Transcription
Hey everyone, nurse Mike here from simple nursing.com. Today we're diving into neurological drugs, covering the must-know medications for your Enlex and nursing exams. And guess what? There are over 19 study guides, one for each medication that'll pop up in the top right corner as we break them down. And for Simple Nursing members, get ready to grab your memory-packed, colorful study guides included in your membership. Now, let's log it in.
First up is our anti-convulsant, Phenytoin, given for long-term protection against seizures, like with patients with epilepsy and other long-term chronic seizure disorders. Now, the key word here is long-term, so it lasts longer in the body, and patients can get very toxic. So, the memory trick is we call Phenytoin "Pheny-toxic," since like most toxic drugs, the max range is 20, and that's the number to know for the Enlex. So, the big key points to write down is 10 to 20 is the therapeutic range. So, below 10, we have to report to the HCP since there's a huge seizure risk, and over 20, we hold as well and notify the HCP because of the huge toxicity risk.
Now, like any toxic drug, we do routine blood tests. So, question banks love to ask, "Blood level monitored routinely." So, that's usually the correct answer. Now, we do this to check the therapeutic range of the drug, as well as to monitor liver function, since any drug that can cause toxicity can also affect the liver heavily. So, the HESI mentions we hold the med for levels higher than 20. So, remember guys, over 20 is very toxic, and we take the medication at the same time daily because of the narrow therapeutic index. Now, that's a really big keyword: same time every day for drugs with a narrow therapeutic range.
Now, the next key point is toxicity. The early signs to report to the HCP. These are the big Enlex tips. So, write this down: ataxia, or basically an unsteady gait or gait disturbance, as well as hand tremor and slurred speech, or having trouble forming sentences. So, just think, "Pheny-toin is Pheny-toxic. You can't talk and you can't walk." So, "Pheny-talk" or "Pheny-walk" if you're Pheny-toxic.
Now, for the other adverse effects, the keyword here is suicidal ideations and skin rash that are new and painful. These are typically priority since it could indicate Stevens-Johnson syndrome. So, we report these to the HCP immediately. Now, some expected side effects: we expect to have bradycardia and hypotension. Since it's a CNS depressant, we expect to have low and slow vitals.
Now, the big key point here is gingival hyperplasia. Huge Enlex tip. Fancy words for overgrowth of gum tissue around the teeth, resulting in big gums that bleed very easily. Again, this is to be expected, so we don't stop the drug for this. 40% of students got this wrong and wanted to stop the drug for this. So, guys, remember, don't stop. Big gums are completely normal. So, we teach the patients good dental hygiene with a soft-bristle toothbrush. The big thing here is soft toothbrush and regular dentist visits and follow-up visits. So, ATI says that you teach patients to inform the dentist that they're taking Phenytoin, and the HESI mentions, "Perform or assist with oral care every shift." And a skin rash, fatigue, and dysarthria are priority. Remember, any type of skin rash could mean Stevens-Johnson syndrome, very deadly.
Now, the Kaplan mentions, "Statements requiring immediate intervention." So, "I noticed a rash on my stomach last week." Again, deadly Stevens-Johnson syndrome. And the second point mentioned was, "Lately, I find myself thinking about driving off a cliff." Definitely not normal. We need immediate intervention here.
So, as far as patient teaching here, switching gears, there are no oral contraceptives. So, Phenytoin deactivates the pill, leading to accidental pregnancies. So, we teach patients to use alternative birth control like an IUD, and there's no stopping abruptly. This typically goes for any drug that's acting on the brain. And we take folic acid, calcium, and vitamin D since this drug decreases folic acid absorption and decreases bone density. So, the Kaplan mentions this in a very interesting way: "Encourage foods such as milk, cantaloupe, and kale." Now, all these foods are high in folate and vitamin D. And they had a second question that mentions, "Requires further teaching when the patient states, 'If I start having adverse effects, I will stop taking this medication immediately.'" Guys, that's a big no-no. We never stop abruptly or immediately. We always taper off.
Now, as far as administration, one question bank stresses the importance of Phenytoin with tube feedings, stating it can decrease the absorption as well as cause seizures. So, big keyword here: stop tube feedings 1 to 2 hours before and after administration. This was mentioned multiple times as a priority since tube feedings can interfere with the absorption and decrease Phenytoin effectiveness. So, guys, we always administer the medication correctly. So, for tube feedings, we flush with 30 to 50 mLs of tap water before and after the drug is given. And then normal saline is not required. So, tap water is okay.
Now, as far as IV administration, we always flush the IV with normal saline before and after giving this drug. Now, lastly, don't let the Enlex trick you here. So, here are three points that students usually get tripped up on. So, again, gums typically bleed, and that's to be expected because of the overgrowth of the gum tissue, but not the face. So, there's no need to use an electric shaver. And secondly, there's no metallic taste. That's typically for Metronidazole. 30% of students chose this as an expected side effect. And lastly, there's no photosensitivity. 50% of students wanted to think that Phenytoin caused photosensitivity and wear sunglasses outside. But guys, no, that's not the case here.
For everything you need to know to pass the Enlex, make sure to check out our Enlex review lecture series and live cram sessions.
Now, our second drug for anti-convulsants is Levetiracetam, given to prevent and treat seizures for those that are at high risk, like those following a brain tumor or surgery or trauma on the brain, which can increase intracranial pressure. This is often preferred over Phenytoin due to the minimal drug-drug interactions. Now, the big common side effects, like Phenytoin, it's a CNS depressant, so we get a low and slow body with drowsiness and fatigue.
Now, the major adverse effects, just like Phenytoin, we get the double S's here: suicidal thoughts and Stevens-Johnson syndrome. So, we report any keywords like new anxiety, new agitation, depression, or even mood changes. And for Stevens-Johnson, we report rash, blistering, and even muscle/joint pain, and even conjunctivitis.
Now, the big key point is for the patient teaching in terms of driving. So, we have to get permission from the HCP and follow transportation department guidelines since this drug can cause drowsiness and fatigue, which is common in the first 4 to 6 weeks when starting the medication. So, guys, don't let the Enlex trick you. Always be sure to get driving permissions.
Now, for the big cholinergics, we have Neostigmine and Pyridostigmine. These are given to patients with MG, Myasthenia Gravis. These clients get too dry and, in result, lack mobility and lack the strength to move since they have tons of muscle cramping. So, we call Myasthenia Gravis "dry-esthenia gravis" since the lack of strength and mobility, like a big weight, is weighing on them. Now, this is sort of like a Tin Man from The Wizard of Oz who needs to be lubed up to move. So, clients, in the same way, get so dry that they can't see, pee, spit, or poop, and even move. So, we basically get massive anticholinergic effects with Myasthenia Gravis, dry-esthenia.
So, with Neostigmine, this drug helps to lube up the body with secretions. So, the memory trick: just think "stigmine" or "stigmine secretions are mine" with the stigmines, and so the body gets super wet and wild. Now, the big side effect to note is this drug can work too well and add too much secretions with the stigmines, causing a huge flood of fluid inside the body. It's kind of like secretion faucets are held wide open. So, the patient gets wet and wild like a water park. Yoohoo!
Now, this is called a cholinergic crisis. Basically, crisis is a secretion crisis with a cholinergic crisis. We see lots of C, lots of P, lots of spit, and lots of poop. So, basically, an increase in pupil constriction. We get a lot of tears called lacrimation, salivation (we have drooling), and sweating (we have diaphoresis). And as far as poop, we get a lot of diarrhea and even some nausea and vomiting.
Now, to stop this cholinergic crisis and to turn off these secretions, we just give an anticholinergic. Just think "anti-secretion" with an anticholinergic. So, the antidote to know is Atropine, the most famous anticholinergic here. So, just think Atropine ends in "-tropine" or "-tropine." So, think you can't pee with the "-tropine." These anticholinergics work by turning off the PNS (the rest and digest) to stop the secretions and turn on the SNS (fight and flight), which makes the heart rate go crazy high.
Now, what did the HESI have to say about the stigmines? Well, the first thing they had to say was, "We anticipate the drug to treat this Myasthenia Gravis is Neostigmine." And secondly, "A patient being managed for myasthenic crisis develops asthma, we have to decrease or discontinue this Pyridostigmine." Now, you have to be thinking to yourself, "Why though?" Well, just think about the patho here. Asthmatics, we have bronchoconstriction, very tight lungs. The last thing we really want is wet and wild lungs. So, we want to turn off that faucet and discontinue the wet.
Now, the last two points that HESI mentions is, "A patient with anticholinergic toxicity, we give Physostigmine." So, it works both ways here. If we have too much dry with an Atropine, we give the wet secretions in the stigmines. Now, the last point here was, "Medication effectiveness of a stigmine." So, "Absence of muscle cramps and adequate vision without diplopia." So, just think of the main Tin Man from The Wizard of Oz. We want our patients to get lubed up and walk around without muscle cramps and have more movement, as well as correct vision here.
Now, the ATI had mentioned about adverse effects: "We get pupil constriction, difficult with visual accommodations, as well as Atropine is given for cholinergic crisis caused by excessive amounts of Neostigmine." And lastly, the Kaplan states that, "Client with Pyridostigmine having salivation, lacrimation, and urination, we notify the HCP since all these things scream a cholinergic crisis." So, all those secretions. So, guys, just remember for your exams, stigmines or stigmines cause too much secretions from all that cholinergic effects.
Now, let's start with the migraine medications. We have Sumatriptan, given to treat migraines and cluster headaches by causing vasoconstriction inside the cerebral blood vessels, basically the blood vessels in the brain. Now, you can probably already guess that vasoconstricting in the brain vessels can cause some serious, dangerous situations. So, with any drug, we always ask ourselves, "What's the worst-case scenario?" or basically, "What kills this patient first?" In this case, we're already thinking a clot in the brain, aka a stroke, or even a clot in the heart since it can cause vasoconstriction all over the body.
So, the big contraindication with Sumatriptan is we can't give it to patients with CAD (coronary artery disease) with already narrowed heart vessels, and we can't give it to uncontrolled hypertension due to the vasoconstriction properties. This could cause hypertensive crisis, angina, and even an MI. Now, the key point to write down is we screen for history of uncontrolled hypertension and we have to report it to the provider. Now, even ATI mentioned we have to teach the patient to report angina or coronary vasospasms. So, this medication again can cause constriction in the blood vessels, worsening hypertension and worsening angina.
Now, our second migraine drug is Ergotamine. Now, it works very similarly to Sumatriptan by constricting the cerebral blood vessels. So, once again, we see the same type of side effects here. So, ATI mentioned the indication is for migraine headaches, and we teach the patient to take one tablet immediately at the onset of headaches. And the HESI mentions the priority finding is pale extremities. So, that's really the biggest keyword there. Any type of pale body means we have a lack of perfusion. So, guys, just look at these keywords for the Enlex: so, pale body, lack of perfusion. In this case, it could be a clot from too much vasoconstriction. So, we have to instruct the patient to go seek medical attention immediately based on this finding.
Now, for the big Parkinson's drugs, we have Carbidopa and Levodopa. Guys, this is the number one drug to know for the neuro section, mentioned heavily in all the question banks. So, to simplify this immensely before diving into this drug, let's recap the pathophysiology real quick. So, Parkinson's disease, we have low dopamine and high acetylcholine with the formation of abnormal protein clusters called Lewy bodies in the brain. This results in clients getting jittery movements like muscle tremors, muscle rigidity, and a lot of slow start and stop motions like a shuffling gait and even pin-rolling of the fingers and other unsteady movements. These movements are known as bradykinesia.
So, the memory trick we use for Parkinson's: just think of a park in Parkinson's. Technically, there's "no dope" allowed in the park, like no drugs kind of allowed in the park. So, there's no dopamine in Parkinson's. And for the signs and symptoms, it's kind of like parking a car with Parkinson's for the first time. So, a lot of jittery movements, starting and stopping motions, like you're pushing the brake. "Brake-kinesia" for bradykinesia. So, just think, if you have low dopamine, this means low movement, and more dopa means more movement. That's why we say, "You can't jump rope if you don't got dope." Or you can think, "You want to jump rope? Well, you need to get more dope." So, we give Levodopa, which leaves the dopamine inside the brain, and Carbidopa, which prevents the breakdown of Levodopa, allowing the body to use it more. So, just say to yourself, "Carbidopa conserves more dopamine, and Levodopa leaves more dopamine in the brain."
Now, the HESI mentioned two things about Levodopa: "It's the main drug for Parkinson's treatment," and "It's a dopamine precursor." Now, for adverse effects, we get hallucinations known as psychosis, as well as orthostatic hypotension, that dizziness upon standing, resulting in falls. So, we have to teach our patients those slow position changes.
Now, as far as administration, we start at a low dose to prevent those big adverse effects. And since prolonged use can lead to toxicity, we have to start slow. Now, the first sign of toxicity is dyskinesia, which is spontaneous or involuntary movement, kind of like ticks. So, just think to yourself, if we got too much dopamine, we have too much movement here. So, we get face or eyelid twitching, even tongue protrusions, and face grimacing. We have to report this to the HCP since it's not normal. Typically, it means that the patient is toxic.
Now, for the key points for patient teaching: this drug has a slow onset, typically taking 2 to 6 weeks to become fully effective. So, typically, this is true for any type of drug that's acting on the brain. It starts slow. And the second thing is slow position changes from that orthostatic hypotension. And the last point here is red and brown urine, sweat, and saliva is completely normal. So, discoloration is normal. Huge Enlex tip there. This is completely normal and doesn't need to be reported to the HCP or provider.
Now, for the big no-nos that are not normal here. Big one to write down is no high-protein meals. That's the biggest Enlex tip. So, protein interferes with the absorption of Levodopa. So, just think, if you're on Levodopa and Carbidopa, you have to "leave the protein" with Levodopa and just "carve it up" with Carbidopa. Now, the second point here is not elimination of tremors or rigidity. We're only decreasing this. Big tip: So, as a general test strategy, no drugs acting on neurotransmitters in the brain, or even hormones for that matter, will ever 100% cure the patient. So, these typically are lifelong drugs. So, be very careful with words like "cure" or "eliminate." They usually indicate that this drug will 100% resolve the disease, which it does not. Now, lastly, we never stop abruptly. This could cause a crisis where we have complete loss of movement. So, remember, if the drug takes a few weeks to kick in, well then it takes a few weeks to taper off, too.
Now, here's an interesting side note to switch gears. MAOIs in combination with this drug actually enhance the effectiveness. So, the HESI mentions two things: "MAOI, the anti-depressant, enhances efficacy," basically effectiveness, and "Selegiline, an MAOI, is used in adjunct treatment with Carbidopa and Levodopa." Now, the last point here is, "How do you evaluate the medication effectiveness?" or basically, "How do we know the medication is working for the patient?" Again, just think here, "If you can jump rope, then you got enough dope." So, the keyword is "improvement in spontaneous movement." This indicates that it's effective for bradykinesia. And Kaplan mentioned, "Carbidopa and Levodopa medication is effective when the family member says, 'My husband can walk around the yard.'" And the second thing they mentioned was effectiveness: "The client is more ambulatory," or basically meaning they can walk around.
Now, lastly, don't let the Enlex trick you. This medication does not help with memory. Typically, that's Donepezil for Alzheimer's patients, but we'll cover that in a moment. So, again, to drive home the key points, the two biggest Enlex tips to know for your exams for Levodopa and Carbidopa: Remember, "leave the protein" with Levodopa since protein can block absorption, and "you can't jump rope if you got no dope." So, remember, more dopamine equals more improvement with movement.
Now, for anticholinergics, we have Benztropine and Atropine, given for a lot of different reasons, from speeding up the heart rate to turning off secretions in a cholinergic crisis. So, the big thing here is don't get tricked. Anticholinergics are "anti-secretions." We get really dry. So, just think "-tropines," we have "no P" with a "-tropine." So, all anticholinergics: we can't see, can't pee, can't spit, and can't poop. Cholinergics lead to more secretions. So, we get really wet, like stigmines, which we call "stigmines, the secretion drugs." So, guys, just remember those things and you won't get tricked.
Now, "-tropine" ending drugs are given to neurological patients mainly to treat the tremors, like with clients with Parkinson's where we have too much secretions from that acetylcholine, and it's even given to help tremors in extrapyramidal side effects, basically with antipsychotic medications. So, the keyword here is tremors. So, just think the "T" in "-tropines" we give to treat the "T" for tremors in neuro patients.
Now, the mechanism of action is pretty simple. It does this by drying up the body, kind of like flicking a light switch. It turns off the vagus nerve that's connected to the PNS, the parasympathetic nervous system (the rest and digest). So, we get no more secretions for that digestion and salivation. This allows the SNS, the sympathetic nervous system (our fight and flight), to be turned on in full force. So, again, we're turning off the PNS and turning on that SNS, that stress nervous system, that sympathetic nervous system, which activates the vital organs, shooting up the heart rate and making the body really dry. So, think you get real dry with a "-tropine." Or just say, "You can't pee with a "-tropine." It just puts your heart rate really high, like on top of a pine tree with a "-tropine."
Now, the keywords to focus on once again: it's given to treat those extrapyramidal side effects like dystonia and even Parkinson's tremors, like that bradykinesia, specifically muscle rigidity and shuffling gait. Remember, "-tropine" treats the tremors like bradykinesia and that dystonia, those abnormal movements of the face, neck, and trunk. Now, don't let the Enlex trick you here. No, it does not treat signs and symptoms of psychosis like delusions. We're only treating the tremors here. Again, the "T" and "-tropine." Just think "T" for tremor treatment.
Now, the next key points are for contraindications. We do not give anticholinergics to any client who's already dry or who has fluid retention, since this can make the condition worse. Now, one question bank stressed the important point: "When to give Atropine?" So, Atropine may precipitate acute glaucoma. So, clients with glaucoma, you have to notify the HCP, and we can't give it. And lastly, no BPH patients (benign prostatic hypertrophy) or even urinary retention patients. The most serious thing is we have to notify the HCP again for any urinary retention. So, the memory trick we use is BPH: a big prostate that holds back urine. No anticholinergics are given to these three patients.
Now, lastly, HESI mentions this in terms of patient teaching. So, first, teaching the patient to notify the HCP if you develop urinary retention. Secondly, this medication can reduce the ability to sweat, so don't overheat. And lastly, sit or stand up slowly to prevent that lightheadedness. So, guys, just remember here, once again, you get really dry with a "-tropine." So, no pee, no see, no spit, and no poop.
Want more tips and tricks to pass your exams? Join our Simple Nursing membership for exit prep lectures and access to over 8,000 questions built to take your studying to the next level.
Now, for osmotic diuretics, we have Mannitol, given to decrease cerebral edema with ICP (intracranial pressure), like with patients with head injuries and swelling in the brain with meningitis, and it's even given for increased ocular pressure for glaucoma emergencies. So, the memory trick we use is Mannitol. Think, "Man, it hurts," or "Man, ICP hurts in the head," or basically, "Man, my eyes hurt" for Mannitol.
So, the ATI mentions we give Mannitol for increased ICP and we assess the level of consciousness every hour. And the HESI mentions four key points for Mannitol: "It's used to decrease ICP." "For IV administration, it cannot be given PO." And "One of the main side effects is edema, which begins 30 to 60 minutes after administration." Okay, you're probably thinking, "Hold up here." This is really interesting. Why would a diuretic, which drains fluid from the body, why would it cause edema or fluid retention? Well, the mechanism of action is it works by draining fluid out of the cell into the vascular spaces. So, swollen brain cells that have all that pressure causing the ICP get drained. So, all that fluid gets drained into the blood vessels, which can put the body in fluid volume overload. This leads to classic heart failure signs and symptoms like peripheral edema (fluid in the extremities) and even pulmonary edema (fluid in the lungs). So, naturally, a big side effect is heart failure. So, think HF for heart failure. We get HF for "heavy fluid" all over the body.
Now, ATI mentions this when talking about Mannitol: "You monitor for signs and symptoms of heart failure, specifically basilar crackles," or basically crackles inside the bases of the lungs, as well as pulmonary edema (that fluid in the lungs). Now, that's why the patho is so important here. So, thanks for watching this entire video to understand all of it.
Now, the next drug class is neuromuscular blocking agents. We have Succinylcholine, and in this drug class, we also have two other drugs: Pancuronium and Rocuronium. But out of all of these, the big focus is on Succinylcholine. It was the only drug mentioned four times in different quiz banks. Now, these drugs are given to paralyze the body before ET tube intubation, as well as mechanical ventilation, typically for those who are difficult to intubate, like before general anesthesia or even in emergency situations. Now, the HESI mentions, "It is used to facilitate mechanical ventilation and it produces deep muscle relaxation." Now, those are big terms for exams and the Enlex.
Now, for the scary part. This drug only paralyzes the body but does not sedate the patient. So, patients are wide awake here. So, we have a huge risk for respiratory arrest since the diaphragm, that muscle that helps us breathe, is now paralyzed. And again, it only paralyzes the body. It does not sedate the brain. So, the patients can still feel pain. So, talk about a horror film. It's like being trapped in your own body during surgery. You can feel everything since you have no loss of consciousness. That's why we always have to sedate with a benzodiazepine while giving this drug. So, the HESI says, "We must give sedation," and "The primary result of this drug is flaccid paralysis, not loss of consciousness." So, it goes: sedation first, like Midazolam or benzo ending in "-pam" and "-lam," then Succinylcholine, and then third, immediate intubation.
Now, for the deadly adverse effects that are always on the Enlex and exit exams. Here we have malignant hyperthermia, better known as MH. This is a life-threatening muscle abnormality from general anesthesia or Succinylcholine. So, the patho is really simple here. Calcium is released from the muscles when anesthetic is administered, causing muscles to contract and become rigid. This increases oxygen demand and metabolism, which results in dangerously high body temperatures. Hence the name MH: malignant hyperthermia, very hot body. So, simply remember MH as the acronym: MH. M for muscle rigidity, and H for hot. The immediate intervention here is to notify the HCP first. Then, secondly, we administer or prepare to administer muscle relaxants like Dantrolene. And then, very last, we give oxygen and cooling measures. So, the HESI actually asked a question about this: "After administration of Succinylcholine, the patient experiences a high fever and muscle rigidity." The correct answer was to prepare IV Dantrolene. Now, 60% of the students got this question wrong. So, again, remember, we notify the HCP first. Then, we also prepare Dantrolene for malignant hyperthermia. And lastly, we use cooling measures.
Now, our last big key point comes in the perioperative nursing care. The biggest thing and the priority here is to screen for high-risk MH. So, three key points to write down: Prior reaction to general anesthesia is the most critical here. We want to know if the patient has had a reaction before we give the anesthesia. Secondly, blood relatives with significant reaction to general anesthesia usually means that the patient will have a reaction. And then lastly, alcoholics, as mentioned by the HESI, typically have a high risk for reacting in MH. Now, these are the priorities above all else for this drug. So, please commit these three to memory since these three came up multiple times on various question banks as the highest risk for that deadly malignant hyperthermia.
Let's dive into some top missed Enlex questions pulled straight from our Simple Nursing Enlex question bank, created by the experts who actually wrote the exam. So, first question here: "Which nursing actions are appropriate for the nurse preparing to administer Phenytoin via nasogastric or NG tube? Select all that apply." Okay, so before looking at the options, let's break this down. The question's asking the appropriate nursing actions when giving Phenytoin via that NG tube. The keyword there is NG tube or nasogastric tube. So, before looking at the options, we're just thinking of a few things we know about the drug. So, we know Phenytoin is "Pheny-toxic" since it lasts a long time to prevent seizures. And the NG tube, we have to flush with water before and after we give really any drug. And specifically for this drug, you have to stop feeding tube at least 1 to 2 hours before and after giving the medication. So, now for the options.
Option number one is correct. "We do hold tube feedings at least 1 hour prior to the administration of Phenytoin." So, the keyword there is holding at least an hour before and after giving.
Now, option two: "Flush the nasogastric tube with 30 mLs of tap water before and after administration." Yes, guys, we always flush with tap water before and after. Now, this one could have been tricky since some of you guys thought that sterile water is needed for an NG tube, which it's not. Tap water is perfectly fine.
Now, option three is incorrect. "Monitor the blood pressure and heart rate every 15 minutes for 2 hours after the administration." So, technically, no, this is not needed to monitor the hard stuff since it's a long-term medication. So, it takes a long time to kick in here.
Now, option four: "Monitor liver function tests on a regular basis for patients taking Phenytoin." Yes, Phenytoin is "Pheny-toxic." So, any toxic drug can be toxic to the liver.
Now, lastly, "Administer Phenytoin at the onset of new seizure activity." So, no, this is a long-acting drug. So, during seizures, we have to give a faster-acting drug like a benzo ending in "-pam" and "-lam," like Alprazolam.
Okay, next question: "Which adverse effects of Phenytoin should the nurse immediately report to the provider? Select all that apply." Okay, let's break this down. This question is asking for the adverse effects of Phenytoin to report immediately. So, this is a priority question. We're looking for the most deadly adverse effects here. So, before looking at the options, think, what do you know about Phenytoin, which we call "Pheny-toxic"? Well, the biggest thing is the therapeutic range: 20 is maximum, should be between 10 and 20. Second thing is the suicidal risk, as well as the rash, which obviously are not good. And the earliest signs of toxicity is ataxia and slurred speech. That inability to walk and talk with that "Pheny-toxic." You can't "Pheny-walk" it and you can't "Pheny-talk" it.
Okay, so option number one here, this one's correct. "New reports feeling of unsteadiness when ambulating," or basically walking around. Yes, the keyword there is "new" and "unsteady gait," which indicates ataxia or that difficulty walking.
Option two is also correct. "The appearance of a new rash on the patient's chest." Yes, any type of new rash. The keyword is we need to report this because it could be the deadly Stevens-Johnson syndrome.
Now, option three: "Report feelings of hopelessness and apathy." Yes, these are big risks for suicidal risk.
And the last two options are also correct here. "A morning Phenytoin level of 26 is technically toxic." Remember, the range is between 10 and a maximum of 20. And lastly, "Difficulty forming words or sentences." Yes, "Pheny-toxic" means "Pheny-talking." So, having difficulty forming words or sentences, or even slurred speech. This is an early sign of toxicity.
Now, the next question here: "The healthcare provider has prescribed four milligrams of Succinylcholine to be administered IV push during a rapid sequence intubation. Which is the nurse's priority action when preparing to administer this medication?" All right, that was a big question. So, let's break this down. The question's asking for priority action when giving Succinylcholine. So, since this question's asking for a priority action, we always have to think, "What kills the patient first?" So, before looking at the options, we're just thinking loss of life as well as loss of limb. So, we know that Succinylcholine, what kills the fastest is malignant hyperthermia. So, we have to screen for those three criteria: a prior reaction to general anesthesia, blood relatives with significant reaction to that general anesthesia, as well as alcoholics, as mentioned by the HESI. So,
Option number one is incorrect. "Check the patient's core body temperature." Guys, that's not the main priority here.
Now, option two is correct. "Ask the patient about a history of alcohol abuse." Yes, we always screen for alcoholism. The key is to anticipate the deadly malignant hyperthermia.
Now, option three was a little bit tricky. "Prepare a dose of Midazolam as prescribed for sedation." Now, this one's really close as a distractor. So, yes, we do give benzos for sedation, but it does not come before screening for those deadly adverse effects.
And option number four, also incorrect. "Ensuring a non-rebreather mask is at the bedside prior to administration." So, oxygen is not the biggest priority here when we're faced with deadly adverse effects.
Now, the last question here: "Which instructions should the nurse include in the plan of care for a patient newly prescribed Carbidopa and Levodopa for the treatment of Parkinson disease? Select all that apply." Okay, let's break this down. The question's asking for the plan of care for the key term "newly prescribed Carbidopa and Levodopa." So, before looking at the options, we're thinking a few things that we know about this drug. So, number one, Levodopa: we have to "leave the protein" since it decreases the absorption of this drug. And two, Levodopa "leaves more dopamine" inside the brain. So, the side note is any drug that acts on the neurotransmitters, the dopamine inside the brain, typically affects balance and typically takes a long time to kick in. So, now let's look at the options here.
Option number one: "If you don't notice improvements in your symptoms within one week, notify the provider." This is big time incorrect. Any drug that acts on the brain usually takes a few weeks. So, specifically Levodopa takes about 2 to 6 weeks to kick in, typically any neurotransmitter, guys. So, put that in your back pocket for the anti-depressant section.
Now, option two: "When going from sitting to standing position, be sure to change your position slowly." Yes, again, typically any brain drugs affecting balance, we have to do slow position changes.
And option three: "It's a good idea to remove any clutter from your home that could cause you to trip and fall." Well, of course. So, yes, it's correct. Preventing falls with Parkinson's, that unsteady gait, and those shuffling feet.
And option number four: "Call your provider if you notice your urine change to a slightly reddish color." This was pretty tricky, but no, it's incorrect. Colored urine is normal.
And lastly, option number five: "We avoid eating meals that contain large amounts of protein while taking this medication." Yes, this is correct. "Leave-a-dopa." You leave those high-protein meals.
Thanks for watching. Did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos? Plus, you'll get access to over 1,200 exclusive videos not on YouTube, all neatly organized by nursing school topic to make that complex nursing knowledge actually stick. You'll also gain thousands of practice questions written by current professors and actual Enlex writers. So, for access to all this and more, click right up here or visit simple nursing.com. And don't forget to subscribe to our YouTube channel. Happy studying, and we'll see you in the next videos.