Nursing 211

N211: Health Differences Across the Lifespan I Hyperkalemia caused by discontinuing the diuretic & continuing the supplement may cause heart block and bradycardia because potassium is a cardiac depressant and it decreases the excitability of the heart. Malignant Hypertension Malignant hypertension, also known as hypertensive crisis, is when the blood pressure elevates rapidly and extremely, the heart, kidney and brain may be damaged. Clients require immediate hospitalization. When diastolic blood pressure is 115-130 mg Hg, client will complain of a severe occipital headache, abnormal neurological signs, seizure activity, and pulmonary edema. IV drugs include vasodilators such as Nipride, Hyperstat, Tridil, and Apresoline. Adrenergic inhibitors such as Aldomet (methyldopa) and Labetalol (Normodyne) can also be used. Nifedipine, a calcium channel blocker is not used due to the severe adverse risk of causing ischemia. Once the blood pressure falls, diuretics are used to continue water and sodium excretion. Nitroprusside dilates the arteries and veins, causing severe hypotension. Patients require hemodynamic monitoring via an intra-arterial line or electronically controlled cuff every five minutes, along with frequent blood pressure and pulse readings. Monitor hourly urine output readings. Monitor for adverse effects of the medications such as headaches, tachycardia, orthostatic hypotension, ventricular dysrhythmias from potassium depletion. Provide a safe environment in case of CNS complications, such as confusion, lethargy, visual disturbances. Nursing Interventions Weight loss if body mass index is >25, limit alcohol consumption to two drinks or less daily, limit sodium intake, stop smoking, reduce saturated fats and cholesterol; reduce or eliminate caffeine intake, and teach client stress reduction techniques. DASH diet (dietary approaches to hypertension diet) to include fruits, vegetables, low fat dairy and fiber with low saturated/total fat. Drugs/Diuretics Indications Adverse Reactions Nursing Interventions Thiazide Chlorthalidone (Hygroton) Hydrochlorothiazide (Microzide, Esidrix) Indapamide (Lozol) Metolazone (Zroxolyn) Decrease fluid volume Inexpensive Effective Used for severe hypertension Taken orally Hypokalemia s/s: dry mouth, thirst, weakness, drowsiness, muscle aches and tachycardia Hyperuricemia Glucose intolerance Sexual dysfunction Observe for postural hypotension Hypokalemia increases risk of digitalis toxicity Administer potassium supplements

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