N-Trivia

December 2010 Nursing Board Exam Room Assignments (Baguio-Cabanatuan-Dagupan-La Union-Vigan)
Romberg Test
Acetazolamide – Drug Study
Plantar and palmar hyperhidrosis

December 2010 Nursing Board Exam Room Assignments (Baguio-Cabanatuan-Dagupan-La Union-Vigan)

Posted: 30 Nov 2010 07:23 PM PST

The Professional Regulation Commission (PRC) announces the availability of the room assignments for the upcoming December 2010 Nursing Board Exam (NLE) .

These room assignments are for December 2010 NLE takers in Baguio, Cabanatuan, Dagupan, La Union and Vigan.

Source: PRC Baguio

Romberg Test

Posted: 30 Nov 2010 06:04 PM PST

Definition and Purpose of the Test

Romberg test is a screening measurement of the body's sense of positioning or balance. A good balance requires a healthy function of spinal cord's dorsal columns. This test is used by doctors in a neurological examination.

Body Balance

Cerebellar influence on the motor system is reflected in the balance control and coordination. A person needs at least two of the three senses to maintain balance when standing:

Proprioception
Sensation
Vision

Proprioception is the unconscious perception of movement and the ability to know one's body in a space. Sensation is the ability of a person to feel pressure, touch or vibration. Vision is the ability to see which is helpful in monitoring changes in balance.

Balance of a person is made possible even though one sense is absent. For example a person without the spatial orientation arising from stimuli within the body itself can still maintain balance with the use of the ability to see and ability to feel touch, pressure or vibration. If a person has a loss of balance a positive Romberg sign is interpreted.

Equipments

Watch

Spacious room

Procedure

Ask the client to stand erect with feet together and arms at the side, first with eyes open then with both eyes closed for one full minute (some books state 20-30 seconds only).
The examiner should stand near the client as a precaution to stop the client from falling over and assure the client that he or she will be supported if he or she begins to fall. A strong assistant is recommended for large subjects or clients. The examiner should stand ready to catch the client who has the risk of falling.
The client with balance problem becomes more unsteady with his or her eyes closed.
Watch the movement of the client's body. A slight swaying is normal. A positive Romberg sign is noted when irregular swaying and toppling (falling over) occurs when the eyes are closed.

The first step of the procedure demonstrates that at least two of the three senses to maintain balance are intact or present. This is demonstrated by a good balance with the eyes open at the beginning of the test. The vision is removed in the next step by instructing the subject to close his or her eyes. If the other two senses of maintaining balance (proprioception and sensation) are intact the client will not fall. If prioception is defective, expect the client to sway irregularly and fall or topple.

Acetazolamide – Drug Study

Posted: 30 Nov 2010 06:02 PM PST

Generic Name: Acetazolamide

Brand Name: Diamox, Dazamide, Diamox Sequels, Storzolamide, Acetazolam, Apo-Acetazolamide

Pharmacologic Classification: Carbonic Anhydrase Inhibitor

Therapeutic Classification: antiglaucoma, diuretics, ocular hypotensive agents, anticonvulsants

Indications

Glaucoma (lowers intraocular pressure in the treatment of glaucoma)
Epilepsy
Congestive heart failure
Drug-induced edema
Altitude sickness (mountain sickness)

Mechanisms of Action

Acetazolamide is an enzyme inhibitor that acts particularly on carbonic anhydrase. Carbonic anhydrase is the enzyme that converts carbon dioxide and water to carbonic acid (H2CO3). Carbonic anhydrase inhibitors, such as Acetazolamide inhibits carbonic anhydrase in the tissues and fluid thus, decreasing carbonic acid in the body.

In the eye, the inhibitory action of Acetazolamide decreases the secretion of aqueous humor that lowers the intraocular pressure which is desirable in glaucoma. In the central nervous system (CNS), restrained carbonic anhydrase retards the abnormal and paroxysmal excessive discharge from the neurons of CNS.

In the kidneys, carbonic acid is excreted due to the inhibited carbonic anhydrase function. The result is renal loss of bicarbonate which carries out sodium, potassium and water. Alkalinization of urine and diuresis then takes place.

Contraindications

Hypersensitivity to carbonic anhydrase inhibitor
Hypersensitivity to sulfonamides
Depressed levels of serum potassium and sodium
Marked kidney and liver disease
Suprarenal grand failure
Hyperchloremic disease
First trimester of pregnancy
Concurrent use of ophthalmic carbonic anhydrase inhibitors (brinzolamide, dorzolamide)
Adrenal gland failure (Addison's disease)
Sickle cell anemia
Chronic non-congestive glaucoma

Use cautiously in

Chronic respiratory disease
Diabetes Mellitus
Second or third trimester of pregnancy
Lactation
History of kidney stones

Adverse Reactions and Side Effects

Depression
Tiredness
Body malaise
Drowsiness and confusion
Transient nearsightedness
Anorexia
Metallic taste
Nausea and vomiting
Crystalluria
Renal calculi
Rashes
Hyperglycemia
Hyperchloremic acidosis
Hypokalemia
Aplastic anemia
Hemolytic anemia
Leucopenia
Weight loss
Paresthesias
Tingling feeling of the extremities
Polyuria
Polydipsia
Blushing
Headache
Irritability
Photosensitivity (rare)

Occasional adverse reactions:

Urticaria
Melena
Hematuria
Glycosuria
Hepatic insufficiency
Flaccid paralysis

During long-term therapy, an acidotic state may occasionally appear. This can managed or corrected by the administration of bicarbonate.

Dosage and Route

PO (adults)

Glaucoma: 250-1000 mg/day in 1-4 divided doses (up to 250 mg every 4 hours)

Epilepsy: 4-30 mg/kg/day in 1-4 divided doses

Altitude sickness: 250 mg 2-4 times a day started 24-48 hours before ascent, continued for 48 hours or longer to control symptoms.

PO (Children)

Glaucoma: 8-30 mg/kg/day in 3 divided doses

IM, IV (Adults): 250-500 mg, may repeat in 2-4 hours

IM, IV (children): 5-10 mg/kg every 6 hours

Nursing Management

1. Monitor individuals taking acetazolamide with primidone and carbamazepine. Acetazolamide may increase the blood levels of carbamazepine and quinidine and may decrease the blood levels of primidone.
Instruct the patient to avoid taking aspirin with Acetazolamide. Increase in side effects such as drowsiness, confusion, lethargy, hyperventilation and ringing in the ears when acetazolamide is taken with aspirin.
Monitor electrolyte levels.

Plantar and palmar hyperhidrosis

Posted: 30 Nov 2010 05:57 PM PST

Palmar Hyperhidrosis

This is a local hyperhidrosis that pertains to occurrence that only happens in one area specifically the hands and often called “sweaty palms”.

Plantar Hyperhidrosis

This is sweating that occurs in the feet in which people with palmar hyperhidrosis may also be affected. Fungal infections and shoe problems such as fitting of it can be common problems faced by people with this condition.

Signs and symptoms:

Perspiration can be either between mild coldness of the hands or feet up to episodes of dripping of sweat.
Peeling or sloughing off of the affected area.
Episodes of excessive wetness then followed by an episode of dryness can occur

Types and Causes:

1. Primary Hyperhidrosis

This means that there is no obvious cause of the excessive sweating episodes. Hereditary tendencies, emotional extremes such as anxiety, fear or excitement can affect this.

2. Secondary Hyperhidrosis

This means that there is a known cause of the excessive sweating:

hormonal causes (diabetes, hyperthyroidism, thyrotoxicosis, menstruation, menopause)
metabolic disorders, malignant disease (lymphoma, pheochromocitoma)
autoimmune disorders (rheumatoid arthritis, systemic lupus erythrematosus)
drugs like hypertensive drugs and certain classes of antidepressants
chronic use of alcohol,
Parkinson's disease
neurological disorders (toxic neuropathy)
homocystinuria
plasma cell disorders.

Conservative Management:

Psychological counseling can be applies of the cause of sweating is emotional in nature.
Smoking and consumption of caffeine-rich substances can worsen the condition
Minimize exposure to places such as high temperature and activities that needs intense energy consumption
Avoid consumption of alcohol and caffeine rich can lessen the occurrence of excessive sweating
Use anti-perspirant compounds such as aluminum chloride and aluminum sesquichlorohydrate foam can reduce the perspiration in that area

Treatment:

Anticholinergic drugs are used as they target the excessive activity of the sympathetic nervous system
Ionophoresis reduces sweat glands by using a small electric charger to deliver medications
Botulinum injections (Botox) are also used to paralyze the nerve endings
Endoscopic transthoracic sympathectomy done if the medications or conservative treatments are note effective. Sympathethic nerves are operated to stop the conduction of the nerve fibers to the sweat glands thus hindering it to overly function.

Nursing Management:

Accept the client as what they are since they are affected by embarrassments or shyness about the condition.
Encourage to use clothes or socks made of cotton since it prevents accumulation of odor.
Emphasize the need use of handkerchief to allow absorption of the sweat.
Listen to the client as he or she voices out the feeling of uneasiness and discomfort during handshaking and other things that involves seeing their condition.
Emphasize the compliance to recommended management and hygienic measures.

Photo credits: www.health.howstuffworks.com