Page 135 - Critical Care Nursing Demystified

120 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

All patients placed on thrombolytic therapy should have bleeding precautions
implemented like close observation of all invasive lines, minimizing venipunctures
for lab draws, preventing tissue trauma, and applying pressure after any invasive
procedures.

TABLE 3–10 Angiotension-Converting Enzyme Inhibitors and Angiotension II
Receptor Blockers
Drugs Action Use Precautions
ACE Inhibitors
Captopril Are part of the “Core First-line drug Contraindicated
(Capoten) Four” to improve patient used in slow- in allergy,
Enalapril outcomes in heart failure ing progres- angioedema,
(Vasotec) according to the Joint sion of heart hypotension
Commissionʼs (JACHO) failure hyperkalemia,
Lisinopril annual report 2007 renal artery
(Prinivil; Zestril) stenosis, and
Blocks conversion of
Quinapril angiotension I to angio- worsening renal Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
(Accupril) tension II, which leads to disease
vasodilation and
decreased vascular
resistance. Decreases
aldosterone secretion
and rids body of sodium
and water. Decreases
symptoms of heart failure
Angiotension II Receptor Blockers (ARBs)
Candesartan Blocks the attachment of Can be used Headache,
(Atacand) angiotension II to its as an alterna- dizziness, and
Losartan receptor resulting in tive in initial orthostatic
(Cozaar) vasodilation and diagnosis of hypotension.
decreased vascular heart failure if
Valsartan resistance. Decreases ACE inhibitors Watch for
(Diovan) aldosterone secretion cause intoler- angioedema and
acute renal
and rids body of sodium able side failure that are
and water. Decreases effects first-dose
symptoms of heart related.
failure

In hypertensive urgency there is no organ damage so the BP can be lowered
in the Emergency Department (ED) until the patient responds to treatment.