreign body or aspiration).
  • Get ready for or assist with intubation, if indicated.
    • Rationale: Presence of prolonged apnea postictally may need ventilatory support.

Nursing Diagnosis
  • Low Self-Esteem

May be related to

  • Stigma associated with condition
  • Perception of being out of control
  • Social role changes
  • Feelings of abandonment
  • Inconsistent behavior

Possibly evidenced by

  • Verbalization about changed lifestyle
  • Fear of rejection; negative feelings about body
  • Change in self-perception of role
  • Change in usual patterns of responsibility
  • Lack of follow-through or nonparticipation in therapy
  • Expressions of helplessness or uselessness
  • Evaluation of self as unable to deal with situations or events
Desired Outcomes
  • Identify feelings and methods for coping with negative perception of self.
  • Verbalize increased sense of self-esteem in relation to diagnosis.
  • Verbalize realistic perception and acceptance of self in changed role or lifestyle.
  • Express positive self-appraisal
  • Demonstrate behaviors to restore positive self-esteem.
  • Participate in treatment regimen or activities to correct factors that precipitated crisis.
Nursing Interventions
  • Determine individual situation related to low self-esteem in the present circumstances.
    • Rationale: Verbalization of concerns about future implications can help patient begin to accept or deal with situation.
  • Explore feelings about diagnosis, perception of threat to self. Encourage expression of feelings.
    • Rationale: Reactions vary among individuals, and previous knowledge or experience with this condition affects acceptance of therapeutic regimen.
  • Analyze possible or anticipated public reaction to condition. Encourage patient to refrain from concealing problem.
    • Rationale: Provides opportunity to problem-solve response, and provides measure of control over situation. Concealment is destructive to self-esteem (potentiates denial), blocking progress in dealing with problem, and may actually increase risk of injury or negative response when seizure does occur.
  • Discuss with patient current and past successes and strengths.
    • Rationale: Concentrating on positive aspects can help alleviate feelings of guilt and self- consciousness and help patient begin to accept manageability of condition.
  • Refrain from over protecting the patient; encourage activities, providing supervision and monitoring when indicated.
    • Rationale: Participation in as many experiences as possible can lessen depression about limitations. Observation and supervision may need to be provided for such activities as gymnastics, climbing, and water sports.
  • Know the attitudes or capabilities of SO. Help individual realize that his or her feelings are normal; however, guilt and blame are not helpful.
    • Rationale: Contradictory or unfavorable expectations from SO may affect patient’s sense of competency and self-esteem and interfere with support received from SO, limiting potential for optimal management and personal growth.
  • Elaborate the positive effect of staff and SO remaining calm during seizure activity.
    • Rationale: Tension and anxiety among caregivers is contagious and can be conveyed to the patient, increasing or multiplying individual’s own negative perceptions of situation or self.
  • Refer patient and SO to support group (Epilepsy Foundation of America,National Association of Epilepsy Centers, and Delta Society’s National Service Dog Center).
    • Rationale: Provides opportunity to gain information, support, and ideas for dealing with problems from others who share similar experiences. Note: Some service dogs have ability to sense or predict seizure activity, allowing patient to institute safety measures, increasing independence and personal sense of control.
  • Talk over and explain referral for psychotherapy with patient and SO.
    • Rationale: Seizures have a profound effect on personal self-esteem, and patient or SO may feel guilt over perceived limitations and public stigma. Counseling can help overcome feelings of inferiority and self-consciousness.

Nursing Diagnosis
  • Knowledge Deficit

May be related to

  • Lack of exposure, unfamiliarity with resources
  • Information misinterpretation
  • Lack of recall; cognitive limitation

Possibly evidenced by

  • Questions, statement of concerns
  • Increased frequency or lack of control of seizure activity
  • Lack of follow-through of drug regimen
Desired Outcomes
  • Verbalize understanding of disorder and various stimuli that may increase potentiate seizure activity.
  • Participate in learning process.
  • Exhibit increased interest or assume responsibility for own learning by beginning to look  for information and ask questions.
  • Adhere to prescribed drug regimen.
  • Identify relationship of signs and symptoms to the disease process and correlate symptoms with causative factors.
  • Initiate necessary lifestyle or behavior changes as indicated.
Nursing Interventions
  • Ascertain level of knowledge, including anticipatory needs.
    • Rationale: To assess readiness to learn
  • Determine client’s ability or readiness and barriers to learning.
    • Rationale: Individual may not be physically, emotionally, or mentally capable at this time.
  • Review pathology and prognosis of condition and lifelong need for treatments as indicated. Discuss patient’s particular trigger factors (flashing lights, hyperventilation, loud noises,video games, TV viewing).
    • Rationale: Provides opportunity to clarify or dispel misconceptions and present condition as something that is manageable within a normal lifestyle.
  • Review possible effects of hormonal changes.
    • Rationale: Alterations in hormonal levels that occur during menstruation and pregnancy may increase risk of seizures.
  • Discuss significance of maintaining good general health, (adequate diet, rest, moderate exercise, and avoidance of exhaustion, alcohol, caffeine, and stimulant drugs).
    • Rationale: Regularity and moderation in activities may aid in reducing or controlling precipitating factors, enhancing sense of general well-being, and strengthening coping ability and self-esteem. Note: Too little sleep or too much alcohol can precipitate seizure activity in some people.
  • Know and instill the importance of good oral hygiene and regular dental care.
    • Rationale: Lessens risk of oral infections and gingival hyperplasia.
  • Identify necessity and promote acceptance of actual limitations; discuss safety measures regarding driving, using mechanical equipment, climbing ladders, swimming, and hobbies.
    • Rationale: Lessens risk of injury to self or others, especially if seizures occur without warning.
  • Review local laws and restrictions pertaining to persons with epilepsy and seizure disorder. Encourage awareness but not necessarily acceptance of these policies.
    • Rationale: Although legal and civil rights of persons with epilepsy have improved during the past decade, restrictions still exist in some states pertaining to obtaining a driver’s license, sterilization, workers’ compensation, and required reportability to state agencies.
  • Review medication regimen, necessity of taking drugs as ordered, and not discontinuing therapy without physician supervision. Include directions for missed dose.
    • Rationale: Lack of cooperation with medication regimen is a leading cause of seizure breakthrough. Patient needs to know risks of status epilepticus resulting from abrupt withdrawal of anticonvulsants. Depending on the drug dose and frequency, patient may be instructed to take missed dose if remembered within a predetermined time frame.
  • Recommend taking drugs with meals, if appropriate.
    • Rationale: May reduce incidence of gastric irritation, nausea and vomiting.
  • Discuss nuisance and adverse side effects of particular drugs (drowsiness, fatigue, lethargy, hyperactivity, sleep disturbances, gingival hypertrophy, visual disturbances, nausea and vomiting, rashes, syncope and ataxia, birth defects, aplastic anemia).
    • Rationale: May indicate need for change in dosage or choice of drug therapy. Promotes involvement and participation in decision-making process and awareness of potential long-term effects of drug therapy, and provides opportunity to minimize or prevent complications.
  • Provide information about potential drug interactions and necessity of notifying other healthcare providers of drug regimen.
    • Rationale: Knowledge of anticonvulsant use reduces risk of prescribing drugs that may interact, thus altering seizure threshold or therapeutic effect. For example, phenytoin (Dilantin) potentiates anticoagulant effect of warfarin (Coumadin), whereas isoniazid (INH) and chloramphenicol (Chloromycetin) increase the effect of phenytoin (Dilantin), and some antibiotics (erythromycin) can cause elevation of serum level of carbamazepine (Tegretol), possibly to toxic levels.
  • Familiarize proper use of diazepam rectal gel (Diastat) with patient, SO and caregiver as appropriate.
    • Rationale: Useful in controlling serial or cluster seizures. Can be administered in any setting and is effective usually within 15 min. May reduce dependence on emergency department visits.
  • Encourage patient to wear identification tag or bracelet stating the presence of a seizure disorder.
    • Rationale: Expedites treatment and diagnosis in emergency situations.
  • Stress need for routine follow-up care and laboratory testing as indicated (CBC should be monitored biannually and in presence of sore throat or fever, signs of other infection).
    • Rationale: Therapeutic needs may change and or serious drug side effects (agranulocytosis or toxicity) may develop.

Other Possible Nursing Care Plans
  • Injury, risk for—weakness, balancing difficulties, cognitive limitations or altered consciousness, loss of large or small muscle coordination.
  • Self-Esteem (specify)—stigma associated with condition, perception of being out of control, personal vulnerability, negative evaluation of self or capabilities.
  • Therapeutic Regimen: ineffective management—social support deficits, perceived benefit (versus side effects of medication), perceived susceptibility (possible long periods of remission).