The Advanced Practice Nurse Is Updating The Plan Of Care

The Advanced Practice Nurse Is Updating The Plan Of Care Of Nursing Ho

The advanced practice nurse is updating the plan of care of nursing home patients with hypertension. Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs). What important teaching points should be addressed for patients receiving antihypertensive drugs? Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources.

Paper For Above instruction

Introduction

Hypertension remains a significant public health concern worldwide, particularly among elderly populations residing in nursing homes. Effective management requires a comprehensive understanding of the pharmacological agents used to control blood pressure and the corresponding patient education necessary to optimize therapeutic outcomes. Advanced practice nurses play a crucial role in updating and implementing individualized care plans that incorporate medication management alongside patient teaching, ensuring safe and effective blood pressure control.

Therapeutic Actions of Antihypertensive Drugs

The pharmacologic management of hypertension involves several classes of drugs, each exerting distinct mechanisms to lower blood pressure and reduce cardiovascular risk. These include diuretics, Angiotensin-Converting Enzyme (ACE) inhibitors, Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers (CCBs), and drugs that modulate the sympathetic nervous system.

Diuretics

Diuretics, particularly thiazide diuretics like hydrochlorothiazide, promote the excretion of sodium and water from the kidneys, leading to decreased plasma volume and reduced peripheral resistance (Williams et al., 2018). They are often first-line agents due to their efficacy, safety profile, and cost-effectiveness, especially in elderly populations.

ACE Inhibitors and ARBs

ACE inhibitors such as lisinopril and enalapril inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby inducing vasodilation and lowering blood pressure (Messerli et al., 2017). ARBs, like losartan, block angiotensin II receptors directly, preventing vasoconstriction and aldosterone-mediated sodium retention. Both classes are renal protective, especially beneficial in hypertensive patients with comorbidities such as diabetes.

Calcium Channel Blockers (CCBs)

CCBs, including amlodipine and diltiazem, inhibit calcium influx into vascular smooth muscle and cardiac myocytes, resulting in vasodilation and decreased myocardial contractility (Grimm et al., 2017). They are particularly useful in isolated systolic hypertension prevalent in older adults.

Sympathetic Nervous System Drugs

Agents impacting the sympathetic nervous system, such as beta-blockers (e.g., metoprolol) and centrally acting agents (e.g., clonidine), reduce sympathetic outflow, decrease heart rate, and diminish peripheral vascular resistance (Zhao et al., 2018). These drugs are usually reserved for specific indications like ischemic heart disease or in resistant hypertension cases.

Important Teaching Points for Patients Receiving Antihypertensive Drugs

Effective patient education enhances medication adherence and minimizes adverse effects. Key teaching points include:

  1. Medication adherence: Patients should understand the importance of taking medications regularly, at the prescribed times, and not skipping doses to achieve optimal blood pressure control.
  2. Potential side effects: Common adverse effects such as dry cough (ACE inhibitors), hyperkalemia (ACE inhibitors, ARBs), edema (CCBs), orthostatic hypotension, and fatigue should be explained, with guidance on when to seek medical attention.
  3. Monitoring blood pressure and side effects: Patients need instructions on home blood pressure monitoring and recognizing signs of hypotension or hypertensive crisis.
  4. Lifestyle modifications: Dietary modifications like reducing sodium intake, weight management, physical activity, and limiting alcohol and caffeine are crucial adjuncts.
  5. Drug interactions: Patients should be aware of potential interactions with over-the-counter medications, supplements, or herbal products that could affect blood pressure or cause adverse effects.
  6. Pregnancy considerations and special populations: For women of childbearing age and frail elderly, medication choices may need adjustments; counseling should reflect these nuances.

Conclusion

In summary, the pharmacological management of hypertension in nursing home patients involves a variety of drug classes, each with unique mechanisms. The advanced practice nurse must ensure comprehensive patient education addressing medication adherence, possible side effects, lifestyle modifications, and vigilant monitoring. Such holistic care promotes better health outcomes, reduces cardiovascular morbidity, and enhances the quality of life for hypertensive patients.

References

  • Grimm, R. H., Jr., Smith, D. H., & Laragh, J. H. (2017). Hypertension: pathophysiology, diagnosis, and management. Elsevier.
  • Messerli, F. H., Williams, B., & Ritz, E. (2017). The changing face of hypertension. The Lancet, 387(10022), 1218-1228. https://doi.org/10.1016/S0140-6736(15)00419-4
  • Zhao, L., et al. (2018). Sympathetic nervous system and hypertension: mechanisms and treatment. Hypertension Research, 41(10), 711-717. https://doi.org/10.1038/s41440-018-0057-z
  • Williams, B., Mancia, G., Spiering, W., et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021–3104. https://doi.org/10.1093/eurheartj/ehy339
  • Meyer, M., et al. (2020). Pharmacology of antihypertensive drugs: mechanisms and clinical application. Clinical Pharmacology & Therapeutics, 108(1), 23-34. https://doi.org/10.1002/cpt.1663

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