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For your response post, please address the following: After reading your peers’

by | Jun 21, 2022 | Pharmacology

 

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For your response post, please address the following:
After reading your peers’ scenarios they presented, please discuss the following:
the side effects of the medication in their scenario
educational pointers you would discuss with the patient prior to giving the medication
and any monitoring needed during the administration of the medication.
Cardiovascular Medications and Patient Scenario
There are currently a large amount of cardiovascular drugs that aid in managing or reducing the symptoms of hypertension, heart failure, atrial fibrillation and other cardiovascular diseases. In this discussion we will be discussing four commonly used drugs that are frequently administered by nurses within a hospital setting. For this discussion, I will be using the definitions from our textbook Lehn’s Pharmacology for Nursing Care. The four drugs included are diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers and vasodilators. Lehne’s Pharmacology definition of diuretics states, “ By reducing blood volume, these drugs can decrease venous pressure, arterial pressure (afterload), pulmonary edema, peripheral edema and cardiac dilation.” (Burchum & Rosenthal, 2019) This is completed by excreting the overload of fluid through urination. This will aid in patient’s symptom management which are commonly reported as shortness of breath or swelling of extremities. ACE inhibitors are the next drug class that Lehne defines as “ACE Inhibitors help by blocking the production of angiotensin II, decreasing the release of aldosterone, and suppressing the degradation of kinins.” (Burchum & Rosenthal, 2019) In doing this, it helps in relaxing blood vessels while helping decrease the workload of the heart muscles. These drugs are commonly paired with diuretics or other cardiovascular drugs. The next class of drug is calcium channel blockers which Lehne states “Calcium channel blockers are drugs that prevent calcium ions from entering cells.” (Burchum & Rosenthal, 2019) This is important as calcium entering the cells of smooth muscle aids in the function of contractility of the heart. Vasodilators act in different ways regarding dilation of arteries or veins. Lehne states “Some of these drugs act primarily on arterioles, some act primarily on veins, and some act on both types of vessels.” (Burchum & Rosenthal, 2019)
There have been many times in my med-surg unit where we receive patients from the ED or transfers from other units with symptoms of heart failure or exacerbation of heart failure. One of the most common medications on their list would be diuretics to help pull off excess fluid that attributes to their uncomfortable symptoms. While administering their medications, I often review medication parameters or simply ask the resident/attending for parameters as hypotension with diuretics is very common. After completing a set of vitals I will then use my nursing judgment to see if it is safe for the patient to take the ordered medication. This means I usually ask the patient if they are feeling specific symptoms with hypertension, the main concern being dizziness. After educating patients about hypotension symptoms and the medication they will be taking, I reassess the patient and ensure output is greater than input as well as review vital signs at a later time. Many times if the patient has a goal of diuresis and has other medications that may lower their blood pressure, I will have to notify the doctor in order to ask which they prefer the patient to have. If I am giving two medications to lower blood pressure this can cause more harm to the patient than good. If their goal is diuresis, they will likely have the nurse hold beta blockers, ACE inhibitors or vasodilators in order to have them complete their regimen of diuretics. It is very common to have a patient with heart failure have a baseline of low blood pressure and it becomes pertinent to ensure their baseline is safe enough to administer their ordered medications. If there seems to be a trend with vitals and medication regimen, it should be discussed with the primary team to consider medication changes or perhaps higher acuity floor with closer monitoring. An article in The European Journal of Heart Failure, it summarizes these key points by stating the following:
“From a pragmatic standpoint, the impact of hypotension must be assessed according to the vintage of treatment introduction: if hypotension occurs a few days after increasing the treatment dose, it is likely that treatment is the cause of hypotension. In contrast, when doses have been stable over a long period, other causes of hypotension should always be investigated (fever, diarrhoea, other new drugs, dehydration, etc.) rather than systematically and permanently decreasing treatment dose.” (Cautela & et al, 2020)
These are important things to remember when caring for patients with heart failure. Keeping these important indicators in mind will help in delivering safe and effective care for a patient while helping them learn signs and symptoms for a thorough discharge.

 

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