★RN-ISPN Review ★ Nursing Considerations for Patients Receiving Mineralocorticoids
盐皮质激素使用者的护理考虑
Assessment: History and Examination 评估：病史与体检
l Assess for allergy to these drugs to avoid hypersensitivity reactions; history of heart failure, hypertension, or infections; high sodium intake; lactation; and pregnancy, which could be cautions or contraindications to use of the drug.
评估有无对这些药物过敏，避免超敏反应；心衰、高血压或感染史；高钠摄入；哺乳；妊娠，需要谨慎用药或禁用
l Assess blood pressure, pulse, and adventitious breath sounds; weight and temperature; tissue turgor; reflexes and bilateral grip strength; and serum electrolyte levels, to determine baseline status before beginning therapy and for any potential adverse effects.
评估血压、脉搏和呼吸附加音；体重和体温；组织膨胀；反射和双手握力；血清电解质水平，以确定治疗前基线状况及有无任何潜在不良效应
Nursing Diagnoses 护理诊断
Nursing diagnoses related to drug therapy might include the following:
与药物疗法有关的护理诊断可能包括如下：
l Imbalanced nutrition: More than body requirements related to metabolic changes
营养失调：多于身体需求，与代谢变化有关
l Excess fluid volume related to sodium retention
液体容量过剩，与钠潴留有关
l Impaired urinary elimination related to sodium retention
排尿受损，与钠潴留有关
l Deficient knowledge regarding drug therapy
知识缺乏，与药物疗法有关
Planning 护理计划
l The patient will receive the best therapeutic effect from the drug therapy.
患者将获得药物疗法的最佳效果
l The patient will have limited adverse effects to the drug therapy.
患者有有限的药物疗法不良效应
l The patient will have an understanding of the drug therapy, adverse effects to anticipate, and measures to relieve discomfort and improve safety.
患者发解药物疗法、预期的不良效应、缓解不适和提高安全性的措施
Implementation with Rationale 实施及说明
l Use only in conjunction with appropriate glucocorticoids to maintain control of electrolyte balance.
只与适当的糖皮质激素联用，维持电解质平衡的控制
l Increase dose in times of stress to prevent adrenal insufficiency and to meet increased demands for corticosteroids under stress.
应激时增加剂量，防止肾上腺功能减退，满足应激时皮质类固醇需求增加的需要
l Monitor for hypokalemia (weakness, serum electrolytes) to detect the loss early and treat appropriately.
监测有无低钾血症（无力、血清电解质），尽早发现丢失，适当治疗
l Discontinue if signs of overdose (excessive weight gain, edema, hypertension, cardiomegaly) occur to prevent the development of more severe toxicity.
若出现服药过量症状（体重增加过量、水胀、高血压、心脏扩大），停药，防止出现更严重的毒性
l Provide thorough patient teaching, including drug name, dosage, and administration; measures to avoid adverse effects; warning signs of problems; and the need for regular evaluation, including blood tests, to enhance patient knowledge about drug therapy and promote compliance.
l Monitor patient response to the drug (maintenance of electrolyte balance).
监测患者的药物反应（电解质平衡维持）
l Monitor for adverse effects (fluid retention, edema, hypokalemia, headache).
监测有无不良效应（液体潴留、水胀、低钾血症、头痛）
l Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and specific measures to avoid them).
评价宣教计划效果（患者能说出药名、剂量、需要留意的不良效应，具体的避免措施）
l Monitor effectiveness of comfort measures and compliance with the regimen.
监测舒适措施效果及治疗依从性
★Video ★
Mineralocorticoid Regulation and Effects
★Test ★
1. When caring for a patient with primary hyperaldosteronism, the nurse would question a physician's order for the use of?
A. Lasix
B. Amiloride (midamor)
C. Spironolactone (aldactone)
D. Aminoglutethimide (cytadren)
2. Hypo-activity of the layer of cells within the bracket would most likely result in:
A. Salt wasting due to insufficient production of mineralocorticoids (e.g. aldosterone).
B. Addison's disease due to insufficient production of glucocorticoids (e.g. cortisol).
C. High blood calcium levels (hypercalcemia).
D. Low blood calcium levels (hypocalcemia).
E. Low basal metabolic rate due to insufficient production of thyroxin (T4) and triiodothyronine (T3).
奥医教育“在线自测”题库
ISPN/RN复习练习、效果检验一站完成。
答案 Answers
1. A. Lasix Rationale: Hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Lasix is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis; amiloride is apotassium-sparing diuretic; and spironolactone blocks mineralocorticoid receptors in the kidney, increasing secretion of sodium and water and retention of potassium. 2. B. Addison's disease due to insufficient production of glucocorticoids (e.g. cortisol). Rationale: The cells indicated are in the zona fasciculata of the adrenal gland which are the primary source of glucocorticoids. Choice 'A' refers to cells of the zonal glomerulosa cells. Choice 'C' refers to HYPERactivity of the parathyroid gland. Choice 'D' refers to Hyperactivity of the parathyroid gland. Choice 'E refers to follicular cells of the thyroid gland.
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