October 22, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Dobutamine, a synthetic analog of dopamine, is a competitive β-adrenergic stimulating agent (β1 > β2 > α). Its major characteristic is a potent inotropic effect. However, its β2 stimulatory effect may lead to hypotension.

October 21, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In patients with acute heart failure, the high central venous pressure impairs renal function. Urine output must be closely monitored. Diuretics, by relieving elevated central venous pressure, help preserve renal function.

October 20, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In acute heart failure the symptom of shortness of breath is often related to high left atrial pressure. Treatment is aimed at reduction of left atrial pressure (preload). Diuretics, nitrates, and possibly morphine (antianxiolytic) are used.

October 19, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
As for all the ARBs, the major antihypertensive effect is present within 1 week. The full effect may take up to 3-6 weeks, and is potentiated by diuretic action or low-salt diet more than by dose increase.

October 18, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
ACE inhibitors act on the enzyme that generates angiotensin II and mediates the breakdown of bradykinin, whereas the ARBs act directly by blocking the major angiotensin II receptor subtype 1 that responds to angiotensin II stimulation.

October 17, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
During diuretic therapy in edematous states, overvigorous diuresis is common and may reduce intravascular volume and ventricular filling so that the cardiac output drops and tissues become underperfused.

October 16, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Most diuretics decrease urate excretion with the risk of increasing blood uric acid, causing gout in those predisposed. Dose reduction is essential to avoid serious reactions, which are dose-related and can be fatal.

October 15, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The chief side effects of furosemide, in addition to hypokalemia, are hypovolemia and hyperuricemia. In pregnancy, furosemide is classified as Category C. In nursing mothers, furosemide is excreted in the milk.

October 14, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Furosemide’s short duration of action (4-5 hours) means that frequent doses are needed when sustained diuresis is required. Twice-daily doses should be given in the early morning and midafternoon to obviate nocturia.

October 13, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Furosemide is a loop diuretic used for congestive heart failure, pulmonary edema and pulmonary congestion. Relief of dyspnea even before diuresis results from venodilation and preload reduction.

October 12, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The three major groups of diuretics are the loop diuretics, the thiazides, and the potassium-sparing agents. Aquaretics constitute a recent fourth. Each type of diuretic acts at a different site of the nephron.

October 11, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
CCBs “block” the entry of calcium through the calcium channel in both smooth muscle and myocardium, so that less calcium is available to the contractile apparatus. The result is vasodilation and a negative inotropic effect.

October 10, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The most important property of all calcium channel blockers is to selectively inhibit the inward flow of charge-bearing calcium ions when the calcium channel becomes permeable. Calcium channel blockers are contraindicated in heart failure.

October 9, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Calcium channel blockers are chemically classified into the dihydropyridines (DHPs) and the non-DHPs, their common pharmacologic property being inhibition of L-type channel opening in vascular smooth muscle and in the myocardium.

October 8, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Calcium channel blockers (CCBs, calcium antagonists) act chiefly by vasodilation and reduction of the peripheral vascular resistance. They remain among the most commonly used agents for hypertension and angina.

October 7, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
β-blockade and nitrates are often combined in the therapy of angina. Both β-blockers and nitrates decrease the oxygen demand, and nitrates increase the oxygen supply. β-blockers block the tachycardia caused by nitrates.

October 6, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Both short- and long-acting nitrates are used as unloading agents in the relief of symptoms in acute and chronic heart failure. Their dilating effects are more pronounced on veins than on arterioles.

October 5, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
When angina starts, the patient should rest in the sitting position (standing promotes syncope, lying enhances venous return and heart work) and take sublingual nitroglycerin every 5 minutes until the pain goes away or maximum dose reached.

October 4, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Sublingual nitroglycerin is very well established in the initial therapy of angina of effort, yet may be ineffective, frequently because the patient has not received proper instruction or because of severe headaches.