Practical Nurse Refresher: Dosage Calculations, Side Effects, and Nursing Implications

RUNNING HEAD: PRACTICAL NURSE REFRESHER
Practical nurse refresher
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PRACTICAL NURSE REFRESHER
Scenario 1
1. What hormone would Eleanor be replacing?
Estrogen
2. Estrogen HRT
Estrogen affects the integrity of bones by inhibiting bone remodeling, preventing bone
resorption, and maintains the bone formation. As menopause kicks in, estrogen production by the
ovaries is reduced significantly, causing among others, a decline in bone mass density
(V.A.Levin X. Jiang, 2018). It leads to weakening of the bones which results in fractures
(Fitzpatrick, 2006). Estrogen signals via two receptors; Estrogen receptors alpha and beta
(nuclear receptors), which are predominant in cortical, and trabecular bones respectively.
Binding of estrogen to its receptors induces a conformational change that causes the formation of
receptor dimers, which bind to estrogen response elements in the genome and induce
transcription of target genes. Estrogen is also able to induce apoptosis of osteoclasts (cells that
break down bones, and are responsible for bone resorption), and inhibit apoptosis of osteoblasts
(cells that produce the matrix for bone formation), by increasing the phosphorylation of two
cytoplasmic receptors; ERK1, and ERK2, which then travel to the nucleus to effect the response
(M. Neale Weitzmann, 2006)
The common side effects of estrogen HRT (M. Neale Weitzmann, 2006).
• Bloating, where one’s abdomen feels distended, as a result of the accumulation of gases in the
belly.
• Nausea.

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PRACTICAL NURSE REFRESHER
• Headaches.
• Breast tenderness and swelling.
• Indigestion.
• Leg cramps.
Life-threatening adverse effects of estrogen HRT (Jane Marjoribanks, 2017).
• Increased possibility of deep vein thrombosis, and pulmonary embolus, especially in women
with a history of these illnesses in their families.
• Endometrial cancer, in women with the uterus. Estrogen can stimulate the growth, and
• proliferation of residual cancer cells lining the uterine wall, leading to recurrence.
• Increased risk of breast cancer
• Abnormal vaginal bleeding
• Increased risk of a heart attack in both the women suffering from heart disease and those who
do not have any known heart disease.
Contraindications of estrogen HRT.
Administration of HRT to women with a history of breast cancer, chorionic heart disease,
thromboembolic event, or stroke, ongoing liver disease, history of endometrial cancer, transient
ischemic attack, and abnormal vaginal bleeding is highly unadvisable. Women with active
gallbladder disease and hypertriglyceridemia are advised not to undergo hormone replacement
therapy (Jane Marjoribanks, 2017).

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PRACTICAL NURSE REFRESHER
3. (a) Calcium
Calcium signaling is important for bone remodeling. Oral calcium administration supplements
the body’s calcium content (stored in the endoplasmic reticulum) that helps to reverse
osteoporosis. Release of calcium by the endoplasmic reticulum(ER) triggers Ca2+ signaling.
Ca2+ bind to calmodulin, to form a Ca2+ /calmodulin complex that targets, and binds the
calmodulin-depended kinase II (CaMKII) phosphorylating it. The now active CaMKII activates
CREB/ATF and ERK signaling pathways, which induce changes in osteoblast functions.
CaMKII can also bind to another class of proteins called calcineurin, which then “binds to, and
dephosphorylates the NFAT transcription factors that regulate osteoblast differentiation”
(Jianwei LI, 2019).
Common side effects of using oral calcium include;
• Constipation, and stomach upsets.
• Nausea/vomiting
• Loss of appetite
• Weight loss
• Bone/ muscle pain
• Increased thirst/ urination
• Weakness and unusual tiredness (Jianwei Li, 2019).
Life-threatening adverse effects of oral calcium
• High risk of myocardial infarction (Jianwei Li, 2019).