Key Drugs: Diuretics - hydrochlorathiazide (Hydrodiuril)
Beta Blockers - Propranolol (Inderal)
Centrally Acting Adrenergic Inhibitors - clonidine hydrochloride (Catapres)
Alpha Adrenergic Blocking Agents - prazosin hydrochloride (Minipress)
Angiotensin Converting Enzyme Inhibitors - captopril (Capoten)
Calcium Channel Blockers nifedipine (Procardia)
hydralazine hydrochloride (Apresoline)
sodium nitroprusside (Nipride)
B. Antihypertensive therapy
2. Special Considerations
b. Sexual dysfunction - loss of libido, impotence
c. Surgical clients - resume antihypertensive medications as soon as possible after surgery
d. Children - goal - to reduce blood pressure without adverse effects that limit compliance or growth and development.
e. Elderly - monitor closely
f. Chronic illness - Careful selection and monitoring
of antihypertensive agents necessary.
eg. beta blockers may increase lipid levels
3. Nursing Management
2. Diabetes mellitus - may need to alter dosage of hypoglycemic agent
3. Monitor I/O, daily wt., assess for edema
4. Check for K+ level
5. Check for allergy to sulfonamides
Nut: N/V, anorexia,
Neuro: Drowsiness, lethargy, dizziness
2. Administer in am to promote night sleep
3. May give with food or milk
4. Monitor for fluid/electrolyte imbalance.
2. Lose weight, exercise, stress management
3. Change position slowly
4. Diet high in potassium
5. Report muscle weakness, cramps, nausea, and dizziness to doctor.
6. Use sunscreen - photosensitivity
2. Decreased edema
3. Decreased B/P
4. Weight loss
b. Centrally Acting Adrenergic Inhibitors
2. Watch for orthostatic hypotension especially in elderly.
3. Transdermal dosage form - assess skin
b. Weight daily 3-4 days as Na++/H2O retention may be a problem.
b. Do not stop abruptly - rebound hypertension
2. Discuss abrupt withdrawal including sequential doses - HTN crisis can occur in 8-24 hours
3. Instruct client to take last dose before bedtime to ensure continuous blood pressure control during night and reduce daytime drowsiness if taking oral form of drug.
4. Avoid alcohol, prolonged standing, and exercising.
5. Side effects - dry mouth, constipation, impotence, drowsiness, withdrawal phenomena
6. Periodic eye examinations to avoid possible retinal degeneration
2. Blod pressure will stay within normal limits.
d. Alpha Adrenergic Blocking Agents - prazosin hydrochloride
b. Nursing Management
b. Check if individual has condition aggravated by renal failure
c. Take blood pressure for baseline reading
hyperkalemia, nausea, HA, skin rash, joint pain, proteinuria.
2. Monitor for neutropenia/agranulocytosis
2. Administer 1 hour before meals to enhance absorption.
3. Clients with renal disease - will increase BUN and Cr.
b. Discuss side effects and what to report to doctor.
c. Report signs of infection or bleeding stat.
d. Do not use salt substitutes as they usually are high in K+
2. Nursing Diagnoses
Altered mucosal membrane - Gingivitis/gingival hyperplasia
Altered comfort - Skin rash , Flushing , Dizziness , HA
Altered elimination - Constipation
Altered cardiac output - hypotension ,
Fluid volume excess - edema ,
PC: CARDIAC ARREST
2. Observe for heart failure
3. Check for hepatic/renal studies
2. Hold if pulse below 50.
3. Meticulous mouth care.
Protection: drug-induced lupus syndrome
Fluid/Elect: sodium retention
Neuro: peripheral neuritis
b. Check CBC, LE cell prep and ANA lab studies
2. Drug tolerance may develop so keep appointments with doctor
3. Orthostatic hypotension - change position slowly
4. Inform that palpitations/HA may occur during early stages of therapy.
5. Report signs of peripheral neuritis
Check for edema
Observe mental status - cerebral ischemia especially if
history of CVA