Watch Me Chase My Dreams

Multiple Sclerosis (MS) is a disease in which the immune system eats away at the protective covering of nerves.

In MS, resulting nerve damage disrupts communication between the brain and the body.

Multiple sclerosis causes many different symptoms, including vision loss, pain, fatigue, and impaired coordination. The symptoms, severity, and duration can vary from person to person. Some people may be symptom free most of their lives, while others can have severe chronic symptoms that never go away.

Examples:  lisinopril, enalapril, and captopril 

Action:  decreases peripheral vascular resistance to decrease blood pressure; indicated for heart failure and hypertension 

Side effects:  postural hypotension, dizziness, nonproductive cough, angioedema, kidney injury, and hyperkalemia

Nursing considerations:  (1) assess patient for history of renal impairment, as ACE inhibitors may exacerbate kidney injury; (2) teach patient to seek immediate medical attention if he/she experiences swelling of the lips (angioedema; as pictured), as severe angioedema may cause respiratory distress; (3) teach patient to notify HCP if a nagging cough develops

Also of note:  ACE inhibitors are contraindicated during second- and third-trimester pregnancies

My clinical experience:  

(1) Angioedema with ACE inhibitor use is quite common, especially with African Americans and may not manifest itself for months/years after starting an ACE inhibitor. 

(2) In light of acute kidney injury, doctors do often suspect fault with ACE Inhibitors and will hold/discontinue medications as appropriate. 

(3) A patient with a nonproductive cough, another common complication, although certainly not an immediate concern, will likely be switched to another class of medication. 

It is common to see “normal lab values” that differ slightly from what you see in your textbook or at the hospital. Laboratory reference values often vary among reference sources and are highly dependent on the analytic methods used.

The NCLEX will not ask you to identify lab values with only slight variations from the norm because of this widely-known fact! Instead, questions on lab values will be obviously “off” or else you will be told about an abnormal lab result and then tested on your understanding of the implications of that result: can you anticipate the manifestations, the risks associated with it, or how to intervene?

Don’t focus on memorizing every reference range, but do learn the ones that are likely to show up on the NCLEX.  The following labs are specifically listed on the detailed version of the NCLEX Test Blueprint:

• pH: 7.35 - 7.45

• PO2: 80 - 100

• SaO2: 95 - 100%

• HCO3: 21 - 28 mEq/L or 21 - 28 mmol/L

• BUN: 10-20 mg/dL or 3.6-7.1 mmol/L

• Creatinine 0.5-1.2  mg/dL or 44-106 µmol/L.

• Cholesterol (total): <200 mg/dL or <5.0 mmol/L

• Glucose: 70 - 110 mg/dL (fasting) and  ≥ 200 (casual) or  <6.1 mmol/L (fasting) or ≥ 11.1 mmol/L (casual).

• Critical glucose levels are <40 and >400 mg/dL or <2.22 and >22.2 mmol/L .

• Hematocrit: 37-52% or 0.37-0.52 volume fraction

• Hemoglobin: 12-18 g/dL or 120-180 mmol/L

• HbA1C: 4-5.9% (nondiabetic), < 7% (good diabetic control), > 9% (poor diabetic control)

• Platelets: 150,000-400,000/mm³ or 150-400 x10⁹/L.

• Potassium: 3.5-5.0 mEq/L or 3.5-5 mmol/L.

• Sodium: 136-145 mEq/L or 136/145 mmol/L.

• WBC: 5,000-10,000/mm³ or 5-10 x10⁹/L.

• Critical WBC: <2,000 or >40,000/mm³ or <2 or >40x10⁹/L.

• PT: 11-12.5 seconds (normal) or  ≥1.5-2 x control (with anticoagulant therapy)

• aPTT: 30-40 seconds (normal) or  ≥1.5-2.5 x control (with anticoagulant therapy)

• INR: 0.8 - 1.1 (normal) or 2 - 3 (for A - fib) or  3 - 4.5 (for prosthetic valves)

NCLEX Mastery provides lab reference ranges from Mosby’s, 5th Edition (2013) and Mosby’s Canadian (2012). In a few instances, SI ranges have been sourced from Stedman’s Online or conversions made from Mosby’s conventional values, calculated using the AMA Manual of Style SI Conversion Calculator.

For a complete lab resource, broken down by gender and age group, consult any of our nursing apps.

Wondering how to give handover to another midwife, doctor, colleague? Follow ISBAR and you can’t go wrong. At the same time always check through the documentation when receiving handover from someone else as they may have forgotten to include something!

My patients > your patients. 😂😂😂😂