Acid-Base Imbalance Chart

Source: Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)


FIVE Things I Wish I Knew Before I Started Nursing School

1) Straight-A …Student

If you are/were a straight-A student, get ready to get knocked down a notch or two. I don’t know anybody in my class of about 100 people who have gotten all A’s. I know there were maybe two in the class ahead of us? Point is, get ready for that not to happen.

I came in head-strong thinking, “I know everyone has been saying this but I can do it. I get can all A’s.”

The first round of exams went through and I thought, “Okay. That’s doable.” But then the second and third round came and eventually I was just doing everything I could to stay afloat.

My advice is this: do your best, do not compare yourself to your classmates, and ask for help when you need it. Your grades are not reflective of your capabilities as a nurse.

2) Mental Health > Study Time

“Don’t pound yourself into the ground with studying because self-care is just as important.”

My mentee

Don’t get me wrong, you need to study hard and make it a good habit. But you also need to realize that if you wear yourself out, no amount of studying is going to help you.

Make a study schedule and stick to it. Study every day, schedule breaks and rewards, and do not study outside of your allotted time. I stop studying around 8-9pm every night, and I always get my 7-9 hours of sleep.

3) Roll with the Punches

I had an expectation that nursing school would be organized, the instructions would be clear, and that there would always be a strict schedule. Boy oh boy was I wrong!!

You will have to learn to “roll with the punches.” Don’t sweat the small details. Be ready to adjust and readjust your schedule. Nursing school is very fluid!

I remember one week last semester where they said, “Oh by the way, this small group of people needs to put together a project and present it at this location. And you have five days.” I remember thinking, you want me to do that and my million other things I have going on?

I go to class every day expecting that something else will be thrown our way. That way, I’m not surprised.

4) Nurse-Administrator

The administrative/paperwork stuff added another level of stress to nursing school. The beginning was extra stressful because you have to submit a lot of paperwork to the state board of nursing. It helps to become ultra-organized with your vaccine records, identification documents, health insurance, CPR certifications, background check documents, drug screen, etc. There are 32 separate documents I have submitted JUST to be eligible to register for classes.

You will most likely also submit additional paperwork for each of your clinical sites. You will also be expected to keep up with your resume and portfolio.

If your school tells you to start working on paperwork before school starts, DO IT RIGHT AWAY. If you wait until school starts, you will be stressed out about the administrative stuff and that will cut into your study time.

5) Tick-tick-tick-DONE

When I got my acceptance letter for school, I thought that the two years would take forever, and I questioned whether or not I wanted to commit to two years of my life.

Now I’ll be starting my last semester of school and I cannot believe how fast time has gone by! When did I get here? I feel like I just woke up and now it’s time for me to apply for big girl jobs!

Nursing school keeps you so busy that time passes by really fast. Each week is so jam-packed that seven days don’t seem like enough time.

Don’t forget to enjoy life in those little moments!



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How I SAVE 💰MONEY💰 as a Nursing Student

If you live in the United States, you know that college tuition is an expensive hot button issue. If you have been to college, you most likely have student loans. While loans can be helpful while you’re in school, it can get really scary to think about paying them off. Loans do not typically cover the cost of living, utilities, car notes, etc.

I wanted to put together a little post about a few things I do to save here and there. It may not be much, but hopefully you can find something here that saves you a few dollars!

Honey Gold

I don’t remember how I heard about this website, but it has saved me a lot of money over the years, and I’ve even been able to redeem the points for gift cards. The best part is that the program is free, and there is a super convenient Chrome extension. To be honest, I am NOT an affiliate of the Honey Gold program. But I do have a referral link just in case you want to try it. (I may in the future become an ambassador, but I need more followers. 😀)

Let me show you how it works!!

Just go to www.joinhoney.com, or click on my referral link. It is recommended to install the extension for your browser. I believe it works for nearly any updated browser (Chrome, Safari, Firefox, Microsoft Edge, etc.). Then as you do your regular shopping, Honey will shop for the best price for you! It will automatically apply different discount codes in the shopping cart. If there are no discount codes available, it will most likely give you some sort of “cash back” in the form of points. The little extension icon will turn orange:

All you have to do is click on it, and Honey will do the work for you!

I have yet to find an online store where Honey does not work. You can also add items to a “Droplist,” and Honey will alert you when the price goes down. That way you don’t have to worry about finding the best deal. I’ve used this on many of my textbooks and school supplies.

You can even use it while ordering pizza! Which is pretty cool. I’ve redeemed most of my points for Groupon and Target gift cards.

Textbooks

Don’t pay full price for textbooks. Please don’t do it. We were offered an $800 package for just our first semester books and I am so glad I did not take it. I ended up spending about $315 instead by doing my research and looking for deals.

The first thing I do when I get a textbook list is I google the name of the textbook and PDF. So for example, I would search “psychiatric mental health nursing 8th edition pdf”

I have found several textbooks this way. If I didn’t find the textbook, sometimes I found the supplemental study guide or other resources that accompany the book. ALWAYS search for your books like this first, unless you absolutely 100% need a physical copy of the book.

One of my favorite websites is Book Depository. They have very competitive pricing and free shipping. I have never run into any stock or customer service issues with them either. Use this website when you need to keep your books. They are an Amazon company but they do not offer rentals or Kindle versions.

We all know and love Amazon. You can find new, used, Kindle, rentals, etc. If you have been told by upperclassmen that they did not keep the book, I would go ahead and rent it. With Amazon, if you rent a book and then decide you want to keep it, you can buy the book and the cost of the rental is applied toward the purchase.

Abebooks is also another great website. They have low prices and a very large inventory including rare books and fine art. I also enjoy using their advanced search feature that allows you to search by price, publisher date, and edition.

Find Cheap Textbooks - Save on New & Used Textbooks at AbeBooks.com

One last helpful tip is that a lot of school libraries have these textbooks on reserve. If you are really in a pinch, you can head to the library and look for your book. You could probably make photocopies (or use your phone camera) for the pages you need.

School Supplies/Organization

I reuse binders, folders, dividers, anything else I can repurpose. I seldomly purchase brand new supplies for a new semester, unless I know I need it. I buy pens and pencils because I lose them.

I have also started to “go paperless” with my notes. I was getting so frustrated with how much paper sat on my floor at home. Nursing school powerpoints are no joke. Last semester, I created folders on my Mac for each class, exam, and clinical. It’s good for the environment and your back! Our school has printing included in the tuition, but I know many schools who do not.

Some people really need those handwritten notes in order to study. I am one of those people! So instead I bought a cheap whiteboard from Wal-Mart and installed it on my wall. I study on my white board and it wastes zero paper. When I fill it up, I take a picture of my notes with my phone and upload it to the appropriate folder!

My whiteboard at home!

Any papers or notes that the instructors give us are scanned and put in my computer. If I need a paper copy, I keep it in a binder or folder on my bookshelf. This is what my folders look like on my Mac—

Budgeting

Love it or hate it, you gotta do it. Listen, y’all. I rarely spend money on things I don’t need. When I do, it’s because I’m rewarding myself (after finals, getting a new job, winning an award, etc.). To be honest, I AM in a lot of debt. Should I be the best source of financial advice? No. But I am a real nursing student with real life problems, and I just want to share how I’ve managed to stay afloat.

I use excel to break down my income and bills. I give myself a little bit of spending money (for vending machine snacks or the occasional post-test celebratory adult beverage). My opinion is that you still need room to live your life. Just don’t spend $300 on shoes you don’t need if you cannot afford it.

We don’t have cable TV, I’m on the cheapest phone plan my service offers, I make my lunches/dinners 95% of the time, and I only purchase new clothes when the ones I have get so worn out that I have no choice.

I always make a grocery list, I shop at Dollar Tree and Aldi, and our house is barely decorated. I’ve switched (reluctantly) all of my luxury or non-drug store makeup brands to drugstore brands. I even tried to grow some of my own vegetables and herbs, but it turns out I do not have a green thumb. 👎🏻

Some of you make think I’m crazy for having this type of lifestyle, but I am doing what I need to do to make it through school. I know that it is temporary. I know that when I start making a better salary, I’ll have a different budget!

I put a certain percentage of my paychecks toward school. That savings account is non-negotiable and I use it to pay for various school expenses from supplies to scrubs.

I hope you found something here of value to you! What do you do to save money?



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FIVE Things I’ve Learned Working in the Emergency Department

1. Staying on Task

The first few months of working as an intern, I found myself just running around with my head cut off with no sense of direction. I have (mostly) learned the art of writing things down and setting alarms on my watch. I no longer hesitate to delegate to our awesome, amazing, wonderful tech’s. I can methodically organize tasks by patient priority. It feels less chaotic for me! I try to go through four “steps” for each patient:

  1. Initial assessment/ABC’s/Intake
  2. Orders
  3. Maintenance/Repeat Labs/Comfort
  4. Discharge/Transport

I like to write the word “comfort” near the middle of my chicken scratch report sheet. Although not a priority in the emergency room, sometimes getting that patient an extra warm blanket can ease them up and give you time to handle another patient.

2. Using SBAR to Talk to Doctors

Before this job, I had never actually done this. They teach it to us all the time in school but I have always been afraid to do it. My tip? I write down my talking points. Each phone call has gotten smoother, and I usually get what I need for my patients!

An example of my talking points:

S- Mr. X, the 80 y/o male in room 16 who is here for respiratory distress now has an O2 sat of 87% 30 min after the breathing treatment

B- He has a history of HTN and type 2 diabetes

A- BP 142/88, RR 30, HR 94, SpO2 87% on 6LNC, no temp. bibasilar crackles

R- I recommend another breathing treatment and a stat chest x-ray

In school, I felt like they teach us to include everything in our SBAR. There are a lot of situations that would warrant a more thorough SBAR (like giving report to the floor nurse). But when something is needed very quickly in the emergency department, you have to just grab the basics (ABC’s) and run with it.

3. Hospice/Palliative care.

Some of you might be wondering why this is happening in the emergency department. Well you know what. The situation warranted it. We are often on saturation, which means no where else for this family to go for several hours to days. I’ve cried with the families that are waiting for a room somewhere else. I sat with them and ignored the noise and chaos down the hall. I took extra time with the extremely uncomfortable patient to make sure the bed was made perfectly, all trash was picked up, and that the family always had fresh ice water. 

When that family makes a decision for their loved one to be DNR, and we cannot get them a room upstairs, the emergency department becomes the place where the family must start the process of grieving.

4. Confidently Asking for Help

Instead of saying, “I don’t know what I’m doing,” or, “I’m really sucking today,” I say, “Hey, it’s time for morphine, could you pull that for me please?” and “Could you please page respiratory?” My preceptor knows my limits, and I am finally feeling like a real nurse.

Negative self-talk can really hinder your day. I don’t know what I’m doing all the time. But I already know that and I don’t need to bring myself down because of it. I also use statements like, “Could we review this process? I think I misunderstood something.”

ALL. NURSES. NEED. HELP.

If your preceptor says they never ask for help, they are doing their job wrong.

5. Targeted Patient Education.

How often have I ever stopped to thoroughly explain something to a patient? Never in my clinicals, honestly. My preceptor usually does it. And in the ED, it isn’t at the top of the priority list. Patient education does not have to be some crazy 30 minute presentation! I can explain insulin and blood sugar during times of illness. I can explain a sliding scale. And I can do it in about three minutes. So yes, that sounds so simple, but I’ve always been afraid to take that initiative!


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Cardiac Drugs Quick Sheet!

Just a quick overview for the major cardiac/ACLS drugs as pertaining to adults. This is essentially what my flash cards would pertain! Get your AHA ACLS Manual here!

Digoxin

  • Action
    • Positive inotrope – increases the force of cardiac contraction
    • Decrease HR
    • Allow for more complete emptying of the ventricles, thus increasing CO
    • Decrease conduction through the AV node, reduce automaticity of the SA node
  • Indications
    • Heart failure
    • A-fib and A-flutter
    • Paroxysmal atrial tachycardia
  • Special Considerations
    • Monitor potassium levels
    • Count apical for 1 min prior to administration

Atropine

  • Action
    • An anticholinergic drug and increases the firing of the SA node by blocking the action of the vagus nerve.
    • Increases HR
  • Indications
    • 1st line for symptomatic bradycardia
  • Special Considerations
    • Anticholinergic S/E
    • Increases myocardial oxygen demand à be careful in presence of myocardial ischemia

Adenosine

  • Action
    • Antiarrhythmic that decreases conduction through the AV node
  • Indications
    • Paroxysmal Supraventricular Tachycardia
  • Special Considerations
    • Commonly causes a few seconds of asystole
    • Very short half-life (6-10 seconds)
    • Push FAST
    • Patient may feel “like they got punched in the chest”

Amiodarone

  • Action
    • Delay repolarization resulting in prolonged duration of action potential and refractory period
    • Class III Potassium Channel Blocker
    • Decreases heart rate and contractility
  • Indications
    • Pulseless V-fib or V-tach
    • Oral – Atrial fibrillation
  • Special Considerations
    • Do NOT use with cardiogenic shock or severe sinus bradycardia à may cause hypotension
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Epinephrine

  • Action
    • Stimulate beta1 receptors à cardiac stimulation
    • Increased HR, CO, and contractility
  • Indications
    • Cardiogenic shock, Anaphylactic shock, Septic shock
    • Cardiac arrest, pulseless ventricular tachycardia, ventricular fibrillation, asystole
  • Special Considerations
    • Raises BP and increases HR à may cause myocardial ischemia, angina
    • May contribute to post-resuscitation myocardial dysfunction

Dopamine

  • Action
    • Positive inotropic
    • Increased myocardial contractility, increased automaticity, increased AV conduction, increased HR, CO, BP, MAP
  • Indications
    • Cardiogenic shock
    • 2nd line for symptomatic bradycardia
  • Special Considerations
    • Correct hypovolemia with volume replacement before using dopamine
    • DO NOT mix with Sodium Bicarb

Lidocaine

  • Action
    • Sodium channel blocker
  • Indications
    • V-fib, V-tach – with and without pulse
  • Special Considerations
    • *REMOVED from ACLS Guidelines*
    • Can cause toxicity!

Sources: 2018 ACLS Guidelines (Provider Manual), Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)



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My First Code.

I am still processing my first full code experience. I had previously been involved in a “chemical” code in which the family chose no intubation and no compressions. The patient did not survive, but he was in his 90’s and probably ready to go. I had another code called during seizures, but the patient’s heart never stopped. This was my first full on ER code blue experience. There are some potentially gross details in this story. Read at your own risk. Portions of this story (i.e. room numbers, times, names, etc.) are adjusted and no private information is given in this scenario.

All Emergency Departments have that phone. Some are red, some are white, all of them are loud enough to pierce through the chaos of a busy shift. There’s a phrase that makes everyone stop what they’re doing and prepare for the worst–“CPR in progress, ETA 10 minutes.

Room 1? Room 1. Let’s go.

In our city, ETA 10 minutes via EMS usually turns into 15-20 minutes. Our preparation was like clockwork. The intubation box was set up and opened. Crash cart plastic ripped off. Body bag placed under the sheets. We didn’t want to use it, but EMS reported asystole and 4 rounds of epi at the scene. I grabbed a handful of gloves, pocketed my stethoscope and badge, tightened the drawstring on my scrubs, and set up the stool. I was set to begin compressions upon arrival.

Upon arrival EMS is vigorously performing CPR on Mr. X. He is easily twice my size and no more than 10 years older than me. “Who else is rotating compressions?” I ask. I have help. We transfer the patient and I immediately begin compressions. It’s a whirlwind. Something came over me. I’m pushing as hard and as fast as I can. I’m exhausted after a minute. But I kept going and had excellent quality compressions.

My team is organized. Methodical. Everyone has a job and knows their job. Hands and arms are working around me, placing stickers and pads, getting lines and blood. The patient’s torso is wet from whatever he vomited before arresting.

Two minutes! Time for a pulse check!” Our recorder says assertively.

I stop compressions and check a carotid pulse while other team members check for radial and femoral pulses. Nothing. The code leader calls for another round of epi. My colleague knows I need to switch out. Five seconds later, compressions are resumed and I snap out of “compression mode.”

This guy is laying here and we don’t know anything about him. We have little to no history. We don’t even know his name.

I look at each person in the room. Everyone is hyperfocused on their task at hand. One nurse is documenting. Another nurse is keeping track of time with that person and giving medications. Another nurse is at the crash cart drawing up everything imaginable. Respiratory is bagging the patient. Another tech is standing near the door. The doctor is setting up the ultrasound and attempting to get a gown on. Two minutes goes by faster when you’re not the one doing compressions. It’s already time for another pulse check. Nothing.

I’m resuming compressions and I notice that the second time around is much harder. My upper body is already exhausted from the first round. I readjusted my position so that I was nearly on the bed. I need as much leverage as I can get. The doctor says that at the next pulse check he will check for movement with the ultrasound. This requires that three of us move our position, one person takes the front pad off, and another person squirts the ultrasound jelly on the patient’s chest. We only have 15 seconds to coordinate.

Two minutes! Time for another pulse check!

To me our movements seem choreographed. To an onlooker it probably looks chaotic. But the job gets done. No heart movement. More medications are pushed. My colleague is resuming compressions and the team gets ready for rapid sequence intubation. “This should have been done at the scene,” I thought.

Two minutes. Time for a pulse check and more epi.

Mr. X is having PEA. It’s not really a rhythm. It’s not shockable. It’s my turn for compressions again.

By the third round, I feel like my whole body is going to give out. My hands are slipping around everywhere because of the vomit and ultrasound jelly.

I can’t continue compressions!” I yell.

Do you need to switch?

No, I need friction!

I lift my hands up for half a second and someone geniously throws a towel over the patient’s chest. Perfect. This is perfect. My compressions are now high quality again. Everyone is ready for intubation. A mask. I need a mask. This guy probably aspirated and I don’t want whatever that was all over my face, too.

Can someone please put a mask and shield on me?

I continue my compressions as my colleague places a mask on me. He did a great job considering I was half on the stool, half on the bed, hair astray, and using all of my body strength to try to bring this guy back. I’m exhausted. I’m thinking to myself, “How much longer can I do this?” It isn’t about me. Everyone in this room is busting their ass for this patient. I’m not going to be the one to give out.

Two minutes. Pulse check!

Asystole. No pulses. No sign of life. Intubation is done and there is a significant amount of fluid coming out. CO2 monitor said 7 but now there are just dashes. No movement on the ultrasound. The doctor wants to resume compressions but he says it will probably be our last round. It has been a total of 45 minutes counting EMS time.

My colleague resumes compressions. He and I are both dripping in sweat.

We have given everything we can. H’s and T’s are checked. Bicarb, calcium, D50, fluids, etc. We have exhausted everything. As a team we were thinking massive pulmonary embolism which is very hard to come back from, if not impossible. I don’t think he was really moving any air.

Are there any objections? Does anyone have any other ideas?” The doctor asks the room.

We all look at each other and realize there is nothing else we can do for Mr. X.

Time of death 1148.


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Emergency Room Essentials

I know what you’re thinking – there’s no such thing as a “typical” day in the ED. In fact, the only thing you can rely on is that your day will be unpredictable. As a nurse intern in a busy adult ED, I have quickly figured out which items are essential during my shift, and which ones I really do not need. I do not currently work in a trauma center–we see most of the city’s STEMI’s, CVA’s, and transplant patients. We also see minor fractures, lacerations, dislocations, etc.

Our ED is divided into “Stations,” and each station has somewhat of a different category of patients. The “front rooms” are the most critical, we have a special room for eye trauma, and we have about 40 beds.

My job as a student intern involves shadowing/helping an Emergency Room RN. I’ve gotten to the point now where I am a helpful partner to my preceptor. When we get a new patient, I know exactly what my role is!

My first day, I showed up with a pocket full of extra supplies that only weighed me down throughout the day. I’ve narrowed down my everyday essentials to just 7 items!

  1. Stethoscope. My beautiful Littman III Classic in matte black is my closest friend in the ED. When assessing ABC’s, lung sounds can give you a clue as to what someone’s respiratory status is. It also isn’t uncommon to uncover distant heart sounds indicating cardiac tamponade.
  2. Retractable badge Sharpie. This is my second most used item! It takes out the possibility of setting your pen/marker down somewhere and losing it forever. I use it to label lines, specimen tags, patient belongings, sign EMS handoff, write down vitals on my glove, and the list goes on.
  3. Pen light. Neuro checks are important for ANY type of patient. If a patient comes in with a sprained ankle, I still do a neuro check. No matter what the patient tells you, they could be making something up because they don’t remember what happened. I also use my pen light for Foley placements and quick airway checks.
  4. Trauma shears. Mine can cut through thick leather! Although we are not a trauma center, I have still cut my fair share of clothing. It is also useful for cutting tape, medication packaging, and during wound care.
  5. Saline flushes. Not something you bring from home, but I always grab a handful at the beginning of my shift. You’ll find that you always need one or two when your hands are already full doing something else.
  6. White board marker. Our rooms are supposed to have their own whiteboard markers. We all know this doesn’t happen. Updating the boards aren’t necessarily the top priority, but I try to update them when I can. It helps patients feel more comfortable if they know the names of their care team.
  7. Black pen. This is probably my least used item, and I often lose it, but it’s good to have!

I hope this can help some of my fellow students. I was so nervous on my first ED shift and I had no idea what I would need! I ended up filling my pockets with 4 pens, a small notebook, and all of my other regular clinical supplies. It was just too much.



Brilliant Nurse NCLEX-RN® Test Prep!

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Top 10 Study Tips!

1. Make a study schedule and stick to it.

2. Pace yourself. Study every day, even if it’s just for 30 minutes.

3. If you don’t understand something, find a different resource (ask a friend, find a YouTube video, email the instructor, etc.).

4. Study for 50 minutes at a time and take a 10-15 minute break in between.

5. During those breaks, don’t just be on your phone or computer. Get up. Move around. Get your blood flowing!

6. Make time for yourself. If you like to read leisurely, do it. If you work out, do it.

7. SLEEP. for the love of God. Get 7-9 hours of sleep a night.

8. Find a method that works for you. Flashcards, outlines, Quizlet, recording yourself, drawing pictures, etc. It’s all trial and error.

My less than artistic attempt at understanding the cardiac system.

9. DON’T CRAM. If you don’t know the material the night before the test, chances are you won’t know it for the test.

10. Studies show that you need to review material 7 times to retain 90% of the information.


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Pharmacology: Seizures and Epilepsy

Definitions:

Convulsion: abnormal motor phenomena (jerking, movements, tics, rigors)
Seizure: a sudden, excessive synchronous electrical discharge of neurons in the brain that can spread to other foci
Epilepsy: group of chronic neurological disorders characterized by recurring seizures

Main Types of Seizures:

Simple Partial: discrete motor, sensory, autonomic and psychoillusionry symptoms. No loss of consciousness. Persists 20-30 seconds.
Tonic-Clonic: major convulsions characterized by a period of muscle rigidity (tonic phase) followed by synchronous muscle jerks (clonic phase). Immediate loss of consciousness. Followed by postictal state. Lasts 90 seconds or less.

Therapeutic Goals:

  • Enable patient to live a normal life.
  • Ideally eliminate seizures, but may not be possible

How do Anti-Epileptic Drugs Work?

  • suppress discharge of neurons within a seizure focus
  • suppress the spread of seizure activity from the focus to other areas of the brain
  • decrease in sodium influx, decrease in calcium influx, increase in potassium influx

Traditional AED’s

  • Phenytoin (Dilantin): Therapeutic range: 10-20mcg/mL, can cause gingival hyperplasia and nystagmus
  • Carbamazepine (Tegretol): Also treats trigeminal neuralgia and bipolar disorder. Contraindicated if patient has bone marrow depression or hypersensitivity. Avoid grapefruit juice!
  • Valproic Acid (Depakote): Also treats migraines and bipolar disorder. Therapeutic range: 50-100mcg/mL. Highly teratogenic! Can cause hepatotoxicity, pancreatitis and hypersensitivity.
  • Ethosuximide (Zarontin): Treats absence seizures. Therapeutic range: 40-100mcg/mL. Generally devoid of adverse effects.
  • Phenobarbital: Older drug, long-acting. Toxicity can cause nystagmus and ataxia. Overdose can cause respiratory depression and possibly death. Has a sedative effect, cognitive/learning impairment, CNS depression and drug dependence. May make children hyper.

Status Epilepticus

A MEDICAL EMERGENCY in which a patient is continually having tonic-clonic seizures for 20-30 minutes and is not conscious the whole time.

Immediate treatment includes: turning patient to the side, administering oxygen, removing objects that could potentially harm, having padded bedrails, suction secretions, and DO NOT restrain the patient or put anything in their mouth. Administer one of the following medications:

  • Diazepam (Valium): Used for emergency treatment of status epilepticus. Short half-life. May develop physical dependence and withdrawal symptoms.
  • Lorazepam (Ativan): Drug of choice used in status epilepticus because of prolonged effects. A rectal gel is available for out of hospital use.

Source: Lehne Pharmacology for Nursing Care, 9th Edition, Chapter 24



Pharmacology: Parkinson’s Disease Quick Sheet

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s Disease Foundation, 2016

Parkinson’s Disease:

  • Idiopathic degenerative disorder of CNS from loss of dopamine-secreting neurons in the substantia nigra
  • – Clinical presentation: resting tremor, rigidity, bradykinesia, postural disturbances
  • Therapeutic goals: Improve ADL’s

Dopaminergic Drugs:

  • Activates dopamine receptors, increase dopamine levels, inhibit actions of ACH
  • LEVODOPA: metabolic precursor of dopamine that crosses the BBB, converted to dopamine once in the brain. Disappointing long term effects such as “wearing-off” and “on-off” phenomenon. 2% reaches the brain
  • CARBIDOPA-LEVODOPA: carbidopa prevents levodopa from getting destroyed by decarboxylase enzymes in the peripheral blood. Allows for lower dose of levodopa and less side effects
  • Major side effects: N/V, dyskinesias, orthostatic hypotension

Anticholinergic Drugs:

  • Decreases effects of ACH
  • Can reduce tremor, possibly rigidity, but not bradykinesia
  • Less effective than dopaminergic drugs
  • Most used: BENZOTROPINE (COGENTIN) and TRIHEXYPHENIDYL (ARTANE)
  • Major side effects: dry mouth, blurred vision, tachycardia, constipation, urinary retention, decreased sweating, increased body temp

COMT Inhibitors

  • inhibit metabolism of levodopa in the periphery
  • have no therapeutic effects of their own
  • ENTACAPONE and TOLCAPONE

MAO-B Inhibitors

  • inhibit inactivation of dopamine in the brain
  • when combined with levodopa, can reduce “wearing off” effect
  • SELEGILLINE (ELDEPRYL)

Source: Lehne’s Pharmacology for Nursing Care, 9th Edition. Burchum and Rosenthal, Chapter 21. | Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)



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