Medical-surgical Nursing Demystified

CHAPTER 1 Cardiovascular System^37

• Smoking


• Dyslipidemia—elevated cholesterol, LDL, triglycerides, low HDL


• Diabetes


• Age greater than 60


• Men and postmenopausal females


• Family history
  Non-pharmacologic interventions are tried first, then medications are pre-
  scribed.

There is a four-step treatment plan:

• Step 1:
  
  
  • Lifestyle changes
  
  
  • Reduce caloric intake and exercise to reduce weight
  
  
  • Low-sodium diet
  
  
  • No smoking
  
  
  • Reduce alcohol intake
  
  
  • Reduce caffeine intake
  
  
  
  


• Step 2: Begin medication
  
  
  • Administer diuretics to reduce circulating blood volume:
    
    
    • furosemide, spironolactone, hydrochlorothazide, bumetanide
    
    
    
    
  
  
  • Beta-adrenergic blockers to lower heart rate and cardiac output:
    
    
    • propranolol, metroprolol, atenolol
    
    
    
    
  
  
  • Calcium channel blockers to cause peripheral vasodilation, less tachycardia:
    
    
    • verapamil, diltiazem, nicardipine
    
    
    
    
  
  
  • Administer ACE to inhibit the rennin angiotensin aldosterone system. In
    diabetes, ACE inhibitors also delay the progression of renal disease.
    
    
    • enalapril, lisinopril, benazepril, captopril, fosinopril, quinapril, perin-
      dopril
    
    
    
    
  
  
  
  


• Step 3:
  
  
  • Increase dosages of currently administered medication
  
  
  
  


• Step 4:
  
  
  • Combination of agents in above classes
  
  
  • Multiple drugs may be needed to control blood pressure