A Game-Changing App to Master Medical Terminology

We are proud to announce that the Medical Findings App is now available in the App store. Here is the quick link to try now: https://apps.apple.com/us/app/id1517353437

Medical findings is a word game that enhances your medical vocabulary. It is the most fun way especially for us nurses to learn, discover, or refresh medical terminologies. It covers dynamic topics like:

  • Root Words, Prefix & Suffix
  • Medical Abbreviations
  • Anatomy and Physiology (All systems)
  • Diseases identification
  • Pharmacology
  • Clinical nursing skills
  • Medical instruments & devices
  • And much more.

The App meticulously integrates the power of medical word games and daily medical tip notification to achieve optimal learning while having fun. Each question was carefully handpicked & researched by our team to ensure we deliver the accuracy and reliability for each medical information. Also, lots of questions that are continuously added to be played, learned, shared, and be reminded.

To make it convenient and enjoyable for players, the game includes flexible letter gameplay. We have included the revert button, shuffle button, and tapping of letters to navigate back and forth of the panel. We also designed it into user-friendly UI navigation and customizable settings & support (you can turn off Sound, Music, and Vibrations). We also included customer support that you can access in settings should you have questions or suggestions.
If you want to share the question, we created Ask a Friend button where you can share unsolved puzzles on Facebook, messenger, or SMS to get your friends to help you with the right answer!

Rheumatic Fever Nursing Care Plan & Management

Notes

Description

Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever.

  • Rheumatic fever (RF) is a systemic illness that may occur following group A beta-hemolytic streptococcal (GABHS) pharyngitis in children.
  • Studies in the 1950s during an epidemic on a military base demonstrated 3% incidence of rheumatic fever in adults with streptococcal pharyngitis not treated with antibiotics.
  • Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

Pathophysiology

Rheumatic fever develops in children and adolescents following pharyngitis with GABHS (ie, Streptococcus pyogenes).

  • The organisms attach to the epithelial cells of the upper respiratory tract and produce a battery of enzymes, which allows them to damage and invade human tissues.
  • After an incubation period of 2-4 days, the invading organisms elicit an acute inflammatory response, with 3-5 days of sore throat, fever, malaise, headache, and elevated leukocyte count.
  • In a small percentage of patients, infection leads to rheumatic fever several weeks after a sore throat has resolved; only infections of the pharynxhave been shown to initiate or reactivate rheumatic fever.
  • Direct contact with oral (PO) or respiratory secretions transmits the organism, and crowding enhances transmission; patients remain infected for weeks after symptomatic resolution of pharyngitis and may serve as a reservoir for infecting others.
  • Severe scarring of the valves develops during a period of months to years after an episode of acute rheumatic fever, and recurrent episodes may cause progressive damage to the valves.
  • The mitral valve is affected most commonly and severely (65-70% of patients); the aortic valve is affected second most commonly (25%).

Statistics and Incidences

Rheumatic fever is most common in 5- to 15-year-old children, though it can develop in younger children and adults.

  • The prevalence of RHD in the United States was less than 0.05 per 1000 population, with only rare regional outbreaks reported in Tennessee in the 1960s and in Utah, Ohio, and Pennsylvania in the 1980’s.
  • However, a recent assessment of temporal trends of patients diagnosed with acute rheumatic fever in the United States from 2001-2011 showed that since 2001, national acute rheumatic fever admissions has steadily increased, with a peak in 2005, and decreased thereafter.
  • Worldwide, there are over 15 million cases of RHD, with 282,000 new cases and 33,000 deaths from this disease each year.
  • RHD is the major cause of morbidity from rheumatic fever and is the major cause of mitral insufficiency and stenosis in the United States and the world.
  • Native Hawaiians and Maori (both of Polynesian descent) have a higher incidence of rheumatic fever; incidence of rheumatic fever in these patients is 13.4 per 100,000 hospitalized children per year, even with antibiotic prophylaxis of streptococcal pharyngitis.
  • Rheumatic fever occurs in equal numbers in males and females; females with rheumatic fever fare worse than males and have a slightly higher incidence of chorea.
  • Rheumatic fever is principally a disease of childhood, with a median age of 10 years; however, GABHS pharyngitis is uncommon in children younger than 3 years, and acute rheumatic fever is extremely rare in these younger children in industrialized countries.

Causes

Rheumatic fever is believed to result from an autoimmune response; however, the exact pathogenesis remains unclear.

  • GABHS infection. Rheumatic fever only develops in children and adolescents following group A beta-hemolytic streptococcal (GABHS) pharyngitis, and only infections of the pharynx initiate or reactivate rheumatic fever.
  • Molecular mimicry. So-called molecular mimicry between streptococcal and human proteins is felt to involve both the B and T cells of peripheral blood, with infiltration of the heart by T cells; some believe that an increased production of inflammatory cytokines is the final mechanism of the autoimmune reaction that causes damage to cardiac tissue in RHD.
  • Streptococcal antigens. Streptococcal antigens, which are structurally similar to those in the heart, include hyaluronate in the bacterial capsule, cell wall polysaccharides (similar to glycoproteins in heart valves), and membrane antigens that share epitopes with the sarcolemma and smooth muscle.
  • Decrease in regulatory T-cells. Decreased levels of regulatory T-cells have also been associated with rheumatic heart disease and with increased severity.

Clinical Manifestations

Revised in 1992 and again in 2016, the modified Jones criteria provide guidelines for making the diagnosis of rheumatic fever; the modified Jones criteria for recurrent rheumatic fever require the presence of 2 major, or 1 major and 2 minor, or 3 minor criteria for the diagnosis of rheumatic fever.

Major Diagnostic Criteria

  • Carditis. Carditis in the child may be clinical and/or subclinical (echo).
  • Polyarthritis. Monoarthritis or polyarthralgia are adequate to achieve major diagnostic criteria in Moderate/High-risk populations; for polyarthralgia exclusion of other more likely causes is also required.
  • Chorea. Jerky, uncontrollable body movements (Sydenham chorea, or St. Vitus’ dance) — most often in the hands, feet, and face.
  • Subcutaneous nodules. Small, painless bumps (nodules) beneath the skin.
  • Erythema marginatum. Flat or slightly raised, painless rash with a ragged edge.

Minor Diagnostic Criteria

  • Fever. Fever of ≥38.5°C ( ≥38°C to achieve a minor diagnostic criteria in Moderate/High-risk populations.
  • Polyarthralgia. Painful and tender joints — most often in the knees, ankles, elbows, and wrists.
  • Prolonged PR interval. Prolonged PR interval for age on electrocardiography.
  • Increased ESR. Elevated peak erythrocyte sedimentation rate during acute illness ≥60 mm/h and/or C-reactive protein ≥3.0 mg/dl.

Assessment and Diagnostic Findings

Although there’s no single test for rheumatic fever, diagnosis is based on medical history, physical exam and certain test results.

  • Throat culture. Throat cultures for GABHS infections usually are negative by the time symptoms of rheumatic fever or rheumatic heart disease (RHD) appear; make attempts to isolate the organism prior to the initiation of antibiotic therapy to help confirm a diagnosis of streptococcal pharyngitis and to allow typing of the organism if it is isolated successfully.
  • Rapid antigen detection test. This test allows rapid detection of group A streptococci (GAS) antigen, allowing the diagnosis of streptococcal pharyngitis to be made and antibiotic therapy to be initiated while the patient is still in the physician’s office.
  • Antistreptococcal antibodies. Clinical features of rheumatic fever begin when antistreptococcal antibody levels are at their peak; thus, these tests are useful for confirming previous GAS infection; antistreptococcal antibodies are particularly useful in patients who present with chorea as the only diagnostic criterion.
  • Acute-phase reactants. C-reactive protein and erythrocyte sedimentation rate are elevated in individuals with rheumatic fever due to the inflammatory nature of the disease; both tests have high sensitivity but low specificity for rheumatic fever.
  • Heart reactive antibodies. Tropomyosin is elevated in persons with acute rheumatic fever.
  • Rapid detection test for D8/17. This immunofluorescence technique for identifying the B-cell marker D8/17 is positive in 90% of patients with rheumatic fever and may be useful for identifying patients who are at risk of developing rheumatic fever.
  • Chest radiography. Cardiomegaly, pulmonary congestion, and other findings consistent with heart failure may be observed on chest radiograph in individuals with rheumatic fever.
  • Echocardiography. In individuals with acute RHD, echocardiography identified and quantitated valve insufficiency and ventricular dysfunction.

Medical Management

Therapy is directed towards eliminating the GABHS pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment of congestive heart failure (CHF).

  • Anti-inflammatory. Treatment of the acute inflammatory manifestations of acute rheumatic fever consists of salicylates and steroids; aspirin in anti-inflammatory doses effectively reduces all manifestations of the disease except chorea, and the response typically is dramatic.
  • Corticosteroids. If moderate to severe carditis is present as indicated by cardiomegaly, third-degree heart block, or CHF, add PO prednisone to salicylate therapy.
  • Anticonvulsant medications. For severe involuntary movements caused by Sydenham chorea, your doctor might prescribe an anticonvulsant, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Tegretol, others).
  • Antibiotics. Your child’s doctor will prescribe penicillin or another antibiotic to eliminate remaining strep bacteria.
  • Surgical care. When heart failure persists or worsens after aggressive medical therapy for acute RHD, surgery to decrease valve insufficiency may be lifesaving; approximately 40% of patients with acute rheumatic fever subsequently develop mitral stenosis as adults.
  • Diet. Advise nutritious diet without restrictions except in patients with CHF, who should follow a fluid-restricted and sodium-restricted diet; potassiumsupplementation may be necessary because of the mineralocorticoid effect of corticosteroid and the diuretics if used.
  • Activity. Initially, place patients on bed rest, followed by a period of indoor activity before they are permitted to return to school; do not allow full activity until the APRs have returned to normal; patients with chorea may require a wheelchair and should be on homebound instruction until the abnormal movements resolve.
Pharmacologic Management

Treatment and prevention of group A streptococci pharyngitis outlined here are based on the current recommendations of the American Heart Association Practice Guidelines on Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis.

  • Antibiotics. The roles for antibiotics are to (1) initially treat GABHS pharyngitis, (2) prevent recurrent streptococcal pharyngitis, rheumatic fever (RF), and rheumatic heart disease (RHD), and (3) provide prophylaxis against bacterial endocarditis.
  • Anti-inflammatory agents. Manifestations of acute rheumatic fever (including carditis) typically respond rapidly to therapy with anti-inflammatory agents; aspirin, in anti-inflammatory doses, is DOC; prednisone is added when evidence of worsening carditis and heart failure is noted.
  • Therapy for congestive heart failure. Heart failure in RHD probably is related in part to the severe insufficiency of the mitral and aortic valves and in part to pancarditis; therapy traditionally has consisted of an inotropic agent (digitalis) in combination with diuretics (furosemide, spironolactone) and afterload reduction (captopril).

Nursing Management

Nursing care of a child with rheumatic fever include:

Nursing Assessment

Nursing assessment for a child with rheumatic fever are as follows:

  • History. Obtain a complete up-to-date history from the child and the caregiver; ask about a recent sore throat or upper respiratory infection; find out when the symptoms began, the extent of the illness, and what if any treatment was obtained.
  • Physical exam. Begin with a careful review of all systems, and note the child’s physical condition; observe for any signs that may be classified as major or minor manifestations; in the physical exam, observe for elevated temperature and pulse, and carefully examine for erythema marginatum, subcutaneous nodules, swollen or painful joints, or signs of chorea.
Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses are:

  • Acute pain related to joint pain when extremities are touched or moved.
  • Deficient diversional activity related to prescribed bed rest.
  • Activity intolerance related to carditis or arthralgia.
  • Risk for injury related to chorea.
  • Risk for noncompliance with prophylactic drug therapy related to financial or emotional burden of lifelong therapy.
  • Deficient knowledge of caregiver related to the condition, need for long-term therapy, and risk factors.
Nursing Interventions

Nursing interventions for a child with rheumatic fever include:

  • Provide comfort and reduce pain. Position the child to reduce joint pain; warm baths and gentle range-of-motion exercises help to alleviate some of the joint discomforts; use pain indicator scales with children so they are able to express the level of their pain.
  • Provide diversional activities and sensory stimulation. For those who do not feel very ill, bed rest can cause distress or resentment; be creative in finding diversional activities that allow bed rest but prevent restlessness and boredom, such as a good book; quiet games can provide some entertainment, and plan all activities with the child’s developmental stage in mind.
  • Promote energy conservation. Provide rest periods between activities to help pace the child’s energies and provide for maximum comfort; if the child has chorea, inform visitors that the child cannot control these movements, which are as upsetting to the child as they are to others.
  • Prevent injury. Protect the child from injury by keeping the side rails up and padding them; do not leave a child with chorea unattended in a wheelchair, and use all appropriate safety measures.
Evaluation

Goals are met as evidenced by:

  • Reducing pain.
  • Providing diversional activities and sensory stimulation.
  • Conserving energy.
  • Preventing injury.
Documentation Guidelines

Documentation in a child with rheumatic fever includes:

  • Baseline and subsequent assessment findings to include signs and symptoms.
  • Individual cultural or religious restrictions and personal preferences.
  • Plan of care and persons involved.
  • Teaching plan.
  • Client’s responses to teachings, interventions, and actions performed.
  • Attainment or progress toward the desired outcome.
  • Long-term needs, and who is responsible for actions to be taken.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Rheumatic Fever Practice Exam.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return

Nursing Care Plan

Acute Rheumatic Fever Nursing Care Plans


Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to
  • Inflammation
  • Arthralgia
Possibly evidenced by
  • Verbal description of pain
  • Guarding and protective behavior of painful joints
  • Warmth at affected joints
  • Edema
  • Redness
Desired Outcomes
  • Child will verbalize less pain by using a scale of 1 to 10.
  • Child will appear relaxed without guarding.
  • Child’s joints will not become inflamed, red, or warm.
Nursing Interventions Rationale
Assess the child’s pain perception using an appropriate scale every 2 to 3 hours. Provides information about the pain level of the child.
Assess changes in behavior, such as high-pitched cry, irritability, restlessness, refusal to move, facial grimace, aggressive or dependent behavior. Nonverbal pain descriptions that are age-related as child or infant may be unable to describe pain; fear and anxietyassociated with pain cause changes in behavioral responses.
Examine affected joints, degree of joint pain, level of joint movement. Provides data about pathologic changes in joints; reversible joint involvement usually affecting large joints, such as knees, hips, wrists, and elbows; an increase in numbers of affected joints occurs over a period of time.
Administer salicylates and anti-
inflammatory medications as prescribed, and advise child that the medication will decrease the pain; administer a sustained-
action analgesic before bedtime or 1 hour before anticipated movement.
Relieves pain, inflammation in joints and provide rest and comfort.
Elevate involved extremities above heart level. Improves circulation to the heart to alleviate edema.
Maintain bed rest during the acute stage
of the disease.
Promotes relief of joint pain caused by movement.
Advise positional changes every 2 hours while maintaining body alignment. Prevents contractures and promotes comfort.
Apply bed cradle under outside covers
over painful joints.
Avoids pressure on painful parts.
Assist in gentle handling and supporting of body parts. Prevents extra pain to affected parts.
Provide toys, games for quiet, sedentary play. Provides diversionary activity to distract from the pain.
Encourage the use of nonpharmacologic interventions such as imagery, relaxation, distraction, cutaneous stimulation, heat application. Provides additional measures to decrease pain perception.
Stress the importance of limited activity or amount of joint movement allowed. Prevents increase or exacerbation of pain.
Teach parents and child of the need for analgesia and that it will help him/her to feel better. Controls pain, and allows for uninterrupted sleep and activity within the tolerance level.
Reassure parents and child that joint involvement is temporary, that pain and edema will subside, and that joints will return to normal size. Reduces anxiety related to fear of irreversible damage.
Educate parents in proper body positioning and handling of affected parts. Promotes comfort and avoids pain and contractures during bed rest.

Hyperthermia

Hyperthermia: Body temperature elevated above normal range.

May be related to
  • Illness or inflammatory disease
Possibly evidenced by
  • Increase body temperature above normal range
  • Hot, flushed skin
  • Chills
  • Tachycardia, tachypnea
Desired Outcomes
  • Child will demonstrate temperature within the normal range and be free of chills.
Nursing Interventions Rationale
Assess temperature, heart rate, and blood pressure frequently. A temperature of 101°F (38.3°C) or above is noted along with redness, pain, and swelling of the joints; HR and BP increase as hyperthermia progresses.
Administer nonsteroidal anti-inflammatory drug (NSAIDs) as prescribed; Observe for any untoward effects of NSAIDs. Reduces inflammation and pain; Side effects of NSAIDs may include abdominal pain, tinnitus, dizziness, headache, stomach ulcer, GI bleeding.
Administer a course of penicillin therapy or a single intramuscular dose of benzathine penicillin. A complete antibiotic treatment of penicillin eliminates group A streptococcus infection.
Provide a tepid sponge bath. Helps reduce the occurrence of fever.
Modify the child’s environment such as room temperature and bed linens as indicated. Room temperature may be accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate the temperature of the client.
Eliminate excess clothing and covers. Exposing skin to room air decreases warmth and increases evaporative cooling.
Maintain bed rest especially during the acute febrile phase. Conserves energy and reduces metabolic rate.
Teach child and family members about the signs and symptoms of hyperthermia and help in identifying factors related to the occurrence of fever; discuss the importance of increased fluid intake to avoid dehydration. Providing health teachings to the patient and family aids in coping with disease condition and could help prevent further complications of hyperthermia.

Activity Intolerance

Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete required or desired activity.

May be related to
  • Decrease cardiac output
  • Muscle weakness
Possibly evidenced by
  • Prolonged bed rest
  • Imposed activity restriction
  • Imbalanced oxygen supply and demand
Desired Outcomes
  • Child can work within the limits of tolerance for that perfectly measured.
Nursing Interventions Rationale
Assess the child’s mobility and physical activity level. Provides baseline information for formulating nursing goals during goal setting.
Assess and evaluate nutritional health status of the client. Adequate energy reserves are needed during activity.
Monitor pulse rate, blood pressure; observe for dyspnea, use of accessory muscles, and skin color before and after activity. Identifies the cardiopulmonary status of the client needed to help determine the ability to tolerate an activity.
Provide emotional support and positive attitude regarding abilities. Appropriate supervision during early efforts can enhance confidence.
Encourage adequate rest periods in between activity. Allows optimal performance during n activity.
Assist with activities of daily living as needed such as eating, bathing, dressing, elimination. Decreases oxygen consumption and boosts confidence in performing a task.
Encourage and teach the child with active range-of-motion exercises. Helps improve joint function and prevent muscle atrophy.
Instruct child to resume activity gradually once asymptomatic at rest and indicators of acute inflammation have resolved. Help pace the child’s energy and provide for maximum comfort.

Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

May be related to
  • Chronic recurrence of disease
Possibly evidenced by
  • [not applicable]
Desired Outcomes
  • Child will experience an absence of occurrence of reinfection.
  • Child will be afebrile; no complaints of discomfort.
  • Child will take medications as ordered.
Nursing Interventions Rationale
Assess parents’ knowledge and skills in the administration of prescribed antimicrobials; daily oral administration or monthly intramuscular injections. Providing long-term antibiotic therapy (as long as 5 years) as a preventive measure may be challenging.
Monitor for chest pain, shortness of breath, fatigue, cough, night sweats, friction rub, gallop during the acute stage of the disease. Signs and symptoms of carditis, which may result in endocarditis causing vegetation that becomes fibrous at the valve areas that is at increased risk of recurrent infections.
Administer antibiotic therapy during the acute phase of disease as prescribed. Inhibits cell wall synthesis of microorganisms, destroying the causative pathogen.
Instruct in the long-term antibiotic regimen, the need for protection prior dental work or any invasive procedure, and inform of importance to prevent recurrence. Therapy begins after the acute phase and medical supervision is needed for life as rheumatic fever may recur; a high percentage of children who incur the disease have cardiac complications later in life.
Notify the physician immediately for any upper respiratory infections, elevated temperature, joint pain, or non-compliance to antibiotic therapy. May indicate recurrence of the disease or need to change or adjust medication.

Normal Laboratory Values

Notes

Common Laboratory Test

SERUM ELECTROLYTES
Sodium (Na+) 135—145 mEq/L
Potassium (K+) 3.5—5.5 mEq/L
Chloride (Cl-) 95—105 mEq/L
Calcium 8.5—10.9 mEq/L
Calcium, ionized 2.24—2.46 mEq/L
Magnesium (Mg) 1.5—2.5 mEq/L
Phosphorus (P) 2.5—4.5 mEq/L
COMPLETE BLOOD COUNT
Red Blood Cell (RBC) M: 4.5—5.5
F: 4.0—4.9
x105/ml
White Blood Cell (WBC) 4,500—10,000 cells/mcL
Platelets 100,000—450,000 cells/mcL
Hemoglobin (Hgb) M: 13.5—16.5
F: 12.0—15.0
Pregnant: 10—15
g/dL
Hematocrit (Hct) M: 41—50%
F: 36—44%
Mean Corpuscular Volume (MCV) 80—100 fL
ARTERIAL BLOOD GAS
pH 7.35—7.45
Partial Pressure of CO2 (pCO2) 35—45 mmHg
Partial Pressure of O2 (pO2) 80—100 mmHg
Bicarbonate (HCO3) 22—26 mEq/L
Base Excess (BE) -2—+2 mEq/L
Oxygen Saturation (SaO2) 95—100%
CHEMISTRY VALUES
Glucose Adults: 70—110 mg/dL
Blood Urea Nitrogen (BUN) Adults: 7—18
Child: 5—20
Infant: 5—15
mg/dL
Serum Creatinine 0.6—1.35 mg/dL
Creatinine Clearance (CrCl) F: 85—132
M: 90—138
mL/min
Albumin 3.4—5.0 g/dL
Bilirubin <1.0 mg/dL
Uric Acid 3.5—7.5 mg/dL
Creatine phosphokinase (CPK) 21—198 units/L

Phases of Diagnostic Testing

Diagnostic testing involves three phases: pretest, intratest, and post-test. Nurses have responsibilities for each phase of diagnostic testing.

Pretest

In the pretest, the main focus is on preparing the client for the diagnostic procedure. Responsibilities during pretest include:

  • Assessment of the patient to assist in determining precautions.
  • Preparation of the equipment and supplies needed.
  • Preparation of a consent form, if required.
  • Providing information and answering client questions about the procedure.

Intratest

During intratest, the main focus is specimen collection and performing or assisting with certain diagnostic procedures. Additional responsibilities during intratest are:

  • Use of standard precautions or sterile technique if necessary.
  • Providing emotional support to the patient and monitoring the patient’s response during the procedure.
  • Ensuring the correct labeling, storage, and transportation of the specimen.

Post-Test

During the last part of diagnostic testing, the nursing care revolves around observations and follow-up activities for the patient. For example, if a contrast media was injected during a CT scan, the nurse should encourage the patient to increase fluid intake to promote excretion of the dye. Additional responsibilities during post-test include:

  • Compare the previous and current test results
  • Reporting of the results to the appropriate members of the healthcare team.

Summary of Normal Laboratory Values

Summary of the different normal laboratory values. You can learn more about each diagnostic testing in the sections ahead.

Erythrocyte Studies

  • Red Blood Cell Count (RBC): Male adult: 4.5 – 6.2 million/mm3 ; Female adult: 4.5 – 5.0 million/mm3
  • Hemoglobin (Hgb): Male: 14-16.5 g/dL; Female: 12-15 g/dL
  • Hematocrit (Hct): Male: 42 – 52%; Female: 35 – 47%
  • Mean corpuscular volume (MCV): 78 – 100 μm3 (male) 78 – 102 μm3 (female)
  • Mean corpuscular hemoglobin (MCH): 25 – 35pg
  • Mean corpuscular hemoglobin concentration (MCHC): 31 – 37%
  • Serum iron: Male: 65 – 175 mcg/dL; Female: 50 – 170 mcg/dL
  • Erythrocyte sedimentation rate (ESR): 0 – 30 mm/hour (value may vary depending on age)

White Blood Cells and Differential

  • White Blood Cell (WBC) Count: 4,500 to 11,000 cells/mm³
  • Neutrophils: 55 – 70% or 1,800 to 7,800 cells/mm³
  • Lymphocytes: 20 – 40% or 1,000 to 4,800 cells/mm³
  • Monocytes: 2 – 8% or 0.0 to 800 cells/mm³
  • Eosinophils: 1 – 4% or 0.0 to 450 cells/mm³
  • Basophils: 0–2% or 0.0 to 200 cells/mm³
  • Bands: 0–2 % or 0.0 to 700 cells/mm³

Coagulation Studies

  • Platelet count (PLT): 150,000 to 400,000 cells/mm³
  • Activated partial thromboplastin time (APTT): 20 to 60 seconds, depending on the type of activator used.
  • Prothrombin time (PT): 11 – 13 seconds
  • Partial Thromboplastin Time (PTT): 25 – 35 seconds
  • International Normalized Ratio (INR): The INR standardizes the PT ratio and is calculated in the laboratory setting by raising the observed PT ratio to the power of the international sensitivity index specific to the thromboplastin reagent used.
  • Fibrinogen: 203 – 377 mg/dL
  • Bleeding time: 1 to 3 minutes (Duke method), 3 to 6 minutes (Ivy method)
  • D-Dimer: < 500 ng/mL

Serum Electrolytes

  • Potassium (K+): 3.5 – 5.0 mEq/L
  • Sodium (Na+): 135-145 mEq/L
  • Chloride (Cl-): 95 – 105 mEq/L
  • Calcium (Ca+):
    • Total calcium: 4.5 – 5.5 mEq/L (8.5 to 10.5 mg/dL)
    • Ionized calcium: 2.5 mEq/L (4.0 – 5.0 mg/dL) 56% of total calcium
  • Phosphorus (P): 1.8 – 2.6 mEq/L (2.7 to 4.5 mg/dL)
  • Magnesium (Mg): 1.6 to 2.6 mg/dL
  • Serum Osmolality: 280 to 300 mOsm/kg
  • Serum bicarbonate: 22 to 29 mEq/L

Renal Function Studies

  • Creatinine (Cr): 0.6 to 1.3 mg/dL
  • Blood urea nitrogen (BUN): 8 to 25 mg/dL

Glucose Studies

  • Glucose:
    • Glucose, fasting: 70 – 110 mg/dL
    • Glucose, monitoring: 60 – 110 mg/dL
    • Glucose, 2-hr postprandial: < 140mg/dL
  • Glucose Tolerance Test (GTT)
    • 70 – 110 mg/dL (baseline fasting)
    • 110 – 170 mg/dL (30 minute fasting)
    • 120 – 170 mg/dL (60 minute fasting)
    • 100 – 140 mg/dL (90 minute fasting)
    • 70 – 120 mg/dL (120 minute fasting)
  • Glycosylated hemoglobin (HbA1c)
    • 7% or lower (good control of diabetes)
    • 7% to 8% (fair control of diabetes)
    • Higher than 8 % (poor control of diabetes)
  • Diabetes Mellitus autoantibody panel: Less than 1:4 titer with no antibody detected

Arterial Blood Gases (ABGs)

  • Arterial blood pH: 7.35 – 7.45
  • Oxygen saturation (SaO2): >95%
  • Partial pressure of carbon dioxide (PCO2): 35 – 45 mmHg
  • Partial pressure of oxygen (PaO2): 80 – 100 mmHg
  • Bicarbonate (HCO3): 22 – 26 mEq/L

Liver Function Tests

  • Alanine Aminotransferase (ALT):
    • Male: 10 to 55 units/L
    • Female: 7 to 30 units/L
  • Aspartate Aminotransferase (AST):
    • Male: 10 – 40 units/L
    • Female: 9 – 25 units/L
  • Total bilirubin: 0.3 – 1.0 mg/dL
  • Direct bilirubin (conjugated): 0.0 to 0.2 mg/dL
  • Indirect bilirubin (unconjugated): 0.1 to 1 mg/dL; Critical level: > 12 mg/dL
  • Albumin: 3.4 to 5 g/dL
  • Ammonia: 35 – 65 mcg/dL (adult)
  • Amylase: 25 to 151 units/L
  • Lipase: 10 to 140 units/L
  • Protein: 6 to 8 g/dL

Lipoprotein Profile

  • Cholesterol: Less than 200 mg/dL
  • High-density lipoprotein (HDL): 30 to 70 mg/dL
  • Low density lipoprotein (LDL): Less than 130 mg/dL
  • Triglycerides: Less than 150 mg/dL

Cardiac Markers and Serum Enzymes

  • Creatine kinase (CK)
    • Male: 38 – 174 U/L
    • Female: 26 – 140 U/L
  • Creatinine kinase isoenzymes
    • CK-MM: 95% – 100% of total
    • CK-MB: 0% – 5% of total
    • CK-BB: 0%
  • Myoglobin: 5–70 ng/mL
  • Troponin:
    • Troponin: Less than 0.04 ng/mL; above 0.40 ng/mL may indicate MI
    • Troponin T: Greater than 0.1 to 0.2 ng/mL may indicate MI
    • Troponin I: Less than 0.6 ng/mL; >1.5 ng/mL indicates myocardial infarction
  • Atrial natriuretic peptide (ANP): 22 to 27 pg/mL
  • Brain natriuretic peptide (BNP): less than 100 pg/mL
  • C-type natriuretic peptide (CNP): reference range provided with results should be reviewed

HIV and AIDS Testing

Thyroid function test

  • Triiodothyronine (T₃): 80 to 230 ng/dL
  • Thyroxine (T₄): 5 to 12 mcg/dL
  • Thyroxine, free (FT₄): 0.8 to 2.4 ng/dL
  • Thyroid-stimulating hormone (thyrotropin): 0.2 to 5.4 microunits/mL

Urinalysis

  • Color: Pale yellow
  • Odor: Aromatic odor
  • Turbidity: Clear
  • Specific gravity: 1.016 to 1.022
  • pH: 4.5 to 7.8
  • Protein: Negative
  • Ketones: Negative
  • Bilirubin: Negative
  • Glucose: >0.5 g/day
  • Red blood cells: < 3 cells/HPF
  • White blood cells: < or = 4 cells/HPF
  • Bacteria: None or >1000/ml
  • Casts: None to few
  • Crystals: None
  • Uric acid: 250 to 750 mg/24 hours
  • Sodium: 40 to 220 mEq/24 hours
  • Potassium: 25 to 125 mEq/24 hours
  • Magnesium: 7.3 – 12.2 mg/dL

Hepatitis Testing

  • Hepatitis A: Presence of immunoglobulin M (IgM) antibody to Hepatitis A and presence of total antibody (IgG and IgM) may suggest recent or current Hep A infection.
  • Hepatitis B: Detection of Hep B core Antigen (HBcAg), envelope antigen (HBeAg), and surface antigen (HBsAg), or their corresponding antibodies.
  • Hepatitis C: Confirmed by the presence of antibodies to Hep C virus.
  • Hepatitis D: Detection of Hep D antigen (HDAg) early in the course of infection and detection of Hep D virus antibody in later stages of the disease.
  • Hepatitis E: Specific serological tests for hepatitis E virus include detection of IgM and IgG antibodies to hepatitis E.

Therapeutic Drug Levels

  • Acetaminophen (Tylenol): 10 to 20 mcg/mL
  • Carbamazepine (Tegretol): 5 to 12 mcg/mL
  • Digoxin (Lanoxin): 0.5 to 2 ng/mL
  • Gentamicin (Garamycin): 5 – 10 mcg/mL (peak); <2.0 mcg/mL (trough)
  • Lithium (Lithobid): 0.5 to 1.2 mEq/L
  • Magnesium sulfate: 4 to 7 mg/dL
  • Phenobarbital (Luminal): 10 to 30 mcg/mL
  • Phenytoin (Dilantin): 10 to 20 mcg/mL
  • Salicylate: 100 to 250 mcg/mL
  • Theophylline: 10 to 20 mcg/dL
  • Tobramycin (Tobrex): 5 – 10 mcg/mL (peak); 0.5 – 2.0 mcg/mL (trough)
  • Valproic acid (Depakene): 50 – 100 mcg/mL
  • Vancomycin (Vancocin): 20 – 40 mcg/mL (peak); 5 – 15 mcg/mL (trough)

Erythrocyte Studies Normal Lab Values

Here are the normal lab values related to erythrocyte studies which include hemoglobin, hematocrit, red blood cell count, serum iron, and erythrocyte sedimentation rate. Venous blood is used as a specimen for completed blood count (CBC) which is a basic screening test that is frequently ordered to give an idea about the health of a patient.

Red Blood Cells (RBC)

Red blood cells or erythrocytes transport oxygen from the lungs to the bodily tissues. RBCs are produced in the red bone marrow, can survive in the peripheral blood for 120 days, and are removed from the blood through the bone marrow, liver, and spleen.

Normal values for red blood cell count:

  • Male adult: 4.5 – 6.2 million/mm3
  • Female adult: 4.5 – 5.0 million/mm3

Indications of RBC count:

  • Helps in diagnosing anemia and blood dyscrasia.

Hemoglobin (Hgb)

Hemoglobin is the protein component of red blood cells that serves as a vehicle for oxygen and carbon dioxide transport. It is composed of a pigment (heme) which carries iron, and a protein (globin). The hemoglobin test is a measure of the total amount of hemoglobin in the blood.

Normal values chart for hemoglobin count:

  • Male adult: 14 – 16.5 g/dL
  • Female adult: 12 – 16 g/dL

Indications of Hemoglobin count: 

  • Hemoglobin count is indicated to help measure the severity of anemia (low hemoglobin) or polycythemia (high hemoglobin).
  • Monitor the effectiveness of a therapeutic regimen.

Hematocrit (Hct)

Hematocrit or packed cell volume (Hct, PCV, or crit) represents the percentage of the total blood volume that is made up of the red blood cell (RBC).

Normal values for hematocrit count:

  • Male adult: 42 – 52%
  • Female adult: 35 – 47%

Red Blood Cell Indices

Red blood cell indicates (RBC Indices) determine the characteristics of an RBC. It is useful in diagnosing pernicious and iron deficiency anemias and other liver diseases.

  • Mean corpuscular volume (MCV): The average size of the individual RBC.
  • Mean corpuscular hemoglobin (MCH): The amount of Hgb present in one cell.
  • Mean corpuscular hemoglobin concentration (MCHC): The proportion of each cell occupied by the Hgb.

Normal Lab Values for RBC Indices are: 

  • Mean corpuscular volume (MCV): Male: 78 – 100 μm3; Female: 78 – 102 μm3
  • Mean corpuscular hemoglobin (MCH): 25 – 35pg
  • Mean corpuscular hemoglobin concentration (MCHC): 31 – 37%

Serum Iron (Fe)

Iron is essential for the production of blood helps transport oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs.

Normal lab values for serum iron:

  • Male adult: 65 – 175 mcg/dL
  • Female adult: 50 – 170 mcg/dL

Indication of serum iron: 

  • Helps in diagnosing anemia and hemolytic disorder.

Nursing considerations for serum iron: 

  • Recent intake of a meal containing high iron content may affect the results.
  • Drugs that may cause decreased iron levels include adrenocorticotropic hormone, cholestyramine, colchicine, deferoxamine, and testosterone.
  • Drugs that may cause increased iron levels include dextrans, ethanol, estrogens, iron preparations, methyldopa, and oral contraceptives.

Erythrocyte Sedimentation Rate (ESR)

Erythrocyte sedimentation rate (ESR) is a measurement of the rate at which erythrocytes settle in a blood sample within one hour.

Normal lab values for erythrocyte sedimentation rate:

  • 0 – 30 mm/hour (value may vary depending on age)

Indication for Erythrocyte Sedimentation Rate: 

  • Assist in the diagnosis of conditions related to acute and chronic infection, inflammation, and tissue necrosis or infarction.

Nursing consideration

  • Fasting is not required
  • Fatty meal prior extraction may cause plasma alterations

White Blood Cells and Differential

The normal laboratory value for WBC count has two components: the total number of white blood cells and differential count.

White Blood Cells (WBC)

White blood cells act as the body’s first line of defense against foreign bodies, tissues, and other substances. WBC count assesses the total number of WBC in a cubic millimeter of blood. White blood cell differential provides specific information on white blood cell types:

  • Neutrophils are the most common type of WBC and serve as the primary defense against infection.
  • Lymphocytes play a big role in response to inflammation or infection.
  • Monocytes are cells that respond to infection, inflammation, and foreign bodies by killing and digesting the foreign organism (phagocytosis).
  • Eosinophils respond during an allergic reaction and parasitic infections.
  • Basophils are involved during an allergic reaction, inflammation, and autoimmune diseases.
  • Bands are immature WBCs that are first released from the bone marrow into the blood.

Normal lab values for white blood cell count and WBC differential: 

  • WBC Count: 4,500 to 11,000 cells/mm³
  • Neutrophils: 55 – 70% or 1,800 to 7,800 cells/mm³
  • Lymphocytes: 20 – 40% or 1,000 to 4,800 cells/mm³
  • Monocytes: 2 – 8% or 0.0 to 800 cells/mm³
  • Eosinophils: 1 – 4% or 0.0 to 450 cells/mm³
  • Basophils: 0–2% or 0.0 to 200 cells/mm³
  • Bands: 0–2 % or 0.0 to 700 cells/mm³

Nursing consideration for WBC count: 

  • A high total WBC count with a left shift means that the bone marrow will release an increased amount of neutrophils in response to inflammation or infection.
  • A “shift to the right” which is usually seen in liver disease, megaloblastic and pernicious anemia, and Down syndrome, indicates that cells have more than the usual number of nuclear segments.
  • A “shift to the left” indicates an increased number of immature neutrophils is found in the blood.
  • A low total WBC count with a left shift means a recovery from bone marrow depression or an infection of such intensity that the demand for neutrophils in the tissue is greater than the capacity of the bone marrow to release them into the circulation.

Coagulation Studies Normal Lab Values

Physicians order coagulation studies such as platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio, bleeding time, and D-dimer to evaluate the clotting function of an individual. In this section, we’ll discuss the indications and nursing implications of each lab test.

Platelets (PLT)

Platelets are produced in the bone marrow and play a role in hemostasis. Platelets function in hemostatic plug formation, clot retraction, and coagulation factor activation.

Normal values for platelet count:

  • 150,000 to 400,000 cells/mm³

Nursing considerations for Platelet counts: 

  • High altitudes, persistent cold temperature, and strenuous exercise increase platelet counts.
  • Assess the venipuncture site for bleeding in clients with known thrombocytopenia.
  • Bleeding precautions should be instituted in clients with a low platelet count.

Activated Partial Thromboplastin Time (APTT)

Activated partial thromboplastin time (APTT) evaluates the function of the contact activation pathway and coagulation sequence by measuring the amount of time it requires for recalcified citrated plasma to clot after partial thromboplastin is added to it. The test screens for deficiencies and inhibitors of all factors, except factors VII and XIII.

Normal lab value for activated partial thromboplastin time:

  • 20 to 60 seconds, depending on the type of activator used.

Indication for APTT: 

  • Monitors the effectiveness of heparin therapy.
  • Detect coagulation disorders in clotting factors such as hemophilia A (factor VIII) and hemophilia B (factor IX).
  • Determine individuals who may be prone to bleeding during invasive procedures.

Nursing consideration for APTT: 

  • Do not draw samples from an arm into which heparin is infusing.
  • If the client is receiving intermittent heparin by intermittent injection, plan to draw the blood sample 1 hour before the next dose of heparin.
  • Apply direct pressure to the venipuncture site.
  • Blood specimen should be transported to the laboratory immediately.
  • The aPTT should be between 1.5 and 2.5 times normal when the client is receiving heparin therapy.
  • Monitor for signs of bleeding if the aPTT value is longer than 90 seconds in a patient receiving heparin therapy.

Prothrombin Time and International Normalized Ratio (PT/INR)

Prothrombin is a vitamin K-dependent glycoprotein produced by the liver that is essential for fibrin clot formation. Each laboratory establishes a normal or control value based on the method used to perform the PT test. The PT measures the amount of time it takes in seconds for clot formation, the international normalized ratio (INR) is calculated from a PT result to monitor the effectiveness of warfarin.

Indication for PT and INR

  • Monitor response to warfarin sodium (Coumadin) therapy.
  • Screen for dysfunction of the extrinsic clotting system resulting from vitamin K deficiency disseminated intravascular coagulation or liver disease.

Normal Lab Value for Prothrombin Time (PT)

  • Normal: 11 – 13 seconds
  • Critical value: >20 seconds for persons who do not use anticoagulants.
  • The INR standardizes the PT ratio and is calculated in the laboratory setting by raising the observed PT ratio to the power of the international sensitivity index specific to the thromboplastin reagent used.

Nursing Care for Prothrombin Time

  • If a PT is prescribed, the baseline specimen should be drawn before anticoagulation therapy is started; note the time of collection on the laboratory form.
  • Provide direct pressure to the venipuncture site for 3 to 5 minutes.
  • Concurrent warfarin therapy with heparin therapy can lengthen the PT for up to 5 hours after dosing.
  • Diets high in green leafy vegetables can increase the absorption of vitamin K, which shortens the PT.
  • Orally administered anticoagulation therapy usually maintains the PT at 1.5 to 2 times the laboratory control value.
  • Initiate bleeding precautions, if the PT value is longer than 30 seconds in a client receiving warfarin therapy.

Bleeding Time

Bleeding time assess the overall hemostatic function (platelet response to injury and vasoconstrictive ability).

Indication for Bleeding Time

  • Useful in detecting disorders of platelet function.

Nursing Considerations for Bleeding Time

  • Assess and validate that the client has not been receiving anticoagulants, aspirin, or aspirin-containing products for 3 days prior to the test.
  • Inform the client that punctures are made to measure the time it takes for bleeding to stop.
  • Apply pressure dressing to clients with bleeding tendencies after the procedure.

Normal Values for Bleeding Time

  • Duke method: 1 to 3 minutes
  • Ivy method: 3 to 6 minutes

D-Dimer Test

D-Dimer is a blood test that measures clot formation and lysis that results from the degradation of fibrin.

Indication of D-Dimer Test

  • Helps to diagnose the presence of thrombus in conditions such as deep vein thrombosis, pulmonary embolism, or stroke.
  • Used to diagnose disseminated intravascular coagulation (DIC).
  • Monitor the effectiveness of treatment.

Normal Lab Value for D-Dimer

  • < 500 ng/mL

Serum Electrolytes

Electrolytes are minerals that are involved in some of the important functions in our body. Serum electrolytes are routinely ordered for a patient admitted to a hospital as a screening test for electrolyte and acid-base imbalances. Here we discuss the normal lab values of the commonly ordered serum tests: potassium, serum sodium, serum chloride, and serum bicarbonate. Serum electrolytes may be ordered as a “Chem 7” or as a “basic metabolic panel (BMP)”.

Serum Potassium (K+)

Potassium is the most abundant intracellular cation that serves important functions such as regulate acid-base equilibrium, control cellular water balance, and transmit electrical impulses in skeletal and cardiac muscles.

Normal Values for Serum Potassium

  • Potassium: 3.5 – 5.0 mEq/L

Indications for Serum Potassium

  • Evaluates cardiac function, renal function, gastrointestinal function, and the need for IV replacement therapy.

Nursing Considerations for Serum Potassium

  • Note on the laboratory form if the client is receiving potassium supplementation.
  • Clients with elevated white blood cell counts and platelet counts may have falsely elevated potassium levels.

Serum Sodium (Na+)

Sodium is a major cation of extracellular fluid that maintains osmotic pressure and acid-base balance, and assists in the transmission of nerve impulses. Sodium is absorbed from the small intestine and excreted in the urine in amounts dependent on dietary intake.

Normal Lab Values for Serum Sodium

  • 135-145 mEq/L

Indications for Serum Sodium

  • Determine whole-body stores of sodium, because the ion is predominantly extracellular
  • Monitor the effectiveness of drug, especially diuretics, on serum sodium levels.

Nursing consideration for Serum Sodium

  • Drawing blood samples from an extremity in which an intravenous (IV) solution of sodium chloride is infusing increases the level, producing inaccurate results.

Serum Chloride (Cl-)

Chloride is a  hydrochloric acid salt that is the most abundant body anion in the extracellular fluid. Functions to counterbalance cations, such as sodium, and acts as a buffer during oxygen and carbon dioxide exchange in red blood cells (RBCs). Aids in digestion and maintaining osmotic pressure and water balance.

Normal Lab Value for Serum Chloride (Cl-)

  • 95 – 105 mEq/L

Nursing Considerations for Serum Chloride

  • Any condition accompanied by prolonged vomiting, diarrhea, or both will alter chloride levels.

Serum Bicarbonate

Part of the bicarbonate-carbonic acid buffering system and mainly responsible for regulating the pH of body fluids.

Normal Lab Value for Serum Bicarbonate

  • 22 to 29 mEq/L

Nursing consideration for Serum Bicarbonate

  • Ingestion of acidic or alkaline solutions may cause increased or decreased results, respectively.

Calcium (Ca+)

Calcium (Ca+) is a cation absorbed into the bloodstream from dietary sources and functions in bone formation, nerve impulse transmission, and contraction of myocardial and skeletal muscles. Calcium aids in blood clotting by converting prothrombin to thrombin.

Normal Lab Value for Calcium

  • Total: 4.5 – 5.5 mEq/L (8.5 to 10.5 mg/dL)
  • Ionized: 2.5 mEq/L (4.0 – 5.0 mg/dL) 56% of total calcium

Nursing Considerations

  • Instruct the client to eat a diet with a normal calcium level (800 mg/day) for 3 days before the exam.
  • Instruct the client that fasting may be required for 8 hours before the test.
  • Note that calcium levels can be affected by decreased protein levels and the use of anticonvulsant medications

Phosphorus (P)

Phosphorus (Phosphate) is important in bone formation, energy storage and release, urinary acid-base buffering, and carbohydrate metabolism. Phosphorus is absorbed from food and is excreted by the kidneys. High concentrations of phosphorus are stored in bone and skeletal muscle.

Normal Lab Value for Phosphorus

  • 1.8 – 2.6 mEq/L (2.7 to 4.5 mg/dL)

Nursing Consideration

  • Instruct the client to fast before the test.

Magnesium (Mg)

Magnesium is used as an index to determine metabolic activity and renal function. Magnesium is needed in the blood-clotting mechanisms, regulates neuromuscular activity, acts as a cofactor that modifies the activity of many enzymes, and has an effect on the metabolism of calcium.

Normal Magnesium Lab Value

  • 1.6 to 2.6 mg/dL

Nursing Considerations

  • Prolonged use of magnesium products causes increased serum levels.
  • Long-term parenteral nutrition therapy or excessive loss of body fluids may decrease serum levels.

Serum Osmolality

Serum osmolality is a measure of the solute concentration of the blood. Particles include sodium ions, glucose, and urea.  Serum osmolality is usually estimated by doubling the serum sodium because sodium is a major determinant of serum osmolality.

Normal Lab Value for Serum Osmolality

  • 280 to 300 mOsm/kg

Renal Function Studies Normal Lab Values

In this section, we’ll be discussing the normal laboratory values of serum creatinine and blood urea nitrogen, including their indications and nursing considerations. These laboratory tests are helpful in determining the kidney function of an individual.

Serum Creatinine (Cr)

Creatinine is a specific indicator of renal function. Increased levels of creatinine indicate a slowing of the glomerular filtration rate.

Normal Lab Value for Serum Creatinine

  • 0.6 to 1.3 mg/dL

Nursing Considerations

  • Instruct the client to avoid excessive exercise for 8 hours and excessive red meat intake for 24 hours before the test.

Blood Urea Nitrogen (BUN)

Urea nitrogen is the nitrogen portion of urea, a substance formed in the liver through an enzymatic protein breakdown process. Urea is normally freely filtered through the renal glomeruli, with a small amount reabsorbed in the tubules and the remainder excreted in the urine. Elevated levels indicate a slowing of the glomerular filtration rate.

Normal Lab Value for Blood Urea Nitrogen

  • 8 to 25 mg/dL

Nursing consideration

  • BUN and creatinine ratios should be analyzed when renal function is evaluated.

Glucose Studies Normal Lab Values

Understanding the normal laboratory values of blood glucose is an essential key in managing diabetes mellitus. Included in this section are the lab values and nursing considerations for glycosylated hemoglobin, fasting blood sugar, glucose tolerance test, and diabetes mellitus antibody panel.

Fasting Blood Glucose

Fasting blood glucose or fasting blood sugar (FBS) levels are used to help diagnose diabetes mellitus and hypoglycemia. Glucose is a monosaccharide found in fruits and is formed from the digestion of carbohydrates and the conversion of glycogen by the liver. Glucose is the main source of cellular energy for the body and is essential for brain and erythrocyte function.

Normal Lab Value for Glucose

  • Glucose, fasting: 70 – 110 mg/dL
  • Glucose, monitoring: 60 – 110 mg/dL
  • Glucose, 2-hr postprandial: < 140mg/dL

Nursing consideration:

  • Instruct the client to fast for 8 to 12 hours before the test.
  • Instruct a client with diabetes mellitus to withhold morning insulin or oral hypoglycemic medication until after the blood is drawn.

Glucose Tolerance Test (GTT)

The glucose tolerance test (GTT) aids in the diagnosis of diabetes mellitus. If the glucose levels peak at higher than normal at 1 and 2 hours after injection or ingestion of glucose and are slower than normal to return to fasting levels, then diabetes mellitus is confirmed.

Normal Lab Values for Glucose Tolerance Test (GTT)

  • 70 – 110 mg/dL (baseline fasting)
  • 110 – 170 mg/dL (30 minute fasting)
  • 120 – 170 mg/dL (60 minute fasting)
  • 100 – 140 mg/dL (90 minute fasting)
  • 70 – 120 mg/dL (120 minute fasting)

Nursing Considerations

  • Instruct the client to eat a high-carbohydrate (200 to 300 g) diet for 3 days before the test.
  • Instruct the client to avoid alcohol, coffee, and smoking for 36 hours before the test.
  • Instruct the client to avoid strenuous exercise for 8 hours before and after the test.
  • Instruct the client to fast for 10 to 16 hours before the test.
  • Instruct the client with diabetes mellitus to withhold morning insulin or oral hypoglycemic medication.
  • Instruct the client that the test may take 3 to 5 hours, requires IV or oral administration of glucose, and the taking of multiple blood samples.

Glycosylated Hemoglobin (HbA1c)

Glycosylated hemoglobin is blood glucose bound to hemoglobin. Hemoglobin A₁C (glycosylated hemoglobin A; HbA1c) is a reflection of how well blood glucose levels have been controlled for the past 3 to 4 months. Hyperglycemia in clients with diabetes is usually a cause of an increase in the HbA1c.

Normal and Abnormal Lab Values for Glycosylated Hemoglobin

  • 7% or lower (good control of diabetes)
  • 7% to 8% (fair control of diabetes)
  • Higher than 8 % (poor control of diabetes)

Nursing Consideration

  • Fasting is not required before the test.

Diabetes Mellitus Autoantibody Panel

Used to evaluate insulin resistance and to identify type 1 diabetes and clients with a suspected allergy to insulin.

Normal Lab Value for DM Autoantibody Panel: 

  • Less than 1:4 titer with no antibody detected

Arterial Blood Gas (ABG) Normal Lab Values

Arterial Blood Gases (ABGs) are measured in a laboratory test to determine the extent of compensation by the buffer system. It measures the acidity (pH) and the levels of oxygen and carbon dioxide in arterial blood. Blood for an ABG test is taken from an artery whereas most other blood tests are done on a sample of blood taken from a vein. To help you interpret ABG results, check out our 8-Step Guide to ABG Analysis Tic-Tac-Toe Method.

Normal Lab Values for Arterial Blood Gases

  • pH: 7.35 – 7.45
  • HCO3: 22 – 26 mEq/L
  • PCO2: 35 – 45 mmHg
  • PaO2: 80 – 100 mmHg
  • SaO2: >95

Liver Function Tests Normal Lab Values

Conditions affecting the gastrointestinal tract can be easily evaluated by studying the normal laboratory values of alanine aminotransferase, aspartate aminotransferase, bilirubin, albumin, ammonia, amylase, lipase, protein, and lipids.

Alanine Aminotransferase (ALT)

Alanine Aminotransferase (ALT) test is used to identify hepatocellular injury and inflammation of the liver and to monitor improvement or worsening of the disease. ALT was formerly known as serum pyretic transaminase (SGPT).

Normal Lab Value for Alanine Aminotransferase (ALT) 

  • Male: 10 to 55 units/L
  • Female: 7 to 30 units/L

Nursing Considerations

  • No fasting is required.
  • Previous intramuscular injections may cause elevated levels.

Aspartate Aminotransferase (AST)

Aspartate Aminotransferase (AST) test is used to evaluate a client with a suspected hepatocellular disease, injury, or inflammation (may also be used along with cardiac markers to evaluate coronary artery occlusive disease). AST was formerly known as serum glutamic-oxaloacetic transaminase (SGOT).

Normal Lab Value for Aspartate Aminotransferase (AST)

  • Male: 10 – 40 units/L
  • Female: 9 – 25 units/L

Nursing Considerations

  • No fasting is required.
  • Previous intramuscular injections may cause elevated levels.

Bilirubin

Bilirubin is produced by the liver, spleen, and bone marrow and is also a by-product of hemoglobin breakdown. Total bilirubin levels can be broken into direct bilirubin, which is excreted primarily via the intestinal tract, and indirect bilirubin, which circulates primarily in the bloodstream. Total bilirubin levels increase with any type of jaundice; direct and indirect bilirubin levels help differentiate the cause of jaundice.

Normal Lab Values for Bilirubin

  • Total bilirubin: 0.3 – 1.0 mg/dL
  • Direct bilirubin (conjugated): 0.0 to 0.2 mg/dL
  • Indirect bilirubin (unconjugated): 0.1 to 1 mg/dL
  • Critical level: > 12 mg/dL

Nursing Considerations

  • Instruct the client to eat a diet low in yellow foods, avoiding foods such as carrots, yams, yellow beans, and pumpkin, for 3 to 4 days before the blood is drawn.
  • Instruct the client to fast for 4 hours before the blood is drawn.
  • Note that results will be elevated with the ingestion of alcohol or the administration of morphine sulfate, theophylline, ascorbic acid (vitamin C), or acetylsalicylic acid (Aspirin).
  • Note that results are invalidated if the client has received a radioactive scan within 24 hours before the test.

Albumin

Albumin is the main plasma protein of blood that maintains oncotic pressure and transports bilirubin, fatty acids, medications, hormones, and other substances that are insoluble in water. Albumin is increased in conditions such as dehydration, diarrhea, and metastatic carcinoma; decreased in conditions such as acute infection, ascites, and alcoholism. Presence of detectable albumin, or protein, in the urine is indicative of abnormal renal function.

Normal Lab Value for Albumin

  • 3.4 to 5 g/dL

Nursing Considerations

  • Fasting is not required.

Ammonia

Ammonia is a by-product of protein catabolism; most of it is created by bacteria acting on proteins present in the gut. Ammonia is metabolized by the liver and excreted by the kidneys as urea. Elevated levels resulting from hepatic dysfunction may lead to encephalopathy. Venous ammonia levels are not a reliable indicator of hepatic coma.

Normal Lab Value for Ammonia

  • Adults: 35 – 65 mcg/dL

Nursing Considerations

  • Instruct the client to fast, except for water, and to refrain from smoking for 8 to 10 hours before the test; smoking increases ammonia levels.
  • Place the specimen on ice and transport to the laboratory immediately.

Amylase

Amylase is an enzyme, produced by the pancreas and salivary glands, aids in the digestion of complex carbohydrates and is excreted by the kidneys. In acute pancreatitis, the amylase level may exceed five times the normal value; the level starts rising 6 hours after the onset of pain, peaks at about 24 hours, and returns to normal in 2 to 3 days after the onset of pain. In chronic pancreatitis, the rise in serum amylase usually does not normally exceed three times the normal value.

Normal Lab Values for Amylase

  • 25 to 151 units/L

Nursing Considerations

  • On the laboratory form, list the medications that the client has taken during the previous 24 hours before the test.
  • Note that many medications may cause false-positive or false-negative results.
  • Results are invalidated if the specimen was obtained less than 72 hours after cholecystography with radiopaque dyes.

Lipase

Lipase is a pancreatic enzyme converts fats and triglycerides into fatty acids and glycerol. Elevated lipase levels occur in pancreatic disorders; elevations may not occur until 24 to 36 hours after the onset of illness and may remain elevated for up to 14 days.

Normal Lab Values for Lipase

  • 10 to 140 units/L

Nursing Consideration

  • Endoscopic retrograde cholangiopancreatography (ERCP) may increase lipase activity.

Serum Protein

Serum protein reflects the total amount of albumin and globulins in the plasma. Protein regulates osmotic pressure and is necessary for the formation of many hormones, enzymes, and antibodies; it is a major source of building material for blood, skin, hair, nails, and internal organs. Increased in conditions such as Addison’s disease, autoimmune collagen disorders, chronic infection, and Crohn’s disease. Decreased in conditions such as burns, cirrhosis, edema, and severe hepatic disease.

Normal Lab Value for Serum Protein: 

  • 6 to 8 g/dL

Lipoprotein Profile

Lipid assessment or lipid profile includes total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides.

  • Cholesterol is present in all body tissues and is a major component of LDL, brain, and nerve cells, cell membranes, and some gallbladder stones.
  • Triglycerides constitute a major part of very-low-density lipoproteins and a small part of LDLs. Increased cholesterol levels, LDL levels, and triglyceride levels place the client at risk for coronary artery disease. HDL helps protect against the risk of coronary artery disease.

Normal Lab Values for Lipid Profile

  • Cholesterol: Less than 200 mg/dL
  • Triglycerides: Less than 150 mg/dL
  • HDLs: 30 to 70 mg/dL
  • LDLs: Less than 130 mg/dL

Nursing Considerations

  • Oral contraceptives may increase the lipid level.
  • Instruct the client to abstain from foods and fluid, except for water, for 12 to 14 hours and from alcohol for 24 hours before the test.
  • Instruct the client to avoid consuming high-cholesterol foods with the evening meal before the test.

Cardiac Markers and Serum Enzymes

Serum enzymes and cardiac markers are released into the circulation normally following a myocardial injury as seen in acute myocardial infarction (MI) or other conditions such as heart failure.

Creatine Kinase (CK)

Creatine kinase (CK) is an enzyme found in muscle and brain tissue that reflects tissue catabolism resulting from cell trauma. The CK level begins to rise within 6 hours of muscle damage, peaks at 18 hours, and returns to normal in 2 to 3 days. The test for CK is performed to detect myocardial or skeletal muscle damage or central nervous systemdamage. Isoenzymes include CK-MB (cardiac), CK-BB (brain), and CK-MM (muscles):

  • CK-MM is found mainly in skeletal muscle.
  • CK-MB is found mainly in cardiac muscle
  • CK-BB is found mainly in brain tissue

Normal Lab Values for Creatinine Kinase and Isoenzymes

  • Creatine kinase (CK)
    • Male: 38 – 174 U/L
    • Women: 26 – 140 U/L
  • Creatinine kinase isoenzymes
    • CK-MM: 95% – 100% of total
    • CK-MB: 0% – 5% of total
    • CK-BB: 0%

Nursing Considerations

  • If the test is to evaluate skeletal muscle, instruct the client to avoid strenuous physical activity for 24 hours before the test.
  • Instruct the client to avoid ingestion of alcohol for 24 hours before the test.
  • Invasive procedures and intramuscular injections may falsely elevate CK levels.

Myoglobin

Myoglobin, an oxygen-binding protein that is found in striated (cardiac and skeletal) muscle, releases oxygen at very low tensions. Any injury to skeletal muscle will cause a release of myoglobin into the blood. Myoglobin rise in 2-4 hours after an MI making it an early marker for determining cardiac damage.

Normal Lab Values for Myoglobin

  • Myoglobin: 5–70 ng/mL

Nursing Considerations

  • The level can rise as early as 2 hours after a myocardial infarction, with a rapid decline in the level after 7 hours.
  • Because the myoglobin level is not cardiac specific and rises and falls so rapidly, its use in diagnosing myocardial infarction may be limited.

Troponin I and Troponin T

Troponin is a regulatory protein found in striated muscle (myocardial and skeletal). Increased amounts of troponin are released into the bloodstream when an infarction causes damage to the myocardium. Troponin levels are elevated as early as 3 hours after MI. Troponin I levels may remain elevated for 7 to 10 days and Troponin T levels may remain elevated for as long as 10 to 14 days. Serial measurements are important to compare with a baseline test; elevations are clinically significant in the diagnosis of cardiac pathology.

Normal Lab Value for Troponin

  • Troponin: Less than 0.04 ng/mL; above 0.40 ng/mL may indicate MI
  • Troponin T: Greater than 0.1 to 0.2 ng/mL may indicate MI
  • Troponin I: Less than 0.6 ng/mL; >1.5 ng/mL indicates myocardial infarction

Nursing Considerations

  • Rotate venipuncture sites.
  • Testing is repeated in 12 hours or as prescribed, followed by daily testing for 3 to 5 days.

Natriuretic Peptides

Natriuretic peptides are neuroendocrine peptides that are used to identify clients with heart failure. There are three major peptides:

  • atrial natriuretic peptides (ANP) synthesized in cardiac ventricle muscle,
  • brain natriuretic peptides (BNP)  synthesized in the cardiac ventricle muscle
  • C-type natriuretic peptides (CNP) synthesized by endothelial cells.

BNP is the primary marker for identifying heart failure as the cause of dyspnea. The higher the BNP level, the more severe the heart failure. If the BNP level is elevated, dyspnea is due to heart failure; if it is normal, the dyspnea is due to a pulmonary problem.

Normal Lab Values for Natriuretic Peptics

  • Atrial natriuretic peptide (ANP): 22 to 27 pg/mL
  • Brain natriuretic peptide (BNP): less than 100 pg/mL
  • C-type natriuretic peptide (CNP): reference range provided with results should be reviewed

Nursing Considerations

  • Fasting is not required.

HIV and AIDS Testing

The following laboratory tests are used to diagnose human immunodeficiency virus (HIV), which is the cause of acquired immunodeficiency syndrome (AIDS). Common tests used to determine the presence of antibodies to HIV include ELISA, Western blot, and Immunofluorescence assay (IFA).

  • A single reactive ELISA test by itself cannot be used to diagnose HIV and should be repeated in duplicate with the same blood sample; if the result is repeatedly reactive, follow-up tests using Western blot or IFA should be performed.
  • A positive Western blot or IFA results is considered confirmatory for HIV.
  • A positive ELISA result that fails to be confirmed by Western blot or IFA should not be considered negative, and repeat testing should take place in 3 to 6 months.

CD4+ T-cell counts

CD4+ T-cell counts help Monitors the progression of HIV. As the condition progresses, usually the number of CD4+ T-cells decreases, with a resultant decrease in immunity. In general, the immune system remains healthy with CD4+ T-cell counts higher than 500 cells/L. Immune system problems occur when the CD4+ T-cell count is between 200 and 499 cells/L. Severe immune system problems occur when the CD4+ T-cell count is lower than 200 cells/L.

Normal Lab Value for  CD4+ T-cell:

  • Normal: 500 to 1600 cells/L.
  • Severe: Less than 200 cells/L
  • CD4-to-CD8 ratio: 2:1

Thyroid Studies Normal Lab Values

Thyroid studies are performed if a thyroid disorder is suspected. Common laboratory blood tests such as thyroxine, TSH, T4, and T3 are done to evaluate thyroid function. Thyroid studies help differentiate primary thyroid disease from secondary causes and from abnormalities in thyroxine-binding globulin levels. Thyroid peroxidase antibodies test may be done to identify the presence of autoimmune conditions involving the thyroid gland.

Laboratory Values for Thyroid Function Test

  • Triiodothyronine (T₃): 80 to 230 ng/dL
  • Thyroxine (T₄): 5 to 12 mcg/dL
  • Thyroxine, free (FT₄): 0.8 to 2.4 ng/dL
  • Thyroid-stimulating hormone (thyrotropin): 0.2 to 5.4 microunits/mL

Nursing Considerations

  • Results of the test may be invalid if the client has undergone a radionuclide scan within 7 days before the test.

Hepatitis Testing

Serological tests for specific hepatitis virus markers assist in determining the specific type of hepatitis. Tests for hepatitis include radioimmunoassay, enzyme-linked immunosorbent assay (ELISA), and microparticle enzyme immunoassay.

Nursing Considerations

  • If the radioimmunoassay technique is being used, the injection of radionuclides within 1 week before the blood test is performed may cause falsely elevated results.
  • Hepatitis A: Presence of immunoglobulin M (IgM) antibody to Hepatitis A and presence of total antibody (IgG and IgM) may suggest recent or current Hep A infection.
  • Hepatitis B: Detection of Hep B core Antigen (HBcAg), envelope antigen (HBeAg), and surface antigen (HBsAg), or their corresponding antibodies.
  • Hepatitis C: Confirmed by the presence of antibodies to Hep C virus.
  • Hepatitis D: Detection of Hep D antigen (HDAg) early in the course of infection and detection of Hep D virus antibody in later stages of the disease.
  • Hepatitis E: Specific serological tests for hepatitis E virus include detection of IgM and IgG antibodies to hepatitis E.

Therapeutic Drug Levels Normal Lab Values

Monitoring the therapeutic levels of certain medications is often conducted when the patient is taking medications with a narrow therapeutic range where a slight imbalance could be critical. Drug monitoring includes drawing blood samples for peak and trough levels to determine if blood serum levels of a specific drug are at a therapeutic level and not a subtherapeutic or toxic level. The peak level indicates the highest concentration of the drug in the blood serum while the trough level represents the lowest concentration. The following are the normal therapeutic serum medication levels:

  • Acetaminophen (Tylenol): 10 to 20 mcg/mL
  • Carbamazepine (Tegretol): 5 to 12 mcg/mL
  • Digoxin (Lanoxin): 0.5 to 2 ng/mL
  • Gentamicin (Garamycin): 5 – 10 mcg/mL (peak); <2.0 mcg/mL (trough)
  • Lithium (Lithobid) 0.5 to 1.2 mEq/L
  • Magnesium sulfate: 4 to 7 mg/dL
  • Phenobarbital (Luminal): 10 to 30 mcg/mL
  • Phenytoin (Dilantin): 10 to 20 mcg/mL
  • Salicylate: 100 to 250 mcg/mL
  • Theophylline: 10 to 20 mcg/dL
  • Tobramycin (Tobrex): 5 – 10 mcg/mL (peak); 0.5 – 2.0 mcg/mL (trough)
  • Valproic acid (Depakene): 50 – 100 mcg/mL
  • Vancomycin (Vancocin): 20 – 40 mcg/mL (peak); 5 – 15 mcg/mL (trough)

How to Obtain a Blood Sample

A phlebotomist or a nurse with training and certification in collecting a blood sample are allowed to perform venipuncture for the purpose of blood specimen collection. These are the steps to follow in obtaining a blood sample:

  1. Identify the client. Accurately identify the client by asking his or her name and birthdate; Explain the reason for the test and procedure to the client.
  2. Proper position. Blood samples should be drawn in a sitting position and the client should remain in that position for at least 5 minutes before the blood collection.
  3. Confirm the request. Check the laboratory form for the ordered test, client information, and additional requirements (fasting, dietary restrictions, medications).
  4. Provide comfort. Make sure the client remove any tight clothing that might constrict the upper arm. The arm is placed in a downward position supported on the armrest.
  5. Ensure proper hand hygiene. Perform hand washing before putting on non-latex gloves.
  6. Identify the vein. Examine the client’s arm to select the most easily accessible vein for venipuncture then place the tourniquet 3 to 4 inches above the chosen site. Do not place the tourniquet tightly or leave on more than 2 minutes.
  7. Prepare the site. When a vein is chosen, cleanse the area using alcohol in a circular motion beginning at the site and working toward.
  8. Draw the sample. Ask the client to make a fist. Grasp the client’s arm firmly using your thumb to draw the skin taut and anchor the vein from rolling. Gently insert the needle at a 15 to 30º angle through the skin and into the lumen of the vein.
  9. Fill the tube. Obtain the needed amount of blood sample, then release and remove the tourniquet.
  10. Remove the needle.  In a swift backward motion, remove the needle from the client’s arm. and apply a folded gauze over the venipuncture site for 1 to 2 minutes.
  11. Label the tube. Label the tube with the client’s name, date of birth, hospital number, date and time of the collection.
  12. Transport specimen. Deliver the specimen to the laboratory for immediate processing and analysis.

References and Sources

Suggested reading and additional resources for this Normal Laboratory Values guide:

  • Corbett, J. V., & Banks, A. (2018). Laboratory Tests and Diagnostic Procedures with Nursing Diagnoses with Nursing Diagnoses. Pearson Education.
  • Kratz, A., & Lewandrowski, K. B. (1998). Normal reference laboratory values. New England Journal of Medicine339(15), 1063-1072.
  • Kratz, A., Ferraro, M., Sluss, P. M., & Lewandrowski, K. B. (2004). Laboratory reference values. New England Journal of Medicine351, 1548-1564.

Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Practice Exam: Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Normal Laboratory Values Practice Exam (PM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
6 7 8 9 10
11 12 13 14 15
16 17 18 19 20
End
Return

Asthma Nursing Care Plan & Management

Notes

Definition
  • Asthma is a chronic inflammatory disease of the airways characterized by hyper-responsiveness, mucosal edema, and mucus production.
  • This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea.
  • Patients with asthma may experience symptom-free periods alternating with acute exacerbations that last from minutes to hours or days.
  • Asthma, the most common chronic disease of childhood, can begin at any age.
Causes

The main triggers for asthma are allergies, viral infections, autonomic nervous system imbalances that can cause an increase in parasympathetic stimulation, medications, psychological factors, and exercise. Of asthmatic conditions in patients under 30 years old, 70% are caused by allergies. Three major indoor allergens are dust mites, cockroaches, and cats. In older patients,the cause is almost always nonallergic types of irritants such as smog. Heredity plays a part in about one-third of the cases.

Pathophysiology

1. An asthma attack may occur spontaneously or in response to a trigger. Either way, the attack progresses in the following manner:

  • There is an initial release of inflammatory mediators from bronchial mast cells, epithelial cells, and macrophages, followed by activation of other inflammatory cells
  • Alteration of autonomic neural control of airway tone and epithelial integrity occur and the increased responsiveness in airways smooth muscle results in clinical manifestations (e.g. wheezing and dyspnea)

2. Three events contribute to clinical manifestations

  • Bronchial spasm
  • Inflammation and edema of the mucosa
  • Production of thick mucus, which results in increased airway resistance, premature closure of airways, hyperinflation, increased work of breathing, and impaired gas exchange

3. If not treated promptly, status asthmaticus – an acute, severe, prolonged asthma attack that is unresponsive to the usual treatment – may occur, requiring hospitalization.

Classification

1. Extrinsic Asthma – called Atopic/allergic asthma. An “allergen” or an “antigen” is a foreign particle which enters the body. Our immune system over-reacts to these often harmless items, forming “antibodies” which are normally used to attack viruses or bacteria. Mast cells release these antibodies as well as other chemicals to defend the body.

Common irritants:

  • Cockroach particles
  • Cat hair and saliva
  • Dog hair and saliva
  • House dust mites
  • Mold or yeast spores
  • Metabisulfite, used as a preservative in many beverages and some foods
  • Pollen

2. Intrinsic asthma – called non-allergic asthma, is not allergy-related, in fact it is caused by anything except an allergy. It may be caused by inhalation of chemicals such as cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress, laughter, exercise, cold air, food preservatives or a myriad of other factors.

  • Smoke
  • Exercise
  • Gas, wood, coal, and kerosene heating units
  • Natural gas, propane, or kerosene used as cooking fuel
  • Fumes
  • Smog
  • Viral respiratory infections
  • Wood smoke
  • Weather changes
 Clinical Manifestations
  • Most common symptoms of asthma are cough (with or without mucus production), dyspnea, and wheezing (first on expiration, then possibly during inspiration as well).
  • Asthma attacks frequently occur at night or in the early morning.
  • An asthma exacerbation is frequently preceded by increasing symptoms over days, but it may begin abruptly.
  • Chest tightness and dyspnea occur.
  • Expiration requires effort and becomes prolonged.
  • As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur.
  • Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure, may occur.
  • Exercise-induced asthma: maximal symptoms during exercise, absence of nocturnal symptoms, and sometimes only a description of a “choking” sensation during exercise.
  • A severe, continuous reaction, status asthmaticus, may occur. It is life-threatening.
  • Eczema, rashes, and temporary edema are allergic reactions that may be noted with asthma.
Primary Nursing Diagnosis

Ineffective airway clearance related to obstruction from narrowed lumen and thick mucus

OUTCOMES. Respiratory status: Gas exchange; Respiratory status: Ventilation; Symptom control behavior; Treatment behavior: Illness or injury; Comfort level
INTERVENTIONS. Airway management; Anxiety reduction; Oxygen therapy; Airway suctioning;Airway insertion and stabilization; Cough enhancement; Mechanical ventilation; Positioning;Respiratory monitoring

Assessment and Diagnostic Methods
  • Family, environment, and occupational history is essential.
  • During acute episodes, sputum and blood test, pulse oximetry, ABGs, hypocapnia and respiratory alkalosis, and pulmonary function (forced expiratory volume [FEV] and forced vital capacity [FVC] decreased) tests are performed.
  • Spirometry will detect:
    1. Decreased for expiratory volume (FEV)
    2. Decreased peak expiratory flow rate (PEFR)
    3. Diminished forced vital capacity (FVC)
    4. Diminished inspiratory capacity (IC)
Steps of Clinical and Diagnostic as per National Asthma Education and Prevention Program
Mild Intermittent Asthma
  • Symptoms ? 2 times per week
  • Brief exacerbations
  • Nighttime symptoms ? 2 times a month
  • Asymptomatic and normal PEF (peak expiratory flow) between exacerbations
  • PEF or FEV, (forced expiratory volume in 1 second) ? 80% of predicted value
  • PEF variability < 20%
Mild Persistent Asthma
  • Symptoms > 2 times/week, but less than once a day
  • Exacerbations may affect activity
  • Nighttimes symptoms > 2 times a month
  • PEF/FEV ? 80% of predicted value
  • PEF variability 20%-30%
Moderate Persistent Asthma
  • Daily Symptoms
  • Daily use of inhaled short-acting ?2 – agonists
  • Exacerbations affect activity
  • Exacerbations ? 2 times a week
  • Exacerbations may last  days
  • Nighttime symptoms > once a week
  • PEF/FEV > 60%-<80% of predicted value
  • PEF variability > 30%
Severe Persistent Asthma
  • Continual symptoms
  • Frequent exacerbations
  • Frequent nighttime symptoms
  • Limited physical activity
  • PEF or FEV ? 60% of predicted value
  • PEF variability > 30 %
Medical Management
Pharmacologic Therapy

There are two classes of medications—long-acting control and quick-relief medications—as well as combination products.

  • Short-acting beta2-adrenergic agonists
  • Anticholinergics
  • Corticosteroids: metered-dose inhaler (MDI)
  • Leukotriene modifiers inhibitors/antileukotrienes
  • Methylxanthines
Nursing Management

The immediate nursing care of patients with asthma depends on the severity of symptoms. The patient and family are often frightened and anxious because of the patient’s dyspnea. Therefore, a calm approach is an important aspect of care.

  • Assess the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
  • Obtain a history of allergic reactions to medications before administering medications.
  • Identify medications the patient is currently taking.
  • Administer medications as prescribed and monitor the patient’s responses to those medications; medications may include an antibiotic if the patient has an underlying respiratory infection.
  • Administer fluids if the patient is dehydrated.
  • Assist with intubation procedure, if required.
Teaching Points
  • Teach patient and family about asthma (chronic inflammatory), purpose and action of medications, triggers to avoid and how to do so, and proper inhalation technique.
  • Instruct patient and family about peak-flow monitoring.
  • Teach patient how to implement an action plan and how and when to seek assistance.
  • Obtain current educational materials for the patient based on the patient’s diagnosis, causative factors, educational level, and cultural background.
Continuing Care
  • Emphasize adherence to prescribed therapy, preventive measures, and need for followup appointments.
  • Refer for home health nurse as indicated.
  • Home visit to assess for allergens may be indicated (with recurrent exacerbations).
  • Refer patient to community support groups.
  • Remind patients and families about the importance of health promotion strategies and recommended health screening.
Documentation Guidelines
  • Respiratory status: Patency of airway, auscultation of the lungs, presence or absence of adventitious breath sounds, respiratory rate and depth
  • Response to medications, oxygen therapy, hydration, bedrest
  • Presence of complications: Respiratory failure, ruptured bleb that may result in a pneumothorax

Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed MSN Exam for Asthma and COPD (PM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
6 7 8 9 10
11 12 13 14 15
16 17 18 19 20
21 22 23 24 25
26 27 28 29 30
31 32 33 34 35
36 37 38 39 40
41 42 43 44 45
46 47 48 49 50
51 52 53 54 55
56 57 58 59 60
61 62 63 64 65
66 67 68 69 70
71 72 73 74 75
76 77 78 79 80
81 82 83 84 85
86 87 88 89 90
91 92 93 94 95
96 97 98 99 100
End
Return

Nursing Care Plan

Ineffective Airway Clearance
Assessment

Patient may manifest

  • Difficulty breathing
  • Changes in depth and rate of respiration
  • Use of respiratory accessory muscles
  • Persistent ineffective cough with or without sputum production
  • Wheezing upon inspiration and expiration
  • Dyspnea
  • Coughing
  • Tachypnea, prolonged expiration
  • Tachycardia
  • Chest tightness
  • Suprasternal retraction
  • Restlessness
  • Anxiety
  • Cyanosis
  • Loss of consciousness
Nursing Diagnosis
  • Ineffective airway clearance RT bronchoconstriction, increased mucus production, and respiratory infection AEB wheezing, dyspnea,  and cough

May be related to

  • Increased production or retainment of pulmonary secretions
  • Bronchospasms
  • Decreased energy
  • Fatigue
Planning
  • Patient will maintain/improve airway clearance AEB absence of signs of respiratory distress
  • Patient will verbalize understanding that allergens like dust, fumes, animal dander, pollen, and extremes of temperature and humidity are irritants or factors that can contribute to ineffective airway clearance and should be avoided.
  • Patient will demonstrate behaviors that would prevent the recurrence of the problem.
Nursing Interventions
  • Keep the patient adequately hydrated.
    • Rationale: Systemic hydration keeps secretion moist and easier to expectorate.
  • Teach and encourage the use of diaphragmatic breathing and coughing exercises.
    • Rationale: These techniques help to improve ventilation and mobilize secretions without causing breathlessness and fatigue.
  • Instruct patient to avoid bronchial irritants such as cigarette smoke, aerosols, extremes of temperature, and fumes.
    • Rationale: Bronchial irritants cause bronchoconstriction and increased mucus production, which then interfere with airway clearance.
  • Teach early signs of infection that are to be reported to the clinician immediately.
    • Rationale: Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of an asthmatic person. Early recognition is crucial.
  • Assist and prepare patient for postural drainage.
    • Rationale: Uses gravity to help raise secretions so they can be more easily expectorated.
  • Administer nebulization as ordered.
    • Rationale: This ensures adequate delivery of medications to the airways.
  • Administer medications as ordered.
    • Rationale: Antibiotics may be prescribed to treat the infection.

Ineffective Breathing Pattern
Assessment

Patient may manifest: 

  • wheezing upon inspiration and expiration
  • dyspnea
  • coughing
  • tachypnea
  • tachycardia
  • chest tightness
  • suprasternal retraction
  • restlessness
  • anxiety
  • cyanosis
  • loss of consciousness
Nursing Diagnosis
  • Ineffective breathing pattern r/t presence of secretions AEB productive cough and dyspnea
Planning
  • Patient will demonstrate pursed-lip breathing and diaphragmatic breathing.
  • Patient will manifest signs of decreased respiratory effort AEB absence of dyspnea
  • Patient will verbalize understanding of causative factors and demonstrate behaviors that would improve breathing pattern
Nursing Interventions
  • Assess patient’s respiratory rate, depth, and rhythm. Obtain pulse oximetry.
    • Rationale: To obtain baseline data
  • Monitor and record vital signs.
    • Rationale:Increase in respiratory rate could mean worsening condition.
  • Auscultate breath sounds and assess airway pattern
    • Rationale: to check for the presence of adventitious breath sounds
  • Elevate head of the bed and change position of the pt. every 2 hours.
    • Rationale: To  minimize difficulty in breathing
  • Encourage deep breathing and coughing exercises.
    • Rationale: To maximize effort for expectoration.
  • Demonstrate diaphragmatic and pursed-lip breathing.
    • Rationale: To decrease air trapping and for efficient breathing.
  • Encourage increase in fluid intake
    • Rationale: To prevent fatigue.
  • Encourage opportunities for rest and limit physical activities.
    • Rationale: To prevent situations that will aggravate the condition
  • Reinforce low salt, low fat diet as ordered.
    • Rationale: To mobilize secretions.

Impaired Gas Exchange
Assessment

Patient may manifest: 

  • wheezing upon inspiration and expiration
  • dyspnea
  • coughing, sputum is yellow and sticky
  • tachypnea, prolonged expiration
  • tachycardia
  • chest tightness
  • suprasternal retraction
  • restlessness
  • anxiety
  • cyanosis
  • Altered loc
  • Changes in ABGs
Nursing Diagnosis
  • Impaired gas exchange RT ventilation perfusion imbalance AEB dyspnea, tachypnea, and tachycardia

May be related to

  • altered delivery of inspired O2 or air trapping
Planning
  • Patient will improve gas exchange AEB absence of respiratory distress
  • Patient will demonstrate improved ventilation and adequate oxygenation of tissues by ABG’s within client’s normal limits and absence of symptoms of respiratory distress.
  • Patient will verbalize understand of causative factors and appropriate interventions (deep breathing, cough exercises, etc)
Nursing Interventions
  • Assess vital signs, noting respiratory rate, depth, and rhythm.
    • Rationale: To obtain baseline data
  • VS monitor and record
    • Rationale: Serve to track important changes
  • Auscultate breath sounds and assess airway pattern
    • Rationale: to check for the presence of adventitious breath sounds
  • Elevate head of the bed and change position of the pt. every 2 hours.
    • Rationale: To minimize difficulty in breathing and promote maximum lung expansion.
  • Encourage deep breathing and coughing exercises.
    • Rationale: To maximize effort for expectoration.
  • Demonstrate diaphragmatic and pursed-lip breathing.
    • Rationale: To decrease air trapping and for efficient breathing.
  • Encourage increase in fluid intake
    • Rationale: To prevent fatigue.
  • Encourage opportunities for rest and limit physical activities.
    • Rationale: To prevent situations that will aggravate the condition
  • Reinforce low salt, low fat diet as ordered.
    • Rationale: To mobilize secretions.

Fatigue
Assessment

Patient may manifest: 

  • Generalized weakness
  • Verbalization of overwhelming lack of energy
  • Inability to maintain usual routines
  • Tired
  • Lethargic
  • Compromised concentration
  • Decreased performance
Nursing Diagnosis
  • Fatigue r/t physical exertion to maintain adequate ventilation AEB use of accessory muscles to breathe
Planning
  • Patient will verbalize understand on health teachings given and report improved sense of energy.
  • Patient will perform ADL’s within client’s ability and participates in desired activities.
  • Patient will be able to identify basis of fatigue and be able to cope up with the problem.
Nursing Interventions
  • Establish rapport
    • Rationale: To gain patient’s trust
  • Monitor and record vital signs.
    • Rationale: For baseline data.
  • Provide environment conducive to relief of fatigue.
    • Rationale: Temperature and level of humidity are known to affect exhaustion.
  • Assist client to identify appropriate coping behaviors.
    • Rationale: Promotes sense of control and improves self-esteem.
  • Encourage patient to restrict activity and rest in bed as much as possible.
    • Rationale: Helps counteract effects of increased metabolism.
  • Avoid topics that irritate or upset patient. Discuss ways to respond to these feelings.
    • Rationale: Increased irritability of the CNS may cause patient to be easily excited, agitated and prone to emotional outbursts.
  • Discuss with the patient the need for activity. Plan schedule with patient and identify activities that lead to fatigue.
    • Rationale: Education may provide motivation to increase activity level even though patient may feel too weak initially.
  • Alternate activity with rest periods.
    • Rationale: Prevents excessive fatigue.
  • Monitor VS before and after activity.
    • Rationale: Indicates physiological levels of tolerance.
  • Increase patient participation in ADL’s as tolerated.
    • Rationale: Increases confidence level and/or self-esteem and tolerance level

Risk for Activity Intolerance
Assessment
  • Not applicable. Presence of signs and symptoms will establish an actual nursing diagnosis. 
Nursing Diagnosis
  • Risk for Activity Intolerance r/t decrease oxygenation
Planning
  • Patient will participate willingly in necessary/ desired activities such as deep breathing exercises.
  • Patient will perform ADL’s within client’s ability and participates in desired activities.
  • Patient will be able to increase activity tolerance AEB attendance of self-care needs.
  • Patient will be able to gradually increase activity within level of ability
Nursing Interventions
  • Monitor VS.
    • Rationale: For baseline data.
  • Assess motor function.
    • Rationale: To identify causative factors.
  • Note contributing factors to fatigue.
    • Rationale: To identify precipitating factors.
  • Evaluate degree of deficit.
    • Rationale: To identify severity.
  • Ascertain ability to stand and move about.
    • Rationale: To identify necessity of assistive devices.
  • Assess emotional or psychological factors
    • Rationale: Stress and/or depression may increase the effects of illness.
  • Plan care with rest periods between activities
    • Rationale: To reduce fatigue
  • Increase activity/exercise gradually such as assisting the patient in doing PROM to active or full range of motions.
    • Rationale: Minimizes muscle atrophy, promotes circulation, helps to prevent contractures
  • Provide adequate rest periods.
    • Rationale: To replenish energy.
  • Assist client in doing self care needs
    • Rationale: To promote independence and increase activity tolerance
  • Elevate arm and hand
    • Rationale: Promotes venous
  • Place knees and hips in extended position
    • Rationale: Maintains functional

Other Possible Nursing Care Plans
  • Anxiety—may be related to perceived threat of death, possibly evidenced by apprehension, fearful expression, and extraneous movements.
  • Risk for contamination—risk factors may include presence of atmospheric pollutants, environmental contaminants in the home.

Bell’s Palsy

Notes

Definition

 palsy (facial paralysis) is due to peripheral involvement of the seventh cranial nerve on one side, which results in weakness or paralysis of the facial muscles.

  • The cause is unknown, but possible causes may include vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or a combination.
  • Bell’s palsy may represent a type of pressure paralysis in which ischemic necrosis of the facial nerve causes a distortion of the face, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye.
  • The patient may experience speech difficulties and may be unable to eat on the affected side owing to weakness.
  • Most patients recover completely, and Bell’s palsy rarely recurs.
Medical Management
  • The objectives of management are to maintain facial muscle tone and to prevent or minimize denervation.
  • Corticosteroid therapy (prednisone) may be initiated to reduce inflammation and edema, which reduces vascular compression and permits restoration of blood circulation to the nerve.
  • Early administration of corticosteroids appears to diminish severity, relieve pain, and minimize denervation.
  • Facial pain is controlled with analgesic agents or heat applied to the involved side of the face.
  • Additional modalities may include electrical stimulation applied to the face to prevent muscle atrophy, or surgical exploration of the facial nerve.
  • Surgery may be performed if a tumor is suspected, for surgical decompression of the facial nerve, and for surgical rehabilitation of a paralyzed face.
Nursing Management

Patients need reassurance that a stroke has not occurred and that spontaneous recovery occurs within 3 to 5 weeks in most patients. Teaching patients with Bell’s palsy to care for themselves at home is an important nursing priority.

Teaching Eye Care

Because the eye usually does not close completely, the blink reflex is diminished, so the eye is vulnerable to injury from dust and foreign particles. Corneal irritation and ulceration may occur. Distortion of the lower lid alters the proper drainage of tears. Key teaching points include the following:

  • Cover the eye with a protective shield at night.
  • Apply eye ointment to keep eyelids closed during sleep.
  • Close the paralyzed eyelid manually before going to sleep.
  • Wear wraparound sunglasses or goggles to decrease normal evaporation from the eye.
Teaching About Maintaining Muscle Tone
  • Show patient how to perform facial massage with gentle
  • upward motion several times daily when the patient can tolerate the massage.
  • Demonstrate facial exercises, such as wrinkling the forehead,
  • blowing out the cheeks, and whistling, in an effort to prevent muscle atrophy.
  • Instruct patient to avoid exposing the face to cold and drafts

Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed MSN Exam for Bell’s Palsy (PM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
6 7 8 9 10
End
Return

Nursing Care Plan

Nursing Diagnosis

Body image disturbance related to alteration in structure and function for vision secondary to Bell’s Palsy.

Desired Outcomes:

Within 1 hour of nursing interventions, the patient will be able to demonstrate increased self esteem and body image by the ability to acknowledge, touch, and look at altered body part.

Nursing Interventions
  • Assess patients knowledge of change in structure or function of the body part.
    • Rationale: The level of response is related to the perceived value or importance that the patient places on the affected body part.
  • Assist patient to identify actual changes
    • Rationale: Patients may perceive changes that are not actually present.
  • Encourage verbalization about concerns of the disease process and future expectations.
    • Rationale: This provides an opportunity to identify fears/misconceptions and deal with them directly.

Nursing Diagnosis

Disturbed sensory perception: Visual

Desired Outcomes:

Within 1 hour of nursing interventions, patient will remain free from harm resulting from visual disturbances.

Nursing Interventions
  • Assess patients knowledge of change in structure or function of the body part.
    • Rationale: The level of response is related to the perceived value or importance that the patient places on the affected body part.
  • Assist patient to identify actual changes
    • Rationale: Patients may perceive changes that are not actually present.
  • Encourage verbalization about concerns of the disease process and future expectations.
    • Rationale: This provides an opportunity to identify fears/misconceptions and deal with them directly.

Bell’s palsy is a condition that causes a temporary weakness or paralysis of the muscles in the face. It can occur when the nerve that controls your facial muscles becomes inflamed, swollen, or compressed.

The condition causes one side of your face to droop or become stiff. You may have difficulty smiling or closing your eye on the affected side. In most cases, Bell’s palsy is temporary and symptoms usually go away after a few weeks.

Although Bell’s palsy can occur at any age, the condition is more common among people between ages 16 and 60. Bell’s palsy is named after the Scottish anatomist Charles Bell, who was the first to describe the condition.

What are the symptoms of Bell’s palsy?

The symptoms of Bell’s palsy can develop one to two weeks after you have a cold, ear infection, or eye infection. They usually appear abruptly, and you may notice them when you wake up in the morning or when you try to eat or drink.

Bell’s palsy is marked by a droopy appearance on one side of the face and the inability to open or close your eye on the affected side. In rare cases, Bell’s palsy may affect both sides of your face.

Other signs and symptoms of Bell’s palsy include:

  • drooling
  • difficulty eating and drinking
  • an inability to make facial expressions, such as smiling or frowning
  • facial weakness
  • muscle twitches in the face
  • dry eye and mouth
  • headache
  • sensitivity to sound
  • irritation of the eye on the involved side

Call your doctor immediately if you develop any of these symptoms. You should never self-diagnose Bell’s palsy. The symptoms can be similar to those of other serious conditions, such as a stroke or brain tumor.

What causes Bell’s palsy?

Bell’s palsy occurs when the seventh cranial nerve becomes swollen or compressed, resulting in facial weakness or paralysis. The exact cause of this damage is unknown, but many medical researchers believe it’s most likely triggered by a viral infection.

The viruses/bacteria that have been linked to the development of Bell’s palsy include:

herpes simplex, which causes cold sores and genital herpes

HIV, which damages the immune system

sarcoidosis, which causes organ inflammation

herpes zoster virus, which causes chickenpox and shingles

Epstein-Barr virus, which causes mononucleosis

Lyme disease, which is a bacterial infection caused by infected ticks

What are the risk factors for Bell’s palsy?

Your risk of developing Bell’s palsy increases if you:

are pregnant

have diabetes

have a lung infection

have a family history of the condition

How is Bell’s palsy diagnosed?

Your doctor will first perform a physical examination to determine the extent of the weakness in your facial muscles. They’ll also ask you questions about your symptoms, including when they occurred or when you first noticed them.

Your doctor can also use a variety of tests to make a Bell’s palsy diagnosis. These tests may include blood tests to check for the presence of a bacterial or viral infection. Your doctor might also use an MRI or CT scan to check the nerves in your face.

How is Bell’s palsy treated?

In most cases, Bell’s palsy symptoms improve without treatment. However, it can take several weeks or months for the muscles in your face to regain their normal strength.

The following treatments may help in your recovery.

Medication

corticosteroid drugs, which reduce inflammation

antiviral or antibacterial medication, which may be prescribed if a virus or bacteria caused your Bell’s palsy

over-the-counter pain medications, such as ibuprofen or acetaminophen, which can help relieve mild pain

eye drops

Home treatment

an eye patch (for your dry eye)

a warm, moist towel over your face to relieve pain

facial massage

physical therapy exercises to stimulate your facial muscles

What are the potential complications of Bell’s palsy?

Most people who have an episode of Bell’s palsy will completely recover without complications. However, complications may occur in more severe cases of Bell’s palsy. These include the following:

You may have damage to the seventh cranial nerve. This nerve controls your facial muscles.

You may have excessive dryness in the eye, which can lead to eye infections, ulcers, or even blindness.

You may have synkinesis, which is a condition in which moving one body part causes another to move involuntarily. For example, your eye may close when you smile.

What is the long-term outlook for people with Bell’s palsy?

The outlook for people with Bell’s palsy is usually good. Recovery time may vary depending on the severity of nerve damage. In general, however, people can see an improvement within two weeks after the initial onset of symptoms. Most will completely recover within three to six months, but it may be longer for people with more severe cases of Bell’s palsy. In rare cases, symptoms may continue to return or may be permanent.

Call your doctor immediately if you’re showing any signs of Bell’s palsy. Prompt treatment can help speed up your recovery time and prevent any complications.

How Serious a Condition is Bell’s palsy?

The ailment can affect 1 in 60 people during their lifetime. Actress Angelina Jolie developed Bell’s palsy last year after separating from Brad Pitt.

There apparently was a reason Angelina Jolie, one of the most famous women in the world, stayed out of sight for a time last year.

The actress had developed a condition called Bell’s palsy, which results in facial paralysis.

Jolie made the surprise announcement last week that she had developed the condition while separating from her husband, actor Brad Pitt.

“Sometimes women in families put themselves last,” Jolie told Vanity Fair, “until it manifests itself in their own health.”

By sharing her story, Jolie spotlighted a condition that affects about 1 in 60 people during their lifetime.

Here’s key information on the condition and what doctors have to say about how to cure it.

What causes Bell’s palsy?

Bell’s palsy is a form of facial paralysis that results from trauma or damaged facial nerves.

“The most commonly affected muscles are closure of the eye and half the smile so the patient is unable to close their eye or smile on half their face,” said Dr. David Simpson, director of the neuromuscular division in the Department of Neurology at Mount Sinai Hospital in New York. “They end up looking like someone with a crooked face.”

A facial nerve, called the 7th cranial nerve, travels through a narrow, bony canal in the skull. The nerve controls sensation and helps move tiny muscles in the face.

If the nerve is damaged and stops functioning it can cause the face to droop. It can also affect tear ducts and taste sensations from the tongue.

It was named after the Scottish surgeon Sir Charles Bell, who figured out what the facial nerve did and how it was connected to facial paralysis.

Currently, doctors believe viral infections can kick-start inflammation and cause the nerve to swell and become damaged.

But, Bell’s palsy has also been associated with headaches, chronic middle ear infections, high blood pressure, diabetes, tumors, and Lyme disease, among other things, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Jolie told Vanity Fair that she developed hypertension, (high blood pressure) last year, and also mentioned stress.

Simpson said stress is associated with the condition, but it’s not clear that it can actually cause the condition to develop or if it’s a coincidence.

Usually people with the condition start to recover within two weeks, with full normal function returning three to six months later, according to the NINDS.

For people who have long-term symptoms other issues like spasms can develop. In rare cases, people can develop a condition called silkiness, where facial muscles may move in tandem. For example, a person may smile and blink at the same time involuntarily.

How is it treated?

The standard treatment for Bell’s palsy is steroids and antiviral medication, according to Simpson.

“Those two medicines are best instituted in the first couple of days of the Bell’s palsy and given for fairly short periods for seven to 10 days,” said Simpson.

Physical therapy can also be done to try and minimize the duration of the facial paralysis.

Jolie told the magazine that she credited acupuncture with helping her recover.

Simpson said there isn’t a lot of solid evidence on how effective acupuncture is at diminishing symptoms.

“There have been some research studies, and there is some relatively weak evidence that acupuncture may help,” Simpson said.

One published analysis Trusted Source examined 14 studies that investigated acupuncture treatment for Bell’s palsy. The research authors found that people in those studies who received the acupuncture treatment did better and had fewer symptoms than those who did not receive the treatment.

However, the analysis authors warned that many of the studies they reviewed had poor methodology, and more research is needed.

Simpson said while there is not good evidence that acupuncture helps, there’s also little risk associated with having it done.

“Since the risk is quite low, if the patient is interested in acupuncture that is perfectly OK,” he said.

For patients who have symptoms months to years after initial onset, there are other more invasive options including Botox injections and surgery to help fix the appearance of drooping.

Who is at risk?

Bell’s palsy affects approximately 40,000 people in the United States every year, mainly between the ages of 15 to 60.

Men and women are affected about equally.

Many people may think they’re having a stroke when they develop the facial droopiness, but a stroke will also lead to weakness on the side where the face is drooping.

Recurrent Herpes Simplex Labialis

Causes

Symptoms

Diagnosis

Complications

Treatment

Prevention

Outlook

What is recurrent herpes simplex labialis?

Recurrent herpes simplex labialis, also known as oral herpes, is a condition of the mouth area caused by the herpes simplex virus. It’s a common and contagious condition that spreads easily.

According to the World Health Organization (WHO)Trusted Source, an estimated two out of three adults in the world under age 50 carry this virus.

The condition causes blisters and sores on the lips, mouth, tongue, or gums. After an initial outbreak, the virus stays dormant inside the nerve cells of the face.

Later on in life, the virus can reactivate and result in more sores. These are commonly known as cold sores or fever blisters.

Recurrent herpes simplex labialis usually isn’t serious, but relapses are common. Many people choose to treat the recurrent episodes with over-the-counter (OTC) creams.

The symptoms will usually go away without treatment in a few weeks. A doctor may prescribe medications if relapses occur often.

What causes recurrent herpes simplex labialis?

Herpes simplex labialis is the result of a virus called herpes simplex virus type 1 (HSV-1). The initial acquisition usually occurs before age 20. It typically affects the lips and areas around the mouth.

You can get the virus from close personal contact, such as through kissing, with someone who has the virus. You can also get oral herpes from touching objects where the virus may be present. These include towels, utensils, razors for shaving, and other shared items.

Since the virus lays dormant inside the nerve cells of the face for the rest of a person’s life, symptoms aren’t always present. However, certain events can make the virus reawaken and lead to a recurrent herpes outbreak.

Events that trigger a recurrence of oral herpes might include:

  • fever
  • menstruation
  • a high-stress event
  • fatigue
  • hormonal changes
  • upper respiratory infection
  • extreme temperature
  • a weakened immune system
  • recent dental work or surgery

Recognizing the signs of recurrent herpes simplex labialis

The original acquisition may not cause symptoms at all. If it does, blisters may appear near or on the mouth within 1 to 3 weeks after your first contact with the virus. The blisters might last up to 3 weeks.

In general, a recurrent episode is milder than the initial outbreak.

Symptoms of a recurrent episode may include:

blisters or sores on the mouth, lips, tongue, nose, or gums

burning pain around the blisters

tingling or itching near the lips

outbreaks of several small blisters that grow together and may be red and inflamed

Tingling or warmth on or near the lips is usually a warning sign that the cold sores of recurrent oral herpes are about to appear in 1 to 2 days.

How is recurrent herpes simplex labialis diagnosed?

A doctor will typically diagnose oral herpes by examining the blisters and sores on your face. They might also send samples of the blister to a laboratory to test specifically for HSV-1.

Potential complications of a herpes acquisition

Recurrent herpes simplex labialis can be dangerous if the blisters or sores occur near the eyes. The outbreak can lead to scarring of the cornea. The cornea is the clear tissue covering the eye that helps focus images that you see.

Other complications include:

frequent recurrence of the sores and blisters that requires constant treatment

the virus spreading to other parts of the skin

widespread bodily infection, which can be serious in people who already have a weakened immune system, such as those with HIV

Treatment options for recurrent herpes simplex labialis

You can’t get rid of the virus itself. Once contracted, HSV-1 will remain in your body, even if you don’t have recurrent episodes.

Symptoms of a recurrent episode usually go away within 1 to 2 weeks without any treatment. The blisters will usually scab and crust over before they disappear.

At-home care

Applying ice or a warm cloth to the face or taking a pain reliever like acetaminophen (Tylenol) may help reduce any pain.

Some people choose to use OTC skin creams. However, these creams usually only shorten an oral herpes relapse by 1 or 2 days.

Prescription medication

Your doctor may prescribe oral antiviral medicines to fight the virus, such as:

  • acyclovir
  • famciclovir
  • valacyclovir

These medications work better if you take them when you experience the first signs of a mouth sore, such as tingling on the lips, and before the blisters appear.

These medications don’t cure herpes and may not stop you from spreading the virus to other people.

Preventing the spread of herpes

The following tips may help prevent the condition from reactivating or spreading:

Wash any items that may have had contact with the contagious sores, like towels, in boiling water after use.

Don’t share food utensils or other personal items with people who have oral herpes.

Don’t share cold sore creams with anyone.

Don’t kiss or participate in oral sex with someone who has a cold sore.

To keep the virus from spreading to other parts of the body, don’t touch the blisters or sores. If you do, wash your hands with soap and water immediately.

Long-term outlook

Symptoms usually go away within 1 to 2 weeks. However, cold sores can frequently return. The rate and severity of the sores usually diminish as you get older.

Outbreaks near the eye or in immune-compromised individuals can be serious. See your doctor in these cases.

Everything You Should Know About Stroke Symptoms

Symptoms

FAST action

Risk factors

Outlook

Be aware

A stroke happens when the blood flow to your brain is interrupted. If oxygen-rich blood doesn’t reach your brain, brain cells begin to die and permanent brain damage can occur.

There are two types of brain stroke. In an ischemic stroke, a blood clot blocks the flow of blood to your brain. If you have a hemorrhagic stroke, a weak blood vessel bursts and you experience bleeding into your brain.

Stroke is the fifth leading cause of death in the United States, affecting around 800,000 people each year. Many people survive a stroke and recover with rehabilitation such as occupational, speech, or physical therapy.

Depending on severity and how long blood flow was interrupted, a stroke can cause temporary or permanent disability. The sooner you recognize signs of a stroke and seek medical attention, the better your chances of recovering and avoiding serious brain damage or disability.

Symptoms of a stroke

Recognizing the symptoms of a stroke and getting help as quickly as possible can lead to a better outlook. Early intervention can reduce the amount of time the blood flow to your brain is disrupted. Keep reading to learn more about the major signs of stroke.

Sudden weakness

Sudden weakness or numbness in your arms, legs, or face is a typical sign of stroke, especially if it’s on only one side of your body. If you smile and look in the mirror, you may notice that one side of your face droops. If you try and raise both arms, you may have difficulty lifting one side. Depending on the severity, a stroke can also lead to paralysis on one side of your body.

Sudden confusion

A stroke can cause sudden confusion. For example, if you’re typing on your computer or having a conversation, you may suddenly have difficulty speaking, thinking, or understanding speech.

Sudden changes in vision

Loss of vision or difficulty seeing in one or both eyes is another symptom of stroke. You may suddenly lose your vision completely, or experience blurred or double vision.

Sudden loss of balance

Due to weakness on one side, you may experience difficulty with walking, loss of balance or coordination, or dizziness.

Sudden headache

If a severe headache develops suddenly with no known cause, you might be having a stroke. This headache may be accompanied by dizziness or vomiting.

If you have a history of migraine headaches, it may be difficult to identify this or vision problems as signs of stroke. Talk with your doctor about how to determine whether you’re having a stroke or a migraine.

Because strokes can be life-threatening, always seek immediate medical help if you suspect symptoms of a stroke.

Fast action after stroke symptoms

If you’re having a stroke, you may experience one or multiple symptoms. Although you’re likely to recognize odd symptoms or feel like something isn’t quite right with your body, you may not realize you have a serious problem until it’s too late.

Stroke symptoms can develop slowly over hours or days. If you have a ministroke, also known as transient ischemic attack (TIA), symptoms are temporary and usually improve within hours. In this case, you may blame sudden symptoms on stress, a migraine, or nerve problems.

Any signs or symptoms of stroke require further investigation by a doctor. If you get to the hospital within three hours of the first symptoms of an ischemic stroke, your doctor can give you a medication to dissolve blood clots and restore blood flow to your brain. Fast action improves your odds of recovering fully after a stroke. It also reduces the severity of disabilities that can result from a stroke.

A simple FAST test can help you identify a stroke in yourself and others.

Face. Ask the person to smile. Look for signs of drooping on one side of the face.

Arms. Ask the person to raise their arms. Look for a downward drift in one arm.

Speech. Ask the person to repeat a phrase without slurring. For example, you could have them say “The early bird catches the worm.”

Time. Waste no time. Immediately call your local emergency services if you or someone you know shows signs of a stroke.

Risk factors

Anyone can have a stroke, but some people are at a higher risk. Knowing you have an increased risk for stroke can help you and your family and friends prepare in case you experience symptoms. Following are some known risk factors:

  • history of stroke or heart attack
  • high cholesterol
  • high blood pressure
  • heart disease
  • diabetes
  • sickle cell disease

Lifestyle choices and behaviors • unhealthy diet

  • obesity
  • tobacco use
  • physical inactivity
  • consuming too much alcohol

Additional risk factors    • family history

  • age: being over the age of 55
  • gender: women are at greater risk than men
  • race: African-Americans have an increased risk

Some risk factors are out of your control, such as your age and family history. You can reduce other risk factors, though, by working with your doctor and making lifestyle changes. Seek treatment for any conditions that may increase your risk for stroke. Adopting healthy habits, such as exercising regularly, reducing alcohol intake, and eating a balanced diet can also help decrease your risk.

Knowing the symptoms of stroke can help you get help quickly and improve your outlook. Early treatment can increase your risk for survival and decrease your risk for more serious complications of stroke, which can include:

paralysis or muscle weakness on one side of the body

difficulty swallowing or speaking

memory loss or difficulty thinking and understanding language

pain, numbness, or tingling sensations

changes in behavior or mood

Call your local emergency services immediately if you think you or someone near you is having a stroke.

Don’t ignore the signs

Other conditions, such as seizures and migraines, can mimic the symptoms of a stroke. This is why you shouldn’t try to self-diagnose. Even if you have a TIA and your symptoms disappear, don’t ignore the signs. A TIA increases your risk for an actual stroke, so you’ll need testing to determine the cause of your ministroke. You’ll also need to start treatment to reduce your risk of having another one.

Being aware of your risk factors and the symptoms of stroke can help improve your outlook if you have a stroke.

To inspire you to exercise and eat well, we’ll send you our top health tips and stories, plus must-read news.

Eyelid Twitch

Causes

Complications

When to see a doctor

Treatment

Prevention

Outlook

What are eyelid twitches?

An eyelid twitch, or myokymia, is a repetitive, involuntary spasm of the eyelid muscles. A twitch usually occurs in the upper lid, but it can occur in both the upper and lower lids.

For most people, these spasms are very mild and feel like a gentle tug on the eyelid.

Others may experience a spasm strong enough to force both eyelids to close completely. This is a different condition called blepharospasm.

Spasms typically occur every few seconds for a minute or two.

Episodes of eyelid twitching are unpredictable. The twitch may occur off and on for several days. Then, you may not experience any twitching for weeks or even months.

The twitches are painless and harmless, but they may bother you. Most spasms will resolve on their own without the need for treatment.

In rare cases, eyelid spasms may be an early warning sign of a chronic movement disorder, especially if the spasms are accompanied by other facial twitches or uncontrollable movements.

What causes eyelid twitches?

Eyelid spasms may occur without any identifiable cause. Since they’re rarely a sign of a serious problem, the cause isn’t usually investigated.

Nevertheless, eyelid twitches may be caused or made worse by:

  • eye irritation
  • eyelid strain
  • fatigue
  • lack of sleep
  • physical exertion
  • medication side effects
  • stress
  • use of alcohol, tobacco, or caffeine

If the spasms become chronic, you may have what’s known as “benign essential blepharospasm,” which is the name for chronic and uncontrollable winking or blinking.

This condition typically affects both eyes. The exact cause of the condition is unknown, but the following may make spasms worse:

  • blepharitis, or inflammation of the eyelid
  • conjunctivitis, or pinkeye
  • dry eyes
  • environmental irritants, such as wind, bright lights, sun, or air pollution
  • fatigue
  • light sensitivity
  • stress
  • too much alcohol or caffeine
  • smoking

Benign essential blepharospasm is more common in women than in men.

According to Genetics Home Reference, it affects approximately 50,000 Americans and usually develops in middle to late adulthood.

The condition will likely worsen over time, and it may eventually cause:

  • blurry vision
  • increased sensitivity to light
  • facial spasms

Complications of eyelid twitches

Very rarely, eyelid spasms are a symptom of a more serious brain or nerve disorder.

When eyelid twitches are a result of these more serious conditions, they’re almost always accompanied by other symptoms.

Brain and nerve disorders that may cause eyelid twitches include:

Bell’s palsy (facial palsy), which is a condition that causes one side of your face to droop downward

dystonia, which causes unexpected muscle spasms and the affected area’s body part to twist or contort

cervical dystonia (spasmodic torticollis), which causes the neck to randomly spasm and the head to twist into uncomfortable positions

multiple sclerosis (MS), which is a disease of the central nervous system that causes cognitive and movement problems, as well as fatigue

Parkinson’s disease, which can cause trembling limbs, muscle stiffness, balance problems, and difficulty speaking

Tourette syndrome, which is characterized by involuntary movement and verbal tics

Undiagnosed corneal scratches can also cause eyelid twitches.

If you think you have an eye injury, see your optometrist or ophthalmologist immediately. Corneal scratches can cause permanent eye damage.

When do eyelid twitches require a visit to the doctor?

Eyelid twitches are rarely serious enough to require emergency medical treatment. However, chronic eyelid spasms may be a symptom of a more serious brain or nervous system disorder.

You may need to see your doctor if you’re having chronic eyelid spasms along with any of the following symptoms:

Your eye is red, swollen, or has an unusual discharge.

Your upper eyelid is drooping.

Your eyelid completely closes each time your eyelids twitch.

The twitching continues for several weeks.

The twitching begins affecting other parts of your face.

How are eyelid twitches treated?

Most eyelid spasms go away without treatment in a few days or weeks. If they don’t go away, you can try to eliminate or decrease potential causes.

The most common causes of eyelid twitching are stress, fatigue, and caffeine.

To ease eye twitching, you might want to try the following:

Drink less caffeine.

Get adequate sleep.

Keep your eye surfaces lubricated with over-the-counter artificial tears or eye drops.

Apply a warm compress to your eyes when a spasm begins.

Botulinum toxin (Botox) injections are sometimes used to treat benign essential blepharospasm. Botox may ease severe spasms for a few months. However, as the effects of the injection wear off, you may need further injections.

Surgery to remove some of the muscles and nerves in the eyelids (myectomy) can also treat more severe cases of benign essential blepharospasm.

How can you prevent eyelid twitches?

If your eyelid spasms are happening more frequently, keep a journal and note when they occur.

Note your intake of caffeine, tobacco, and alcohol, as well as your level of stress and how much sleep you’ve been getting in the periods leading up to and during the eyelid twitching.

If you notice that you have more spasms when you aren’t getting enough sleep, try to go to bed 30 minutes to an hour earlier to help ease the strain on your eyelids and reduce your spasms.

Eyelid twitches have many causes. The treatment that works and the outlook varies depending on the person.

Research is being done to see if there’s a genetic link, but it doesn’t seem to run in families.

Twitches related to stress, lack of sleep, and other lifestyle factors have the best outlook. If an underlying health condition is the cause, then treating the underlying condition is the best way to relieve the twitching.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Uses

Procedure

Risks

Normal results

Abnormal results

Treatment

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

What is the Epstein-Barr virus test?

The Epstein-Barr virus (EBV) is a member of the herpes virus family. It’s one of the most common viruses to infect people around the world.

According to the Centers for Disease Control and PreventionTrusted Source, most people will contract EBV at some point in their lives.

The virus typically causes no symptoms in children. In adolescents and adults, it causes an illness called infectious mononucleosis, or mono, in about 35 to 50 percent of cases.

Also known as “the kissing disease,” EBV is usually spread through saliva. It’s very rare for the disease to be spread through blood or other bodily fluids.

The EBV test is also known as “EBV antibodies.” It’s a blood test used to identify an EBV infection. The test detects the presence of antibodies.

Antibodies are proteins that your body’s immune system releases in response to a harmful substance called an antigen. Specifically, the EBV test is used to detect antibodies to EBV antigens. The test can find both a current and past infection.

When will your doctor order the test?

Your doctor may order this test if you show any of the signs and symptoms of mono. Symptoms typically last for one to four weeks, but they can last up to three to four months in some cases. They include:

  • fever
  • sore throat
  • swollen lymph nodes
  • headache
  • fatigue
  • stiff neck
  • spleen enlargement

Your doctor may also take into account your age and other factors when deciding whether or not to order the test. Mono is most common in teens and young adults between the ages of 15 and 24.

How is the test performed?

The EBV test is a blood test. During the test, blood is drawn at your doctor’s office or at an outpatient clinical laboratory (or hospital lab). Blood is drawn from a vein, usually on the inside of your elbow. The procedure involves the following steps:

The puncture site is cleaned with an antiseptic.

An elastic band is wrapped around your upper arm to make your vein swell with blood.

A needle is gently inserted into your vein to collect blood in an attached vial or tube.

The elastic band is removed from your arm.

The blood sample is sent to a lab for analysis.

Very little (or even zero) antibodies may be found early in the illness. Therefore, the blood test may need to be repeated in 10 to 14 days.

What are the risks of an EBV test?

As with any blood test, there’s a slight risk of bleeding, bruising, or infection at the puncture site. You may feel moderate pain or a sharp prick when the needle is inserted. Some people feel light-headed or faint after having their blood drawn.

What do normal results mean?

A normal result means that no EBV antibodies were present in your blood sample. This indicates that you’ve never been infected with EBV and don’t have mono. However, you can still get it at any point in the future.

What do abnormal results mean?

An abnormal result means that the test has detected EBV antibodies. This indicates that you’re currently infected with EBV or have been infected with the virus in the past. Your doctor can tell the difference between a past and a current infection based on the presence or absence of antibodies that fight three specific antigens.

The three antibodies the test looks for are antibodies to viral capsid antigen (VCA) IgG, VCA IgM, and Epstein-Barr nuclear antigen (EBNA). The level of antibody detected in the blood, called the titer, doesn’t have any impact on how long you’ve had the disease or how severe the disease is.

The presence of VCA IgG antibodies indicates that an EBV infection has occurred at some time recently or in the past.

The presence of VCA IgM antibodies and the absence of antibodies to EBNA mean that the infection has occurred recently.

The presence of antibodies to EBNA means that the infection occurred in the past. Antibodies to EBNA develop six to eight weeks after the time of infection and are present for life.

As with any test, false-positive and false-negative results do happen. A false-positive test result shows that you have a disease when you actually don’t. A false-negative test result indicates that you don’t have a disease when you really do. Ask your doctor about any follow-up procedures or steps that can help make sure your test results are accurate.

How is EBV treated?

There are no known treatments, antiviral drugs, or vaccines available for mono. However, there are things you can do to ease your symptoms:

Stay hydrated and drink a lot of fluids.

Get plenty of rest and avoid intensive sports.

Take over-the-counter pain relievers, such as ibuprofen (Advil) or acetaminophen (Tylenol).

The virus can be hard to treat, but symptoms usually resolve on their own in one to two months.

After you recover, EBV will remain dormant in your blood cells for the rest of your life.

This means that your symptoms will go away, but the virus will stay in your body and can occasionally reactivate without causing symptoms. It’s possible to spread the virus to others through mouth-to-mouth contact during this time.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

What Are the Different Types of Strokes?

A stroke happens when the blood flow to your brain is interrupted. Blood flow in the brain can be interrupted by a blood clot blocking the brain’s…

Pituitary Hormone Drugs Nursing Considerations & Management

Notes


Table of Common Drugs and Generic Names

Here is a table of commonly encountered pituitary agents, their generic names, and brand names:

Classification Generic Name Brand Name
Anterior Pituitary Hormone Drugs
Growth Hormone Agonists somatropin Nutropin, Saizen, Humatrope
Growth Hormone Antagonists bromocriptine Parlodel
lantreolide Somatuline Depot
octreotide Sandostatin
pegvisomant Somavert
Other Drugs Affecting Anterior Pituitary Hormones chorionic gonadotropin Chorex
corticotropin Acthar
cosyntropin Cortrosyn
menotropin Pergonal
thyrotropin alfa Thyrogen
Posterior Pituitary Hormone Drugs
Drugs Affecting Posterior Pituitary Hormones conivaptan Vaprisol
desmopressin DDAVP
tolvaptan

 Growth Hormones Agonists

Description
  • Growth Hormone Agonists are responsible for linear skeletal growth, growth of internal organs, protein synthesis, and stimulation of processes required for normal growth.Disease Spotlight: GH Deficiency
  • Hypopituitarism is often seen as GH deficiency before any other signs and symptoms occur. It occurs as a result of the following: developmental abnormalities, congenital defects of the pituitary, circulatory disturbances (e.g. hemorrhage), acute or chronic inflammation of the pituitary, and pituitary tumors.
  • Dwarfism is the GH deficiency in children which results to short stature.
  • Somatotropin deficiency syndrome (SDS) is a condition in adults with hypopituitarism caused by pituitary tumors or trauma, or may have been treated for GH deficiency as children, resulting in a shutdown of the pituitary production of somatotropin.
Therapeutic Action

The desired and beneficial action of GH agonists is:

  • replacing human GH and stimulate skeletal growth, growth of internal organs, and protein synthesis.
Indications

GH agonists are indicated for the following medical conditions:

  • long-term treatment of children with growth failure associated with various deficiencies, girls with Turner’s syndrome, AIDS wasting and cachexia, GH deficiency in adults, and treatment of growth failure in children of small gestational age who do not achieve catch-up growth by 2 years of age.
  • Somatropin (Nutropin, Saizen, Genotropin, Serostim) and somatropin rDNA origin (Zorbtive) are used for GH replacement today.
Pharmacokinetics

Here are the characteristic interactions of GH agonists and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
IM, subcutaneous Varies 5-7.5 h
T1/2: 15-20 min
Metabolism: liver
Excretion: urine, feces
Contraindications and Cautions

The following are contraindications and cautions for the use of GH agonists:

  • Allergy to any component of the drug. To prevent hypersensitivity reactions.
  • Closed epiphyses and cranial lesions. Risk of serious complications with somatropin.
  • Abdominal surgery and acute illness secondary to complications of open heart surgery. Potential problems with healing.
  • Pregnancy or lactation. Potential adverse effects on the fetus.
Adverse Effects

Use of GH agonists may result to these adverse effects:

  • development of antibodies to GH
  • inflammation and autoimmune-type reactions (swelling, joint pain)
  • endocrine reactions (hypothyroidism, insulin resistance).
Interactions

The following are drug-drug interactions involved in the use of GH agonists:

  • change in metabolism with drugs using P450 liver enzyme system
Nursing Considerations

Here are important nursing considerations when administering GH agonists:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for contraindications or cautions (e.g. history of allergy, pregnancy, serious infection after open heart surgery, etc.) to avoid adverse effects.
  • Assess height, weight, thyroid function tests, glucose tolerance tests, and GH levels to determine baseline status before beginning therapy and for any potential adverse effects.   
Nursing Diagnoses and Care Planning

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Imbalanced nutrition: less than body requirements related to metabolic changes
  • Acute pain related to need for injections
Nursing Implementation with Rationale

These are vital nursing interventions done in patients who are taking GH agonists:

  • Reconstitute the drug following manufacturer’s directions because individual products vary; administer IM or SQ as ordered for appropriate drug delivery.
  • Monitor response closely to determine need for dose adjustment.
  • Monitor thyroid function, glucose tolerance, and GH levels periodically to monitor endocrine changes and to institute treatment as needed.
  • Provide comfort measures to help patient cope with the drug effects. 
  • Provide patient education (storage, preparation, administration techniques) about drug effects and warning signs to report to enhance patient knowledge and to promote compliance.   
Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (return of GH levels to normal, growth and development).
  • Monitor for adverse effects (e.g. nutritional imbalance, hypothyroidism).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy

Growth Hormone Antagonists

Description
  • Growth Hormone antagonists are used in treating GH hypersecretion (hyperpituitarism) caused by pituitary tumors.
Disease Spotlight: Hyperpituitarism
  • GH hypersecretion is usually caused by pituitary tumors and can occur at any time of life.
  • Gigantism occurs before the epiphyseal plates of the long bones fuse and cause acceleration in linear skeletal growth. Individuals with gigantism can reach 7 to 8 feet in height with fairly normal body proportions.
  • Acromegaly is a form of hyperpituitarism after epiphyseal closure (adults). As linear growth is impossible, hypersecretion of GH causes enlargement in the peripheral parts of the body such as hands and feet as well as internal organs (heart).
Therapeutic Action

The desired and beneficial action of GH antagonists is:

  • acting directly on postsynaptic dopamine receptors in the brain to inhibit GH secretion
  • Octreotide and lanreotide are somatostatin analogues which are more potent in inhibiting GH release with less of an inhibitory effect on insulin release. They are used instead of somatostatin.
Indications

GH antagonists are indicated for the following medical conditions:

  • Treatment of Parkinson’s disease, hyperprolactinemia associated with pituitary adenomas, female infertility associated with hyperprolactinemia, and acromegaly; short-term treatment of amenorrhea or galactorrhea.
  • Bromocriptine is a semisynthetic ergot alkaloid and a dopamine agonist which is frequently used to treat acromegaly. It may also be used as adjunct to irradiation.
Pharmacokinetics

Here are the characteristic interactions of GH antagonists and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
PO Varies 1-3 h 14 h
T1/2: 3 h, 45-50 h
Metabolism: liver
Excretion: bile
Contraindications and Cautions

The following are contraindications and cautions for the use of GH antagonists:

  • Allergy to any component of the drug. To prevent hypersensitivity reactions.
  • Pregnancy or lactation. Potential adverse effects on the fetus.
  • Diabetes, thyroid dysfunction. May be exacerbated by blocking GH.
Adverse Effects

Use of GH antagonists may result to these adverse effects:

  • CNS: headache
  • CV: sinus bradycardia, arrhythmias
  • GI: nausea, vomiting, abdominal cramps, constipation, diarrhea, acute cholecystitis, cholestatic jaundice, biliary tract obstruction, pancreatitis
  • Others: decreased glucose tolerance, inflammation at injection sites
Interactions

The following are drug-drug interactions involved in the use of GH antagonists:

  • Erythromycin. Increased toxicity with bromocriptine
  • Phenothiazine. Decreased effectiveness of bromocriptine
  • Opioids. Higher doses of pegvisoman will be required
Nursing Considerations

Here are important nursing considerations when administering GH antagonists:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for contraindications or cautions (e.g. history of allergy to the drug,  other endocrine disturbances, pregnancy and lactation, etc.) to avoid adverse effects.
  • Assess orientation, affect, and reflexes; blood pressure, pulse, and orthostatic blood pressure; abdominal examination; glucose tolerance tests; and GH levels to determine baseline status before beginning therapy and for any potential adverse effects.   
Nursing Diagnosis 

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Imbalanced nutrition: more than body requirements related to metabolic changes
  • Acute pain related to need for injections
Implementation with Rationale

These are vital nursing interventions done in patients who are taking GH antagonists:

  • Reconstitute the drug following manufacturer’s directions because individual products vary; administer IM or SQ as ordered for appropriate drug delivery.
  • Inject lanreotide deep into subcutaneous fat in the superior quadrant of the buttocks and alternate from right to left to ensure proper drug delivery and prevent local reactions. 
  • Monitor thyroid function, glucose tolerance, and GH levels periodically to monitor endocrine changes and to institute treatment as needed.
  • Arrange for baseline and periodic ultrasound evaluation of gallbladder if using octreotide or lanreotide to detect any gallstone development and to arrange for appropriate treatment.
  • Provide comfort measures to help patient cope with the drug effects. 
  • Provide patient education about drug effects and warning signs to report to enhance patient knowledge and to promote compliance.   
Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (return of GH levels to normal).
  • Monitor for adverse effects (e.g. nutritional imbalance).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Drugs Affecting Posterior Pituitary Hormones

Description
  • The posterior pituitary stores two hormones produced by the hypothalamus(antidiuretic hormone or vasopressin [ADH] and oxytocin).
  • ADH possesses antidiuretic, hemostatic, and vasopressor properties. It is the hormone affected in diabetes insipidus, a condition characterized by production of a large amount of dilute urine containing no glucose.
Therapeutic Action

The desired and beneficial actions of posterior pituitary agents are:

  • Pressor and antidiuretic effect by causing the cortical and medullary parts of the collecting duct to become permeable to water, thereby increasing water reabsorption and decreasing urine formation.
  • Increasing levels of clotting factor VIII
Indications

Posterior pituitary agents are indicated for the following medical conditions:

  • Treatment of neurogenic diabetes insipidus and hemophilia A
Pharmacokinetics

Here are the characteristic interactions of posterior pituitary agent and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral 1 h 60-90 min 7 h
IV, subcutaneous 30 min 90-120 min Varies
Nasal 15-60 min 1-5 h 5-21 h
T1/2: 7.8 min, 75.5 min (IV); 1.5-2.5 h (oral); 3.3-3.5 h (nasal
Metabolism: tissues
Excretion: unknown
Contraindications and Cautions

The following are contraindications and cautions for the use of posterior pituitary agents:

  • Allergy to any component of the drug. To prevent hypersensitivity reactions.
  • Severe renal dysfunction. Can alter the effects of the drug
  • Any known vascular disease. Can be exacerbated by the effects of the drug on vascular smooth muscle
  • Pregnancy. Risk of premature uterine contractions.
  • Lactation. Potential adverse effects to the neonate.
Adverse Effects

Use of posterior pituitary agents may result to these adverse effects:

  • Water intoxication. Drowsiness, light-headedness, headache, coma, convulsions
  • GI: abdominal cramps, flatulence, nausea, vomiting, constipation, dry mouth
  • Local reaction at injection site
Interactions

The following are drug-drug interactions involved in the use of posterior pituitary agents:

  • Carbamazepine, chlorpropamide. Increased antidiuretic effects if with desmopressin
  • Digoxin, ACEI, ARBs, potassium-sparing diuretics. Risk of hyperkalemia with tolvaptan and conivaptan
  • Telithromycin. Severe tolvaptan toxicity.
Nursing Considerations

Here are important nursing considerations when administering posterior pituitary agents:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for contraindications or cautions (e.g. history of allergy, pregnancy, renal dysfunction, etc.) to avoid adverse effects.
  • Assess skin for lesions; orientation, affect, and reflexes; blood pressure and pulse; respiration and adventitious sounds; abdominal examination; renal function tests; and serum electrolytes, to determine baseline status before beginning therapy and for any potential adverse effects.    
Nursing Diagnosis and Care Planning

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Altered urinary elimination
  • Changes in fluid volume related to water retention or excretion
Nursing Implementation with Rationale

These are vital nursing interventions done in patients who are taking posterior pituitary agents:

  • Monitor patient fluid volume to watch for signs of water intoxication and fluid excess or excessive fluid loss.
  • Monitor patient with vascular disease for any sign of exacerbation to provide for immediate treatment.
  • Monitor condition of nasal passages if given intranasally to observe for nasal ulceration, which can occur and could affect drug absorption.
  • Provide comfort measures to help patient cope with the drug effects. 
  • Provide patient education about drug effects and warning signs to report to enhance patient knowledge and to promote compliance.   
Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (maintenance of fluid balance).
  • Monitor for adverse effects (e.g. water intoxication, GI problems).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Affecting Anterior and Posterior Pituitary Hormones Drugs*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return

Enterobiasis Nursing Management

Notes

Description

Enterobiasis (also called pinworm, seatworm, or threadworm infection) is a benign intestinal disease caused by the nematode Enterobius vermicularis. It is the most prevalent helminthic infection in the United States.

  • Enterobius vermicularis is a small nematode. This common helminthic infestation has an estimated prevalence of 40 million infected individuals in the United States.
  • The pinworm is a white threadlike worm that invades the cecum and may enter the appendix.
  • The female nematode averages 10 mm X 0.7 mm, whereas males are smaller.
  • Article contaminated with pinworm eggs spread pinworms from person to person.
  • All socioeconomic levels are affected; infestation often occurs in family clusters. Infestation does not equate with poor home sanitary measures (an important point when discussing therapy).

Pathophysiology

The life cycle of these worms is 6 to 8 weeks, after which reinfestation commonly occurs without treatment.

  • E. vermicularis is an obligate parasite; humans are the only natural host.
  • Fecal-oral contamination via hand-mouth contact or via fomites (toys, clothes) are common methods of infestation.
  • After ingestion, eggs usually hatch in the duodenum within 6 hours.
  • Worms mature in as little as 2 weeks and have a lifespan of approximately 2 months.
  • Adult worms normally inhabit the terminal ileum, cecum, vermiform appendix, and proximal ascending colon; the worms live free in the intestinal lumen.
  • The female worm migrates to the rectum after copulation and, if not expelled during defecation, migrates to the perineum (often at night) where an average of 11,000 eggs are released.
  • Eggs become infectious within 6-8 hours and, under optimum conditions, remain infectious in the environment for as long as 3 weeks.

Statistics and Incidences

The incidence of enterobiasis are highest in school-age children and next highest in preschoolers.

  • Prevalence is approximately 5-15% in the general population; however, this rate has declined in recent years; prevalence rates are probably higher in institutionalized individuals; humans are the only known host.
  • Infestation rate increases with increased population density, and with personal habits such as thumb sucking.
  • E. vermicularis infestation occurs worldwide. Prevalence data vary by country.
  • A study that aimed to determine the extent of enterobiasis, strongyloidiasis, and other helminth infections in infants, preschool-aged, and school-aged children from rural coastal Tanzania reported that Enterobius vermicularis infections were found in 4.2% of infants, 16.7%, of preschool-aged children, and 26.3% of school-aged children.
  • Secondary bacterial skin infection may develop from vigorous scratching to relieve pruritus.
  • The people most likely to be infected with pinworms are children younger than 18 years, people who take care of infected children, and people who are institutionalized; in these groups, the prevalence can reach 50%.

Clinical Manifestations

Symptoms of enterobiasis in children include:

  • Perianal itching. Intense perianal itching is the primary symptom of pinworms. This occurs especially at night when the female worm leaves the anus to deposit ova.
  • Erythema. Patients often have excoriation or erythema of the perineum, vulvae, or both, but infestation can occur without these signs.
  • Abdominal pain. Abdominal pain may sometimes be severe and can mimic acute appendicitis.
  • Visual worm sighting. Visual sighting of a worm by a reliable source (e.g., a parent) is usually accepted as evidence of infestation and grounds for treatment.

Assessment and Diagnostic Findings

The usual method of diagnosis is to use cellophane tape to capture the eggs from around the anus.

  • Cellophane tape test. The cellophane tape test for identifying worms is performed in the early morning, just before or as soon as the child wakens; the tape is then examined microscopically for eggs in the laboratory.

Medical Management

Treatment of enterobiasis consists of the following:

  • Handwashing. Thorough and regular handwashing is effective in preventing disease transmission.
  • Personal hygiene. Changing personal habits such as thumb-sucking or nail-biting may reduce re-infection; The child should also be encouraged to observe other hygiene measures, such as regular bathing and daily change of underclothing; the nurse should teach caregivers to keep the child’s fingernails short and clean.
Pharmacologic Management

Drug therapy with pyrantel, mebendazole, or albendazole is the current standard in treating enterobiasis:

  • Anthelmintics. Mebendazole is not currently available in the United States; Pyrantel pamoate or albendazole (not currently approved for this use by the US Food and Drug Administration) are recommended alternatives; a second dose given 2 weeks after the initial dose is recommended. Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class.
  • Anal albendazole. Anal albendazole may help with symptoms of pruritus ani.

Nursing Management

Nursing care for a child with enterobiasis include the following:

Nursing Assessment

Assessment includes the following:

  • History. Patients with enterobiasis are often asymptomatic. Worms may be incidentally discovered when they are seen in the perineal region; if patients are symptomatic, pruritus ani and pruritus vulvae are common presenting symptoms.
  • Physical exam. Worms can be found in stools or on the patient’s perineum before bathing in the morning.
Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses are:

  • Risk for impaired skin integrity related to intense perianal scratching.
  • Acute pain related to smooth muscle spasm secondary to migration of parasites in the stomach.
  • Imbalanced Nutrition: less than body requirements related to anorexia and vomiting.
  • Hyperthermia related to decrease in circulation secondary to dehydration.
Nursing Care Planning and Goals

The major goals for a child with Enterobiasis are:

  • Reduce discomfort from perianal itching.
  • Diminish pain to a tolerable level.
  • Regain adequate nutrition.
  • Reduce or eliminate increase in temperature.
Nursing Interventions

The nursing interventions for a child with Enterobiasis are:

  • Administer medications as ordered. Drug therapy with pyrantel, mebendazole, or albendazole to destroy the causative parasites. Effective eradication requires treatment of the patient’s family or members of the household.
  • Inform patient of the side effects of pyrantel. Stool may be bright red and may cause vomiting. The tablet form of this drug is coated with aspirin and shouldn’t be given to aspirin-sensitive patients.
  • Improve skin integrity. Application of an antipruritic ointment or albendazole may help control scratching; keeping the patient’s fingernails trimmed to prevent excoriations is helpful.
  • Diminish pain. An antihelminthic medication should be prescribed to patients with enterobiasis.
  • Improve hygienic status. Avoid scratching the area and nail-biting because this is a cause of autoinfection; thorough handwashing should be done before and after meals. Tell family not to shake bed linens to avoid aerosolization of eggs that may be found on linens.
  • Diminish increase in temperature. Administer antipyretics as prescribed; tepid sponge baths may also be given.
  • Inform patient
Evaluation

Goals are met as evidenced by:

  • Reduced discomfort from perianal itching.
  • Diminished pain to a tolerable level.
  • Regained adequate nutrition.
  • Diminished increase in temperature.
Documentation Guidelines

Documentation in a patient with enterobiasis include:

  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcome.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Enterobiasis Practice Exam.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return

Lead Poisoning Nursing Care Plan & Management

Notes

Description

Lead poisoning is a worldwide pediatric problem.

  • Lead is a ubiquitous and versatile metal; it has been extensively used since ancient times, and the history of public exposure to lead in food and drink is extensive.
  • Lead poisoning (also known as plumbism) was common in Roman times because of the use of lead in water pipes and in wine containers.
  • In 1904, the Australian physician J. Lockhart Gibson concluded that lead paint in the home was responsible for poisoning children; despite Gibson’s work, and subsequent confirmation of it in the US medical literature, lead was not banned from US household paints until 1978.
  • In 1991, the Centers for Disease Control and Prevention (CDC) defined blood lead levels (BLLs) ≥10 µg/dL as the “level of concern” for children aged 1–5 years.
  • In May 2012, the CDC replaced the term “level of concern” with an upper reference interval value defined as the 97.5th percentile of BLLs in US children aged 1–5 years from two consecutive cycles of the National Health and Nutrition Examination Survey (NHANES).

Statistics and Incidences

According to the Centers for Disease Control and Prevention (CDC), the percentage of confirmed blood lead levels (BLLs) ≥10 µg/dL in US children younger than 72 months fell from 7.61% in 1997 to 0.56% in 2013.

  • Nevertheless, the CDC estimates that at least 4 million US households have children living in them that are being exposed to high levels of lead, and approximately half a million US children age 1-5 years have blood lead levels above 5 µg/dL, the reference level at which CDC recommends public health actions be initiated.
  • Children who belong to minority populations or low-income families or who live in older homes are, particularly at risk.
  • Lead continues to be a significant public health problem in developing countries.
  • In general, children with heavy exposure to automobile exhaust (in countries where leaded gasoline is still sold), lead-based paint, or home-industry manufacture of batteries, ceramics, or painted artifacts have high lead burdens.
  • Overall, from 1999-2002, non-Hispanic blacks and Mexican Americans had higher percentages of elevated BLLs (1.4% and 1.5%, respectively) than did non-Hispanic whites (0.5%).
  • Lead poisoning chiefly affects children younger than age 6 years and adults in lead-risk occupations.

Causes

Lead toxicity may be caused by inorganic or organic lead.

  • Inorganic lead. Most cases of lead poisoning are caused by inorganic lead; lead may enter the body through ingestion, inhalation, or transdermal absorption; ingestion is the most common source of lead poisoning in children because of their normal hand-to-mouth activities.
  • Organic lead. However, organic lead, such as tetraethyl lead, may enter through the skin; tetraethyl lead, the main organic compound in leaded gasoline, is converted in the body to triethyl lead and inorganic lead

Clinical Manifestations

The clinical picture associated with lead poisoning is vague; symptoms are not specific enough to alarm the physician about lead toxicity.

  • Pallor. No specific physical signs for lead poisoning are recognized, but patients may exhibit pallor (due to associated anemia).
  • Impaired consciousness. The child may become lethargic or may lose consciousness after a considerable amount of time from contact with lead.
  • Bradycardia. There is a decrease in the heart rate of the child.
  • Hypertension. Increase in blood pressure is one of the signs of increased intracranial pressure, a common finding in children affected by lead.
  • Respiratory depression. The child may experience shortness of breath as a sign of respiratory depression.

Assessment and Diagnostic Findings

In the early 1990s, both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommended universal screening for lead toxicity in children at 1 and 2 years of age.

  • Whole blood lead level (BLL) is the criterion standard for confirming the diagnosis of lead poisoning; for convenience, a fingerstick capillary lead level has been used for screening; properly collected capillary samples have a 10% false-positive rate; once an elevated lead level is detected, a venous lead level is assessed for confirmation.
  • Erythrocyte protoporphyrin. Erythrocyte protoporphyrin (EP) may be obtained in selected patients; lead toxicity affects heme synthesis at several steps; this includes interference with the enzyme ferrochelatase, leading to the accumulation of EP; EP is easily detected because it fluoresces easily; EP is an adjunct for the diagnosis in the presence of elevated lead levels of 55 mcg and higher.
  • Hair samples. In Russia, hair sample is the standard for lead poisoning screening.; however, studies have demonstrated that blood lead specimens are more sensitive than hair samples in detecting lead exposure.
  • Abdominal radiography. Presence of radiopaque flakes is a clear indicator of pica.
  • Long-bone radiography. Radiodensity may be detected at the distal metaphyseal area; these indications, known as lead lines, are true growth arrest lines and, although not pathognomonic, are associated with chronic lead exposure.

Medical Management

Treatment of lead toxicity involves the prevention of further lead exposure, decontamination, chelation, and supportive therapy.

  • Decontamination. Decontamination may be performed in patients with acute lead ingestion in whom lead paint chips are identified on plain abdominal radiographs; gastric lavage may be performed; secure the airway before the initiation of gastric lavage in an obtunded child with acute lead ingestion.
  • Chelation. Use of chelating agents is recommended for children with venous lead levels of 45 μg/dL or higher; these include oral succimer and parenteral calciumdisodium edetate (calcium EDTA) and British antilewisite (BAL; dimercaprol).
  • Supportive therapy. Certain children may develop acute lead encephalopathy; in such circumstances, protection of the airway via endotracheal intubation may be necessary; in the event of seizures, benzodiazepines are indicated; maintenance of seizure control with phenobarbital may be needed; if seizures are difficult to control, presume the presence of increased intracranial pressure and pursue measures to decrease it (eg, hyperventilation, mannitol, steroids).
  • Primary prevention. Parents should be educated about sources of lead, the common behavior involved (ie, pica), and the hazards associated with lead exposure on children’s development; nutritional assessment is of particular importance because lead absorption is enhanced by improper dietary intake, especially in the presence of high fat intake and/or deficiency of certain elements, such as calcium and iron.
  • Secondary prevention. Secondary prevention focuses on the early detection of lead poisoning; the CDC has devised screening criteria to determine which children are at high risk for lead poisoning; screening of BLLs should be carried out according to these criteria.
  • Dietary measures. The diet should be adequate in energy (caloric) intake and replete with calcium, zinc, and iron; data from the Normative Aging Study suggest that low dietary intake of vitamin D may increase accumulation of lead in bones, whereas low dietary intake of vitamin C and iron may increase lead levels in blood in subjects who range in age from middle-aged to elderly.
Pharmacologic Management

Medications for a child who has lead poisoning include:

  • Chelating agents. These agents bind to lead and promote its excretion; patients receiving chelation therapy must be closely monitored because of the agents’ potential toxicities; Dimercaprol was first developed as an antidote for lewisite toxicity; it is water soluble and rapidly crosses the blood-brain barrier; Dimercaprol forms a nonpolar compound with lead that is excreted in bile and urine; it is the drug of choice in patients with acute lead encephalopathy, in whom the first dose is given and then the second dose is given combined with calcium EDTA after a 4-hour interval.

Nursing Management

Nursing care for a child who has lead poisoning include:

Nursing Assessment

Assessment of a child who experiences lead poisoning involves:

  • History. Assess for the presence of lead in any household furniture or fixture, any lead-containing materials, and lead-contaminated food or beverages.
  • Physical examination. Assess the child for signs of lead poisoning, such as hyperactivity or lethargy, irritability, pallor, and signs of shock.
Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses are:

  • Delayed growth and development related to effects of lead on the brain.
  • Disorganized infant behavior related to irritability and lethargy.
  • Ineffective breathing pattern related to shortness of breath.
Nursing Care Planning and Goals

The major goals are:

  • The child will have a normal blood lead level.
  • The child will be able to communicate and interact with the parents.
  • Breathing pattern will return to normal.
Nursing Interventions

The nursing interventions are:

  • Reduce lead exposure. Children with symptomatic lead poisoning (with or without encephalopathy) must be treated only at a pediatric center that has an intensive care unit; they should be managed by a multidisciplinary team that includes, as needed, critical care, toxicology, neurology, and neurosurgery; the child’s neurological status and fluid balance must be carefully monitored.
  • Medication administration. Administer edetate calcium disodium or EDTA, as ordered, intravenously because intramuscular administration is painful.
  • Monitor for side effects. All the chelating drugs may have toxic side effects, and children being treated must be carefully monitored with frequent urinalysis, blood cell counts, and renal function tests.
  • Education. Educate the family about lead poisoning prevention and nutrition.
  • Remove lead-containing materials. Throw out old painted toys if you do not know whether the paint contains lead; avoid canned goods from foreign countries, and the walls must be covered with a paneling or Masonite.
Evaluation

Goals are met as evidenced by:

  • The child will have a normal blood lead level.
  • The child will be able to communicate and interact with the parents.
  • Breathing pattern will return to normal.
Documentation Guidelines

Documentation in a child who underwent lead poisoning include:

  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Characteristics of vomitus.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcome.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Lead Poisoning Nursing Management Practice Exam.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return

Intussusception Nursing Care Plan & Management

Notes

Description

Intussusception usually appears in healthy babies without any demonstrable cause.

  • Intussusception is a process in which a segment of intestine invaginates or telescopes into the adjoining intestinal lumen, causing bowel obstruction.
  • It occurs most commonly at the juncture of the ileum and the colon, although it can appear elsewhere in the intestinal tract.
  • The invagination is from above downward, the upper portion slipping over the lower portion pulling the mesentery along with it.

Pathophysiology

The pathogenesis of intussusception is not well established.

  • It is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall.
  • As a result of an imbalance in the forces of the intestinal wall, an area of the intestine invaginates into the lumen of the adjacent bowel.
  • The invaginating portion of the intestine (ie, the intussusceptum) completely “telescopes” into the receiving portion of the intestine (ie, the intussuscipiens); this process continues and more proximal areas follow, allowing the intussusceptum to proceed along the lumen of the intussuscipiens.
  • If the mesentery of the intussusceptum is lax and the progression is rapid, the intussusceptum can proceed to the distal colon or sigmoid and even prolapse out the anus.
  • The mesentery of the intussusceptum is invaginated with the intestine, leading to the classic pathophysiologic process of any bowel obstruction.

Statistics and Incidences

A wide geographic variation in the incidence of intussusception among countries and cities within countries make determining a true prevalence of the disease difficult.

  • Its estimated incidence is approximately 1 case per 2000 live births.
  • In Great Britain, incidence varies from 1.6-4 cases per 1000 live births.
  • Overall, the male-to-female ratio is approximately 3:1.
  • With advancing age, gender difference becomes marked; in patients older than 4 years, the male-to-female ratio is 8:1.
  • Two-thirds of children with intussusception are younger than 1 year; most commonly, intussusception occurs in infants aged 5-10 months.
  • Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years.
  • Intussusception can account for as many as 25% of abdominal surgical emergencies in children younger than 5 years, exceeding the incidence of appendicitis.

Causes

In most cases, however, no cause can be identified for intussusception.

  • Hyperperistalsis. The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it.
  • Digestive system activities. The unusual mobility of the cecum and ileum normally present in early life may also cause intussusception.

Clinical Manifestations

The constellation of signs and symptoms of intussusception represents one of the most classic presentations of any pediatric illness; however, the classic triad of vomiting, abdominal pain, and passage of blood per rectum occurs in only one-third of patients.

  • Abdominal pain. In rare circumstances, the parents report 1 or more previous attacks of abdominal pain within 10 days to 6 months prior to the current episode; pain in intussusception is colicky, severe, and intermittent.
  • Vomiting. Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes bilious.
  • Currant jelly stool. Parents also report the passage of stools that look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood.
  • Lethargy. Lethargy is a relatively common presenting symptom with intussusception; the reason lethargy occurs is unknown because lethargy has not been described with other forms of intestinal obstruction.

Assessment and Diagnostic Findings

The care provider usually can make a diagnosis from:

  • Rectal examination. The healthcare provider may perform a rectal examination during a calm interval.
  • Palpation. A baby is often unwilling to tolerate palpation, and sedation may be ordered; a sausage-shaped mass can be often felt through the abdominal wall.
  • Radiographs. Plain abdominal radiography reveals signs that suggest intussusception in only 60% of cases; as the disease progresses, the earliest radiographic evidence includes an absence of air in the right lower and upper quadrants and a right upper quadrant soft tissue density present in 25-60% of patients.
  • Ultrasonography. One study reported that the overall sensitivity and specificity of ultrasonography for detecting ileocolic intussusception was 97.9% and 97.8%, respectively; the authors concluded that ultrasonography should be used as a first-line examination for the assessment of possible pediatric intussusception.
  • CT scanning. Computed tomography (CT) scanning has also been proposed as a useful tool to diagnose intussusception; however, CT scan findings are unreliable, and CT scanning carries risks associated with intravenous contrast administration, radiation exposure, and sedation.
  • Contrast enema. The traditional and most reliable way to make the diagnosis of intussusception in children is to obtain a contrast enema (either barium or air); contrast enema is quick and reliable and has the potential to be therapeutic.

Palpable sausage  mass in the right upper quadrant.

Medical Management

Unlike pyloric stenosis, intussusception is an emergency in the sense that prolonged delay is dangerous.

  • Intravenous fluid.  For all children, start intravenous fluid resuscitation and nasogastric decompression as soon as possible.
  • Therapeutic enema. Therapeutic enemas can be hydrostatic, with either barium or water-soluble contrast, or pneumatic, with air insufflation; therapeutic enemas can be performed under fluoroscopic or ultrasonographic guidance; the technique chosen is not important as long as the radiologist performing the enema is comfortable with the method.
  • Surgical reduction. If a nonoperative reduction is unsuccessful or if obvious perforation is present, promptly refer the infant for surgical care; risk of recurrence of the intussusception after operative reduction is less than 5%.
  • Laparoscopy. Laparoscopy has been added to the surgical armamentarium in the treatment of intussusception; laparoscopy can be performed in all cases of intussusception; reduction of the intussusception, confirmation of radiologic reduction, and detection of lead points have all been reported.
Pharmacologic Management

Drug therapy is not currently a component of the standard of care for intussusception. Medications are limited to those used for pain control after surgery. In the immediate postoperative period, weight-adjusted intravenous morphine is usually administered.

Nursing Management

Nursing management of a child with intussusception includes:

Nursing Assessment

Assessment of a child with intussusception includes:

  • Physical examination. The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign).
  • History. The patient with intussusception is usually an infant, often one who has had an upper respiratory infection, who presents with vomiting, abdominal pain, passage of blood and mucus, lethargy, and palpable abdominal mass.
Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses are:

  • Acute pain related to bowel invagination.
  • Deficient fluid volume related to vomiting, nausea, fever, and diaphoresis.
  • Ineffective breathing pattern related to abdominal distention and rigidity.
  • Anxiety related to change in health status.
Nursing Interventions

Nursing interventions appropriate for the infant are:

  • Intravenous fluids. Administer IV fluids as ordered; if the patient is in shock, give blood or plasma as ordered.
  • Decompression. A nasogastric tube is inserted to decompress the bowel.
  • Monitor I&O. Replace volume lost as ordered, and monitor the intake and output accordingly.
  • Education. Educate the family caregivers on what happens during intussusception and about the surgery, and answer questions to reduce the anxiety.
Evaluation

Goals are met as evidenced by:

  • The patient shows stable vital signs.
  • The patient exhibits balanced intake and output.
  • The patient’s pain decreases and is comfortable.
  • The patient’s pattern of breathing is effective.
  • The caregiver’s anxiety is resolved.
Documentation Guidelines

Documentation in a child with intussusception include:

  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Intake and output.
  • Characteristics of vomitus.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcome.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Intussusception Nursing Practice Exam .
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return

Nursing Care Plan

Deficient Fluid Volume

Deficient Fluid Volume: Decreased intravascular, interstitial, and intracellular fluid.

May be related to
  • Excessive losses through normal routes
Possibly evidenced by
  • Vomiting
  • Decreased urine output
  • Inadequate fluid intake
  • Signs and symptoms of dehydration or electrolyte imbalance
Desired Outcomes
  • Child will be able to tolerate age-appropriate foods and fluids without vomiting or recurrence of symptoms and will be free from fluid and electrolyte imbalances.
Nursing Interventions Rationale
Assess for signs and symptoms of dehydration such as poor skin turgor, dry mucous membranes, irritability, and delayed capillary refill. Repeated vomiting and insufficient fluid intake may lead to dehydration.
Assess fluid intake and output. Measurement of fluid intake and output is an important indicator of child’s fluid status.
Monitor vital signs as frequently as possible. Vital sign changes such as hypotension, tachycardia and increased temperature reveals hypovolemia.
Monitor characteristic of stool (consistency and color). Initially, a child with intussusception may pass a normal stool, but later on, a mucus, blood-filled or jelly-like stool is observed.
Suggest and offer infant the use of a pacifier. Sucking on a pacifier may promote peristaltic movement and passage of gas.
Administer IV fluids as ordered. Post-operatively, intravenous fluids are continued to re-established electrolyte imbalance and to promote adequate fluid intake.
Instruct parents that they may offer clear liquids then gradually advanced diet as tolerated. A clear liquid diet, then progressing to soft diet is given until normal bowel function is established.
Provide frequent oral hygiene. Deficient fluid intake can cause a dry, sticky mouth. Attention to mouth care promotes interest in drinking and reduces discomfort of dry mucous membranes.

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to
  • Lack of information about condition
Possibly evidenced by
  • Request for information about causes of condition, postoperative or postprocedural care
Desired Outcomes
  • Parents verbalize understanding of intussusception, the need for a barium enema, and possibility of surgical intervention.
Nursing Interventions Rationale
Assess parent’s knowledge of the condition, signs and symptoms, therapeutic regimen following procedures. Promotes the development of an effective plan of instruction.
Offer parents with clear and brief information; May utilize teaching aids and encourage questions. Ensures understanding of care needs based on ability to learn.
Teach parents of signs and symptoms
of infection in the incision area and demonstrate and allow for return demonstration of dressing change.
Raises awareness of signs and symptoms of wound infection to facilitate an immediate intervention.
Instruct parents to monitor any blood in stool, change in stool characteristics or diarrhea or constipation or absence of stools. Reveals gastrointestinal bleeding and possible recurrence or chronicity of condition.
Instruct parents about preparation procedures for reduction by barium enema or surgery and antibiotic and postoperative care given to the child. Provides information regarding care to expect during hospitalization.
Teach parents that a nothing-per-orem (NPO) status will be ordered initially
and will be offered clear fluids and slowly progress to usual diet once advised.
Prevents vomiting or abdominal distention until condition resolved.
Educate parents about activity restrictions. Allows condition and/or wound to heal and resolve itself without complications.
Inform parents that bowel elimination of brown stools indicate that condition has been improved. Provides parents with baseline expected with successful resolution of the problem.

Risk for Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

May be related to
  • Bowel dysfunction
Possibly evidenced by
  • [not applicable]
Desired Outcomes
  • Intussusception will be reduced by hydrostatic pressure.
  • Client will pass a normal brown stool.
Nursing Interventions Rationale
Assess presence of acute abdominal
pain accompanied by loud crying and drawing knees up to chest which may be episodic, vomiting, passage of a brown stool followed by red, currant jelly-like stool, pallor, irritability.
Provides information that intussusception is present which may result in obstruction and if left untreated, will lead to peritonitis.
Monitor older child for presence of diarrhea, constipation, and vomiting episodes. Reveals presence of intussusception and a further assessment is needed.
Observe bowel elimination and
characteristics of stool and ability to eliminate barium following the procedure.
Signifies that the procedure in reducing the affected bowel is successful as the condition may recur within 36 hours.
Provide NG tube attached to suction,
IV fluids to decompress bowel and
maintain hydration status and maintain patency of therapy as ordered.
Avoids episodes of vomiting and dehydration and prepares the child for barium enema procedure to diagnose and reduce the invagination.
Provide information on the therapeutic regimen and allow for an opportunity to inquire questions about procedures. Decreases anxiety and helps eliminate the fear of the unknown.
Provide reassurance to parents and allow to accompany the child during the procedure. Promotes trust and reduces anxiety.
Inform parents on the purpose for IV
and NG tube, NPO status.
Provides information about treatments for understanding and lessening of anxiety.
Inform parents that surgical reduction may be needed if barium enema fail to reduce the invagination. Prepares parents for a possibility of surgical correction.
Reinforce information given by the physician. Provides information about surgical intervention if barium enema reduction is unsuccessful or if bowel obstruction and necrosis is present.

Hydrocele Nursing Management

Notes

Image credit to : Stanford Children’s Health

Description

Few of the genitourinary conditions may affect the infant in the first year of life.

  • A hydrocele is a collection of peritoneal fluid that accumulates in the scrotum through a small passage called the processus vaginalis.
  • This processus is a finger-like projection in the inguinal canal through which the testes descend.
  • A hydrocele is a fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord.
  • These fluid collections may represent persistent developmental connections along the spermatic cord or an imbalance of fluid production versus absorption.
  • The description of the abdominal cavity parietes to the tunica vaginalis is attributed to Galen in 176 AD; however, the clear description of the inguinal anatomy and its relationship to groin hernias and hydroceles was not recorded until the 19th century.

Pathophysiology

The pathophysiology of hydroceles requires an imbalance of scrotal fluid production and absorption; this imbalance can be divided further into exogenous fluid sources or intrinsic fluid production.

  • Alternatively, hydroceles can be divided into those that represent a persistent communication with the abdominal cavity and those that do not.
  • Fluid excesses are from exogenous sources (the abdomen) in communicating hydroceles, whereas noncommunicating hydroceles develop increased scrotal fluid from abnormal intrinsic scrotal fluid shifts.
  • With communicating hydroceles, simple Valsalva maneuvers probably account for the classic variation in size during day-sleep cycles.
  • Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption.
  • A sudden onset of scrotal hydrocele in older children has been noted after viral illnesses; in such cases, viral-mediated serositis may account for the net increased fluid production.
  • Posttraumatic hydroceles likely occur secondary to increased serosal fluid production due to underlying inflammation.
  • Although rare in the United States, filarial infestations are a classic cause of the decreased lymphatic fluid absorption resulting in hydroceles.

Statistics and Incidences

In endemic tropical regions, scrotal hydrocele may occur in males of any age as a result of filariasis, especially from Wuchereria bancrofti infection.

  • A patent processus vaginalis is found in 80-90% of term male infants at birth.
  • This frequency rate steadily decreases until age 2 years, at which point it appears to plateau at approximately 25-40%.
  • Indeed, autopsy series of men have identified a frequency rate of 20% of the processus vaginalis remaining patent until late in life.
  • However, clinically apparent scrotal hydroceles are evident in only 6% of term males beyond the newborn period.
  • The incidence of hydroceles in men is less well known.

Causes

The causes of hydroceles are legion.

  • Patency of processus vaginalis. In children, most hydroceles are of the communicating type, in which patency of the processus vaginalis allows peritoneal fluid to flow into the scrotum, particularly during Valsalva maneuvers.
  • Infection. In the adult population, filariasis, a parasitic infection caused by Wuchereria bancrofti, accounts for most causes of hydroceles worldwide, affecting more than 120 million people in more than 73 countries.
  • Iatrogenic causes. Following laparoscopic or transplant surgery in males, inadequate irrigation fluid aspiration may cause hydroceles in patients with a patent processus vaginalis or a small hernia.

Clinical Manifestations

Hydroceles typically manifest as the following:

  • Palpable fullness. Hydroceles typically manifest as a soft nontender fullness within the hemiscrotum.
  • Transillumination. When the scrotum is investigated with a focused beam of light, the scrotum transilluminates, revealing a homogeneous glow without internal shadows.
  • Swelling. Hydroceles of the canal of Nuck in female patients typically present as soft, nontender inguinal or labial swelling.

Assessment and Diagnostic Findings

Simple hydroceles are diagnosed on clinical grounds.

  • Laboratory studies. Few laboratory tests, if any, are warranted specifically for simple hydroceles, communicating or noncommunicating; concomitant medical conditions may be indications for preoperative laboratory studies; laboratory studies may be indicated to exclude other surgical or medical conditions that may be in the differential diagnosis.
  • Ultrasonography. Ultrasonography provides excellent detail of the testicular parenchyma; spermatoceles can be clearly distinguished from hydroceles on sonograms; if a testicular tumor is a diagnostic consideration, ultrasonography is an excellent screening study.
  • Duplex ultrasonography. Duplex studies may provide substantial information regarding testicular blood flow when a hydrocele may be associated with chronic torsion.
  • Plain abdominal radiography. Plain radiography may be useful for distinguishing an acute hydrocele from an incarcerated hernia; gas overlying the groin may indicate an incarcerated hernia.

Surgical Management

Surgical therapy can be divided into three approaches: inguinal, scrotal, and sclerotherapy.

  • Inguinal. The inguinal approach, with ligation of the processus vaginalis high within the internal inguinal ring, is the procedure of choice for pediatric hydroceles; if a testicular tumor is identified on testicular ultrasonography, an inguinal approach with high control/ligation of the cord structures is mandated.
  • Scrotal. The scrotal approach, with excision or eversion and suturing of the tunica vaginalis, is recommended for chronic noncommunicating hydroceles; this approach should be avoided upon any suspicion for underlying malignancy.
  • Sclerotherapy. An additional adjunctive, if not definitive, procedure, is scrotal aspiration and sclerotherapy of the hemiscrotum using tetracycline or doxycycline solutions; recurrence after sclerotherapy is common, as is significant pain and epididymal obstruction, making this treatment a last resort in poor surgical candidates with symptomatic hydroceles and in men in whom fertility is no longer an issue.

Nursing Management

Nursing care management for a patient with hydrocele includes the following:

Nursing Assessment

Assessment of a child with hydrocele includes:

  • Physical examination. The scrotum is enlarged on both sides; a smooth, cystic feeling mass completely surrounding the testicle and not involving the spermatic cord is characteristic of a hydrocele.
Nursing Diagnoses

Based on the assessment data, the major nursing diagnoses are:

  • Excess fluid volume related to the collection of fluid in the scrotal sac.
  • Acute pain related to the presence of postoperative wound.
  • Risk for infection related to surgical incision.
  • Impaired urinary elimination related to postoperative wound.
  • Fear/Anxiety related to the surgical procedure.
Nursing Care Planning and Goals

Nursing care planning and goals for a patient with hydrocele includes:

  • The patient or the caregivers will be able to acknowledge feelings and identify healthy ways to deal with them.
  • The patient will be able to appear relaxed, and is able to rest/sleep appropriately.
  • The caregivers will be able to identify individual risk factors and interventions to reduce potential for infection.
  • The caregivers will be able to maintain safe aseptic environment for the child.
  • The patient will be able to demonstrate adequate fluid balance, as evidenced by stable vital signs, palpable pulses of good quality, normal skin turgor, moist mucous membranes, and individually appropriate urinary output.
  • The patient will be able to report relief from pain.
  • The patient’s wound will be able to achieve timely healing.
Nursing Interventions

The nursing interventions appropriate for the child are:

  • Health education. Provide preoperative education, including visit with OR personnel before surgery when possible; discuss anticipated things that may concern patient: masks, lights, IVs, BP cuff, electrodes, bovie pad, feel of oxygen cannula or mask on nose or face, autoclave and suction noises, child crying.
  • Reduce risk for infection. Verify that preoperative skin, vaginal, and bowel cleansing procedures have been done as needed depending on specific surgical procedure; apply sterile dressing to prevent environmental contamination of fresh wound; and administer antibiotics as indicated.
  • Monitor fluid volume. Measure and record I&O (including tubes and drains); monitor vital signs noting changes in blood pressure, heart rate and rhythm, and respirations; and resume oral intake gradually as indicated.
  • Relief from pain. Evaluate pain regularly (every 2 hrs noting characteristics, location, and intensity (0–10 scale); note presence of anxiety or fear, and relate with nature of and preparation for procedure; assess causes of possible discomfort other than operative procedure; and provide additional comfort measures: backrub, heat or cold applications.
Evaluation

Goals are met as evidenced by:

  • The patient or the caregivers acknowledged their feelings and identified healthy ways to deal with them.
  • The patient appeared relaxed, and is able to rest/sleep appropriately.
  • The caregivers identified individual risk factors and interventions to reduce potential for infection.
  • The caregivers maintained a safe aseptic environment for the child.
  • The patient demonstrated adequate fluid balance, as evidenced by stable vital signs, palpable pulses of good quality, normal skin turgor, moist mucous membranes, and individually appropriate urinary output.
  • The patient reported relief from pain.
  • The patient’s wound achieved timely healing.
Documentation Guidelines

Documentation in a patient with hydrocele should involve:

  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Intake and output.
  • Signs of infection.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcome.

Practice Exam

Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Choose the letter of the correct answer. Good luck!
Start
Congratulations – you have completed Hydrocele Nursing Practice Exam.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Return
Shaded items are complete.
1 2 3 4 5
End
Return