December 18, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
ACE inhibitors offer several advantages over most other antihypertensive drugs. ACE inhibitors do not interfere with cardiovascular reflexes. Hence, exercise capacity is not impaired and orthostatic hypotension is minimal.

December 17, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Inhibition of ACE can also cause hyperkalemia and fetal injury. Elevation of bradykinin causes vasodilation (secondary to increased production of prostaglandins and nitric oxide) and can promote cough and angioedema.

December 16, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
By reducing levels of angiotensin II, ACE inhibitors can dilate blood vessels, reduce blood volume and prevent or reverse pathologic changes in the heart and blood vessels mediated by angiotensin II and aldosterone.

December 15, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Angiotensin II acts in two ways to promote renal retention of water. First, by constricting renal blood vessels and thereby reduces glomerular filtration. Second, angiotensin II stimulates release of aldosterone from the adrenal cortex.

December 14, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
In RAAS, vasoconstriction occurs within minutes to hours of activating the system. In contrast, days, weeks, or even months are required for the kidney to raise blood pressure by increasing blood volume. 

December 13, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Factors that lower BP turn the RAAS on and factors that raise BP turn it off. The RAAS, acting through angiotensin II, raises blood pressure through two basic processes: vasoconstriction and renal retention of water and sodium.

December 12, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Reduced renal perfusion pressure is an especially important stimulus for renin release, and can occur in response to (1) stenosis of the renal arteries, (2) reduced blood pressure and (3) reduced plasma volume.

December 11, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Aldosterone acts on distal tubules of the kidney to cause retention of Na+ and excretion of K+. Because retention of Na+ causes water to be retained as well, aldosterone increases blood volume, which causes blood pressure to rise. 

December 10, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
In hypertension, angiotensin II may be responsible for increasing the thickness of blood vessel walls. In atherosclerosis, it may be responsible for thickening the intimal surface of blood vessels.

December 9, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Angiotensin II may cause pathologic structural changes in the heart and blood vessels. In the heart, it may cause hypertrophy (increased cardiac mass) and remodeling (redistribution of mass within the heart).

December 8, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Angiotensin II can cause vasoconstriction indirectly by acting on (1) sympathetic neurons to promote norepinephrine release, (2) the adrenal medulla to promote epinephrine release and (3) the CNS sympathetic outflow to blood vessels.

December 7, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Angiotensin II is a powerful vasoconstrictor and acts directly on vascular smooth muscle to cause contraction. Vasoconstriction is prominent in arterioles. As a result, angiotensin-induced vasoconstriction causes blood pressure rises.

December 6, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Severe respiratory alkalosis resulting from hysteria can be controlled by having the patient rebreathe his or her CO2-laden expired breath. This can be accomplished by holding a paper bag over the nose and mouth.

December 5, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
In most cases, metabolic alkalosis can be corrected by infusing a solution of sodium chloride plus potassium chloride. This facilitates renal excretion of bicarbonate, and thereby promotes normalization of plasma pH.

December 4, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Spironolactone is a steroid derivative with a structure similar to that of steroid hormones. As a result, spironolactone can cause a variety of endocrine effects including gynecomastia, menstrual irregularities, impotence and hirsutism.

December 3, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
The ability of thiazides to promote diuresis is dependent on kidney function. These drugs are ineffective when GFR is low (< 15 to 20 mL/min). Thiazides can't be used to promote fluid loss in patients with severe renal impairment.

December 2, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Hydrochlorothiazide promotes urine production in the distal convoluted tubule. Since only 10% of filtered sodium and chloride is normally reabsorbed at the site, the maximum urine flow is lower than with the high-ceiling drugs.

December 1, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
The principal difference between the thiazides and high-ceiling agents is that the maximum diuresis produced is considerably lower. In addition, loop diuretics can be effective even when urine flow is scant, thiazides can't do this. 

November 30, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Furosemide reduces high-density lipoprotein (HDL) cholesterol and raises low-density lipoprotein (LDL) cholesterol and triglycerides. These undesirable effects can increase the risk of coronary heart disease.

November 29, 2014

Nursing Tip of the Day! - Medical Surgical Nursing

Category: Medical Surgical Nursing 
Rarely, loop diuretics cause hearing impairment. With furosemide, deafness is transient. With ethacrynic acid (another loop diuretic), irreversible hearing loss may occur. The ability to impair hearing is unique to the high-ceiling agents.