Question

List the nursing implications and education needs for each of the following categories of medication related to heart failure: o Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) o Beta-adrenergic receptor blockers o Diuretics o Positive inotrope agents o Sympathomimetic agents o Phosphodiesterase inhibitors

Answer 1

A. Angiotensin-converting enzyme(ACE) inhibitors and angiotensin receptor blockers(ARB)

Nursing implications

• Closely monitor patients blood pressure
• Monitor electrolytes because of the chance of hyperkalemia and hypotension
• ACE inhibitors have a risk of first-dose hypotension, therefore patients should be advised to sit or lie down for 2-4 hours

Patient teaching

• Teach patient to slowly from sitting or lying to minimize orthostatic hypotension
• Warn patient not to stop taking drugs abruptly.
• Advise patient to take sunlight precautions because photosensitivity may occur.
• Advice not to take excess alcohol, this can enhance the hypotensive effect.

B. Beta-adrenergic receptor blocker

Nursing implications

• Collect the complete health history of the patient
• Observe the daily intake and output of fluids. check body weight
• Monitor pulse and blood pressure prior to the administration of medicine. Report the physician if it is not in the normal range.
• Observe the hypoglycemic effect in diabetics patient

Patient teaching

• Inform diabetic patient to check blood glucose level often during therapy
• Inform patients not to stop the drug abruptly
• Advise patient to notify health practitioner if pulse rate Falls below 60 beats per minute
• Advice the patient to notify the health practitioner immediately if he has shortness of breath.

C. Diuretics

Nursing implications

• Monitor patients weight before and during therapy to obtain fluid loss
• Expect patient to have a periodic hearing test during prolonged or high dose IV therapy
• Monitor blood pressure and hepatic and renal function as appropriate
• Give drug in the morning so patients sleep won't be interrupted by the increased need to urinate
• Observe for the change in consciousness, dizziness, fatigue
• Monitor daily fluid intake

Patient teaching

• Advise patient to take diuretics at this same time each day to maintain therapeutic effect
• Advise patients to change position slowly to minimize orthostatic hypotension
• Advice them to take with meals
• Take potassium-containing diet if using loop or thiazide diuretics

D. Positive inotropic agents

Nursing implications

• Assess closely patients heart rate and blood pressure
• Obtaining baseline electrocardiogram of the patient and monitor rhythm changes
• Obtain a complete physical examination and health history to collect baseline data.
• Monitor serum electrolyte and renal function test frequently
• Auscultate heart sounds to note abnormal heart sounds and possible conduction problems.

Patient teaching

• Urge her to notify prescriber if pulse rate below 60 beats per minute
• Educate patients on drug therapy including drug name, dosage, action, adverse effects to promote adherence to therapy.
• Educate patients regarding the adverse effect of the drug, notify health practitioners, if anything is noted.