• The gold standard diagnosis for VTE is using a venous duplex ultrasonography which is a non-

invasive test that may be performed at the bedside.

• The appropriate anatomical landmark to administer an intramuscular (IM) injection into the
client's vastus lateralis is locating the thigh's anterolateral aspect. It extends in an adult from a
handbreadth above the knee to a handbreadth below the greater trochanter of the femur. The nurse
should use the middle third for the injection. To help relax the muscle, ask the client to lie flat with the
knee slightly flexed and foot externally rotated or to assume a sitting position. IM injections are
administered at 90 degrees.

To administer an IM in the client's deltoid, it is located three finger widths below the acromion process.
The landmark for an IM administered ventrogluteal is just below the iliac crest on the side of the thigh.

• Isotonic fluids are used when providing fluid resuscitation to a client who sustained a major
burn. Thus, LR is an appropriate choice for treating the hypovolemia caused by the burn. The Parkland
formula (4 mL x client’s weight in kilograms x total body surface area burned) will determine the 24-hour
fluid requirement. An indwelling catheter is necessary to determine if the client is responding to the fluid
volume replacement. While weight is the gold standard in determining a client’s fluid status, urine
output should be monitored closely during acute fluid resuscitation.

• Doxycycline is an effective treatment for Lyme disease. Lyme disease is an infectious disease
caused by the Borrelia bacterium, spread by ticks. The most common sign of infection is an expanding
area of redness on the skin, known as erythema migrans, that appears at the tick bite site about a week
after it occurred. The rash is typically neither itchy nor painful. The rash is classically referred to as a
bullseye rash.

>>Doxycycline is a commonly used tetracycline antibiotic that effectively treats various bacterial
infections, including acne, pelvic inflammatory disease, and Lyme disease.

>>Because dairy products contain calcium, doxycycline should not be concomitantly administered with
milk. This also includes avoiding antacids containing calcium, aluminum, and magnesium. Doxycycline
intake and ingestion of these products must be separated by 2–3 hours.

>>Doxycycline is recommended to be taken on an empty stomach.

>>Oral contraception and doxycycline: Current literature suggests no evidence of increased

contraceptive failure when doxycycline is used concurrently with estrogen-containing oral
contraceptives. Older literature recommended additional birth control methods (e.g., barrier methods)
during concomitant use of estrogen-based oral contraceptives and doxycycline due to the theoretical risk
of decreased contraceptive effect. However, this theory remains unproven.

>>Pregnancy and breast-feeding: Doxycycline crosses the placenta and is excreted in breast milk—
doxycycline chelates with calcium in the bones and the teeth. If given to pregnant women, it may lead to
skeletal growth retardation and permanent teeth discoloration in the fetus. Doxycycline in breastfed
infants and children under eight causes permanent teeth discoloration, tooth enamel damage, skeletal
growth retardation, and photosensitivity. Therefore, it should be avoided in these populations.

• Disease-Modifying Anti Rheumatic Drugs (DMARDs) are indicated in the treatment of

Rheumatoid Arthritis. These medications primarily work by suppressing the immune system from
attacking the joint spaces. Drugs within this class include methotrexate and hydroxychloroquine.

Methotrexate may cause a client to develop pancytopenia (low red blood cells, white blood cells, and
platelets). During therapy, the client's blood counts will be monitored, and female clients should not
become pregnant because of the teratogenicity of this drug. Folic acid deficiency is common while a
client is taking the medication, and the client is encouraged to increase the intake of folic acid-rich foods
and supplemental folic acid.

• Calcitonin is a drug indicated for individuals with Paget’s disease and hypercalcemia. This drug
inhibits osteoclastic activity, therefore, increasing bone density. Allopurinol lowers uric acid and is
prescribed for Gout. Glucosamine is a supplement that some may use in the treatment of osteoarthritis.

Nifedipine is a calcium channel blocker indicated for the treatment of hypertension. It also may be used
as a tocolytic to mitigate preterm labor. Venlafaxine is a serotonergic drug used to manage depressive
and anxiety disorders. Prazosin is indicated for the treatment of hypertension as well as PTSD.

• ✓ A borderline personality disorder is about five times more common in first-degree biological
relatives with the same disorder compared with the general population

✓ This disorder is characterized by the individual having an unstable self-image, fear of rejection,
impulsivity, and emotional dysregulation

✓ A key intervention for a client with BPD is to assess for suicidality

✓ Parasuicide is common with this personality disorder; however, it is essential to keep this client safe

✓ Defense mechanisms commonly seen in this personality disorder include splitting, projective
identification, and denial

✓ Treatment is therapy, specifically dialectal behavioral therapy, which focuses on emotional regulation
and strategies to respond to stressors in a mature way

✓ No medication is approved to treat any personality disorder

• Glucocorticoids may cause potential mood changes such as overall mood lability. This may
encompass a client feeling euphoric, agitated, depressed, and anxious. Exposure to long-term
corticosteroids may cause an individual to develop leukopenia which may cause immunosuppression.
Weight gain is a common finding with corticosteroid use because of the retention of sodium which
causes the body to hold onto water.

✓ Corticosteroids may cause an array of adverse effects while they mitigate inflammation.

✓ This includes peptic ulcer disease, edema, hypokalemia, hyperglycemia, and hypernatremia.

✓ If not contraindicated, the client should be educated to maintain a low sodium and high potassium
diet while taking corticosteroids.