March 2022 ~ Nursing Path

RCN officially returns to international nursing fold

March 31, 2022 Nursing Path No comments

The Royal College of Nursing has confirmed that, as of tomorrow, it will have officially re-joined the International Council of Nurses, following an absense of nearly a decade. It comes almost a year after RCN members voted in support of the move during the college’s…

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Government rejects workforce amendment to Health and Care Bill

March 31, 2022 Nursing Path No comments

The government has been accused of “sticking its head in the sand” over nurse staffing shortages, after voting down a workforce planning amendment to the Health and Care Bill. Health minister Edward Argar yesterday persuaded the House of Commons to reject ‘amendment 29’, despite strong…

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Scotland seeks to strengthen residents’ rights to care home visits

March 31, 2022 Nursing Path No comments

Residents at care homes in Scotland will be given the right to have visits from a loved one, even in lockdown conditions, after the government changed Health and Social Care Standards as a step towards introducing a legal right for care home visits. The change…

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Community Health Nursing Quiz Series - 24

March 31, 2022 Nursing Path No comments

Community Health Nursing Quiz Series - 23

Community Health Nursing Quiz Series - 25

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Ockenden report into maternity scandal demands workforce investment

March 31, 2022 Nursing Path No comments

A robust and funded maternity workforce plan for England is urgently needed to prevent serious failures of care in maternity services, such as those identified at Shrewsbury and Telford Hospital NHS Trust, an independent review has concluded. The final report of the Independent Review of…

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NHS Staff Survey: Nurses burnt out and unhappy with pay and staffing

March 31, 2022 Nursing Path No comments

The morale of nurses in England has plummeted as more and more report feeling undervalued, overworked and concerned about staff shortages, according to the latest NHS Staff Survey. The results from the 2021 poll, which covers all NHS trusts in the country and was conducted…

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End to free pandemic parking for hospital nurses in England

March 30, 2022 Nursing Path No comments

Free car parking on NHS hospital sites for nurses and other staff in England, which was introduced in response to the coronavirus pandemic, will end from tomorrow. The government said it had invested £130m over the past two years to allow hospitals to scrap charges…

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Free Covid-19 testing to continue for nurses in England

March 30, 2022 Nursing Path No comments

Nurses in England will continue to be able to access free Covid-19 testing after it ends for the wider population on 1 April, ministers have confirmed in what is being called a “victory for common sense”. The announcement comes as part of an update on…

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First nurses arrive from Philippines under ‘less disruptive’ recruitment scheme

March 30, 2022 Nursing Path No comments

A firm that recruits nurses from developing countries to work in the UK has said it has developed a more ethical model of bringing those staff in from abroad. The first cohort of nurses brought to the UK as part of the programme arrived from…

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NCLEX Quiz Series - 14

March 30, 2022 Nursing Path No comments

NCLEX Quiz Series - 13

NCLEX Quiz Series - 15

NCLEX Quiz Series NSAID Quiz Vitamin A Quiz

Previous Nursing Exam Question Paper Red blood cell (RBC) Quiz

Anatomy and Physiology Quiz Series Immunoglobin & Immunity Quiz

Anatomy and Physiology Quiz Series BCG or MMR Quiz

Community Health Nursing Quiz Series

Child Health Nursing Quiz Series Female Reproductive System

Medical – Surgical Nursing Quiz Series

Maternity Nursing Quiz Series Polio Vaccine Quiz

Mental Health Nursing Quiz Series DT Vaccine

Fundamental Health Nursing Quiz Series Mental Health Quiz

Nutrition and Biochemistry Quiz Series

Psychology Quiz Series Components of blood Quiz

Microbiology Quiz Series Vitamin Quiz

Pharmacology Quiz Series DPT Vaccine

Nursing Education Quiz Series

Nursing Research & Statistics Quiz Series

Nursing Management Quiz Series

Overseas nurses ‘trapped’ in UK contracts with exorbitant exit fees

March 29, 2022 Nursing Path No comments

Some international nurses are being locked into “toxic” work environments in the UK due to “exploitative” contracts that require them to pay thousands of pounds to leave, it has been revealed. Concerning evidence has emerged over the methods some UK employers are using to try…

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Specialist nurse appointed for rare Covid-19 condition affecting children

March 29, 2022 Nursing Path No comments

A hospital in London has become one of the first in the UK to appoint a dedicated nurse for a rare inflammatory condition in children linked to Covid-19. Evelina London Children's Hospital has recruited Michael Bell into the role of clinical nurse specialist for paediatric…

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Exclusive: Wales CNO reflects on first months in role and outlines priorities

March 29, 2022 Nursing Path No comments

The chief nursing officer (CNO) for Wales has ambitious plans to help support and grow the workforce, ensure professional equity and improve patient outcomes. In her first interview with Nursing Times since being appointed, Sue Tranka sets out her priorities and the challenges she hopes…

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Enalapril Maleate

March 29, 2022 Nursing Path No comments

Drug Name

Generic Name : enalapril maleate

Brand Name: Vasotec , enalaprilat , Vasotec I.V.

Classification: Antihypertensive, ACE inhibitor

Pregnancy Category D

Dosage & Route

Available forms : Tablets—2.5, 5, 10, 20 mg; injection—1.25 mg/mL

ADULTS

Oral

Hypertension:

Patients not taking diuretics: Initial dose is 5 mg/day PO. Adjust dosage based on patient response. Usual range is 10–40 mg/day as a single dose or in two divided doses.
Patients taking diuretics: Discontinue diuretic for 2–3 days if possible. If it is not possible to discontinue diuretic, give initial dose of 2.5 mg, and monitor for excessive hypotension.
Converting to oral therapy from IV therapy: 5 mg daily with subsequent doses based on patient response.

CHF: 2.5 mg PO daily or bid in conjunction with diuretics and digitalis. Maintenance dose is 5–20 mg/day given in two divided doses. Maximum daily dose is 40 mg.

Asymptomatic LVD: 2.5 mg PO bid; target maintenance dose 20 mg/day in two divided doses.

Parenteral

Give IV only. 1.25 mg q 6 hr given IV over 5 min. A response is usually seen within 15 min, but peak effects may not occur for 4 hr.

Hypertension:
Converting to IV therapy from oral therapy: 1.25 mg q 6 hr; monitor patient response.

Patients taking diuretics: 0.625 mg IV over 5 min. If adequate response is not seen after 1 hr, repeat the 0.625-mg dose. Give additional doses of 1.25 mg q 6 hr.

PEDIATRIC PATIENTS 1 MO–16 YR

Oral

Hypertension: Initial dose is 0.08 mg/kg PO once daily; maximum dose is 5 mg.

GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT

Oral

Excretion is reduced in renal failure; use smaller initial dose, and adjust upward to a maximum of 40 mg/day PO. For patients on dialysis, use 2.5 mg on dialysis days.

Therapeutic actions

Enalapril is de-esterified into the active enalaprilat resulting in potent inhibition of ACE thus leading to reduced levels of angiotensin II and aldosterone. Clinically, BP is reduced, salt and water retention is corrected. Ventricular hypertrophy is reversed. Renal blood flow is increased but in patients with renal impairment there may be oliguria or acute renal failure.

Indications

Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics
Treatment of acute and chronic CHF
Treatment of asymptomatic left ventricular dysfunction (LVD)
Unlabeled use: Diabetic nephropathy

Adverse effects

Initial hypotension may be severe and prolonged. Dizziness, headache, fatigue, persistent dry cough, abnormal taste, lassitude, rash, neutropenia, renal impairment or failure.
Potentially Fatal: Angioedema.

Contraindications

Hypersensitivity. History of angioedema due to previous treatment with ACE inhibitors; bilateral renal artery stenosis. Pregnancy.

Nursing considerations

Assessment

History: Allergy to enalapril, impaired renal function, salt or volume depletion, lactation, pregnancy
Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC, and differential

Interventions

WARNING: Alert surgeon, and mark patient’s chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.
Be aware that use of this drug in second and third trimesters can cause serious injury or death to the fetus; advise contraceptive use.
Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril.
Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.
Arrange for reduced dosage in patients with impaired renal function.
WARNING: Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked.

Teaching points

Do not stop taking the medication without consulting your health care provider.
Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting, dehydration).
Avoid over-the-counter medications, especially cough, cold, and allergy medications that may interact with this drug.
You may experience these side effects: GI upset, loss of appetite, change in taste perception (will pass with time); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes in a few days; change position slowly, limit activities to those not requiring alertness and precision).
Use of contraception is advised while taking the drug.
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.

NCLEX Quiz Series NSAID Quiz Vitamin A Quiz

Previous Nursing Exam Question Paper Red blood cell (RBC) Quiz

Anatomy and Physiology Quiz Series Immunoglobin & Immunity Quiz

Anatomy and Physiology Quiz Series BCG or MMR Quiz

Community Health Nursing Quiz Series

Child Health Nursing Quiz Series Female Reproductive System

Medical – Surgical Nursing Quiz Series

Maternity Nursing Quiz Series Polio Vaccine Quiz

Mental Health Nursing Quiz Series DT Vaccine

Fundamental Health Nursing Quiz Series Mental Health Quiz

Nutrition and Biochemistry Quiz Series

Psychology Quiz Series Components of blood Quiz

Microbiology Quiz Series Vitamin Quiz

Pharmacology Quiz Series DPT Vaccine

Nursing Education Quiz Series

Nursing Research & Statistics Quiz Series

Nursing Management Quiz Series

Concern over prosecution of US nurse who made fatal drug error

March 29, 2022 Nursing Path No comments

Criminalising nurses who have made genuine mistakes could deter others from speaking out when errors occur and create a “culture of blame rather than one of accountability”, according to nurses reacting to a high-profile court case in the US. On Friday 25 March 2022, former…

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Nursing regulator welcomes opening of fourth OSCE test centre

March 28, 2022 Nursing Path No comments

A new test centre has today opened its doors in Newcastle for overseas nurses and returners to practice going through the process of joining the UK nursing register. The opening of the new centre takes the number of sites across the UK where people can…

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Former nurse in jail for trafficking ordered to give up crime money

March 28, 2022 Nursing Path No comments

A former London-based nurse who is currently serving an 18-year prison term for trafficking women into prostitution has been ordered to give up almost £184,000 of her “illicit earnings”. Josephine Iyamu, 54, was the first British national to be convicted under the Modern Slavery Act…

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Cystic Fibrosis

March 28, 2022 Nursing Path No comments

Description

Is an autosomal recessive disorder affecting the exocrine glands, in which their secretions become abnormally viscous and liable to obstruct glandular ducts.
It primarily affects pulmonary and GI function.
The average life expectancy for the cystic fibrosis patient is currently age 30 to 40. Death may occur because of respiratory infection and failure.
Other complications include esophageal varices, diabetes, chronic sinusitis, pancreatitis, rectal polyps, intussusceptions, growth retardation, and infertility.

Causes/ Risk Factors

The responsible gene, the CF transmembrane conductance regulator (CFTR),is mapped to chromosome 7 (see Genetic Considerations). The underlying defect of this autosomal recessive condition involves a defective protein that interferes with chloride transport, which, in turn, makes the body’s secretions very thick and tenacious. The ducts of the exocrine glands subsequently become obstructed.

Assessment

Usually present before age 6 months but severity varies and may present later.
Meconium ileus is found in neonate.
Usually present with respiratory symptoms, chronic cough, and wheezing.
Parents may report salty taste when skin is kissed.
Recurrent pulmonary infections.
Failure to gain weight or grow in the presence of a good appetite.
Frequent, bulky, and foul smelling stools (steatorrhea), excessive flatus, pancreatitis and obstructive jaundice may occur.
Protuberant abdomen, pot belly, wasted buttocks.
Bleeding disorders.
Clubbing of fingers in older child.
Increased anteroposterior chest diameter (barrel chest).
Decreased exertional endurance.
Hyperglycemia, glucosuria with polyuria, and weight loss.
Sterility in males.

Diagnostic Evaluation

Sweat chloride test measures sodium and chloride level in sweat.
- Chloride level of more than 60 mEq/L is virtually diagnostic.
- Chloride level of 40 to 60 mEq/L is borderline and should be repeated.
Duodenal secretions: low trypsin concentration is virtually diagnostic.
Stool analysis:
- Reduced trypsin and chymotrypsin levels-used for initial screening for cystic fibrosis.
- Increased stool fat concentration.
- BMC ( Boehringer-Mannheim Corp.) meconium strip test for stool includes lactose and protein content; used for screening.
Chest X-ray may be normal initially; later shows increased areas of infection, overinflation, bronchial thickening and plugging, atelectasis, and fibrosis.
Pulmonary function studies (after age 4) show decreased vital capacity and flow rates and increased residual volume or increased total lung capacity.
Diagnosis is made when a positive sweat test is seen in conjunction with one or more of the following:
- Positive family history of cystic fibrosis.
- Typical chronic obstructive lung disease.
- Documented exocrine pancreatic insufficiency.
Genetic screening may be done for affected families.

Primary Nursing Diagnosis

Ineffective airway clearance related to excess tenacious mucus

Therapeutic Intervention / Medical Management

Treatment for lung problems includes:

Antibiotics to prevent and treat lung and sinus infections. They may be taken by mouth, or given in the veins or by breathing treatments. People with cystic fibrosis may take antibiotics only when needed, or all the time. Doses are usually higher than normal.
Inhaled medicines to help open the airways
DNAse enzyme replacement therapy to thin mucus and make it easier to cough up
Flu vaccine and pneumococcal polysaccharide vaccine (PPV) yearly (ask your health care provider)
Lung transplant is an option in some cases
Oxygen therapy may be needed as lung disease gets worse

Treatment for bowel and nutritional problems may include:

A special diet high in protein and calories for older children and adults (see: Cystic fibrosis nutrional considerations)
Pancreatic enzymes to help absorb fats and protein
Vitamin supplements, especially vitamins A, D, E, and K
Your doctor can suggest other treatments if you have very hard stools

Pharmacologic Intervention

Antimicrobial therapy as indicated for pulmonary infection.
- Oral or I.V. antibiotics as required.
- Inhaled antibiotics, such as gentamicin or tobramycin, may be used for severe lung disease or colonization of organisms.
Bronchodilators to increase airway size and assist in mucus clearance.
Pulmozyme recombinant human DNase (an enzyme) administered via nebulization to decrease viscosity of secretions.
Pancreatic enzyme supplements with each feeding.
- Favored preparation is pancrelipase.
- Occasionally, antacid is helpful to improve tolerance of enzymes.
- Favorable response to enzymes is based on tolerance of fatty foods, decreased stool frequency, absence of steatorrhea, improved appetite, and lack of abdominal pain.
Gene therapy, in which recombinant DNA containing a corrected gene sequence is introduced into the diseased lung tissue by nebulization, is in clinical trials.

Nursing Intervention

Monitor weight at least weekly to assess effectiveness of nutritional interventions.
Monitor respiratory status and sputum production, to evaluate response to respiratory care measures.
To promote airway clearance, employ intermittent aerosol therapy three to four times per day when the child is symptomatic.
Perform chest physical therapy three to four times per day after aerosol therapy.
Help the child to relax to cough more easily after postural drainage.
Suction the infant or young child when necessary, if not able to cough.
Teach the child breathing exercises using pursed lips to increase duration of exhalation.
Provide good skin care and position changes to prevent skin breakdown in malnourished child.
Provide frequent mouth care to reduce chances of infection because mucus is present.
Restrict contact with people with respiratory infection.
Encourage diet composed of foods high in calories and protein and moderate to high in fat because absorption of food is incomplete.
Administer fat-soluble vitamins, as prescribed, to counteract malabsorption.
Increase salt intake during hot weather, fever, or excessive exercise to prevent sodium depletion and cardiovascular compromise.
To prevent vomiting, allow ample time for feeding because of irritability if not feeling well and coughing.
Encourage regular exercise and activity to foster sense of accomplishments and independence and improve pulmonary function.
Provide opportunities for parents to learn all aspects of care for the child.
Teach the parents about dietary regimen and special need for calories, fat, and vitamins.
Discuss need for salt replacement, especially on hot summer days or when fever, vomiting, and diarrhea occur.

Documentation Guidelines

Physical response: Pulmonary assessment; color, odor, character of mucus; cardiac and GI assessment; pulse oximetry
Nutritional data: Weight, use of enzymes, adherence to supplemental feedings
Emotional response: Patient’s feelings about dealing with a chronic illness, patient’s body image, parents’ coping ability, siblings’ response

Discharge and Home Healthcare Guidelines

Teach the patient and family how to prevent future episodes of pneumonia through CPT, expectoration of sputum, and avoidance of peers with common colds and nasopharyngitis. Explain that medications need to be taken at the time of each meal, especially pancreatic enzymes and supplemental vitamins. Teach the parents protocols for home IV care, as needed. Teach parents when to contact the physician: when temperature is elevated over 100.5°F, sputum has color to it, or the child complains of increased lung congestion or abdominal pain. Also educate parents on the need to keep routine follow-up appointments for medication, laboratory, and general checkups. Teach the patient or parents proper insulin administration and the appropriate signs and symptoms of high and low glucose levels.

Nursing Care Plan

Nursing Diagnosis

Ineffective airway clearance related to thick mucus secretions and effort and a lot of bad cough.

Goal: Not experiencing aspiration.

Outcomes

Shows an effective cough and increased air exchange in the lungs.

Interventions

Auscultation of breath sounds. Note the example of wheezing breath sounds, crackles, rhonchi.
- Rationale: Some degree of spasm of the bronchial obstruction with airway obstruction and may / not indicated the presence of abnormal breath sounds or crackles eg absence of breath sounds.
Perform physiotherapy to issue secret and give the patient a comfortable position, eg, elevation of the head of the bed, sitting on the back of the bed (position semi-Fowler / Fowler).
- Rationale: head of bed elevation facilitate respiratory function using gravity.
Assist clients to dilute sputum, with the collaboration expectorant administration to improve airway clearance.
- Rationale: Giving expectorants may help thin the secret, that secret is more easily removed.
Provide nebulizer with a solution and in accordance with the right tools.
- Rationale: Nebulization can help spending viscous secretions.
Observations clients closely after aerosol therapy and chest physiotherapy to preventaspiration due to many sputum suddenly become watery.
- Rationale: To prevent aspiration.
Provide postural drainage (adjust the area where there is a buildup of mucus) as prescribed to reduce the viscosity of mucus.
- Rationale: Postural drainage aids in the excretion of mucus is thick.

Nursing Diagnosis

Impaired gas exchange related to airway obstruction by nasal obstruction.

Goal: Maintaining adequate oxygenation or ventilation.

Outcomes

The patient showed respiratory rate effectively.
Free of respiratory distress.
Arterial blood gas within the normal range.

Nursing Interventions

Maintain a patent airway.
- Rationale: Preventing complications of respiratory failure.
Position the patient to obtain maximum efficiency ventilators, such as a high Fowler’s position or sitting, leaning forward.
- Rationale: Position Fowler / semi-Fowler can facilitate respiratory function and can reduce airway collapse, dyspnoea, and breath work by using gravity.
Monitor vital signs, arterial blood gases (ABGs), and pulse oximetry to detect / prevent hypoxemia.
- Rationale: increased PaCO2 indicates impending respiratory failure during asthmatic. Tachycardia, dysrhythmias, and changes in BP may indicate systemic hypoxemia effects on cardiac function.
Provide supplemental oxygen according to the provisions / requirements. Monitor patients closely for carbon dioxide narcosis due to oxygen is danger of oxygen therapy in patients with chronic lung disease.
- Rationale: Occurrence / respiratory failure that would require effort dating lifesaving action. Supplemental oxygen administration can fix / prevent worsening hypoxia.
Motivation exercise appropriate physical condition of the patient.
- Rationale: Physical exercise is often effective to clear accumulated lung secretions and to improve endurance exercise capacity before experiencing dyspnea

Nursing Diagnosis

Ineffective breathing pattern related to tracheobronchial obstruction.

Goal:

Repairing or maintaining a normal breathing pattern.
Patients achieving lung function maximum.

Outcomes

Patients showed an effective respiratory frequency with the frequency and depth within the normal range and lungs clear / clean.
Patients free of dyspnea, cyanosis, or other signs of respiratory distress.

Nursing Interventions

Provide position Fowler or semi-Fowler.
- Rationale: Position Fowler / semi-Fowler enables lung expansion and ease breathing. Changing position and ambulation improve air charging different lung segments which improves gas diffusion.
Teach deep breathing techniques, and or lip breathing or diaphragmatic breathingabdominal exercises when indicated and effective cough.
- Rationale: to help spending sputum.
Observation vital signs (RR or frequency per minute).