nonblack – a. 非黑人的
ARB – angiotensin receptor blocker血管紧张素受体阻断剂
thiazide-type diuretic – 噻嗪类利尿剂
labetalol – n. 拉贝洛尔
Normodyne – n. 盐酸拉贝洛尔
Dietary Approaches to Stop Hypertension (DASH) -- 控制高血压饮食治疗
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Treatment Goals of Hypertension 高血压治疗目标
General population 60 years or older: <150/<90
60岁以上普通人群：<150/<90
General population under 60 years: <140/<90
60岁以下普通人群：<140/<90
Patients 18 years or older with chronic kidney disease: <140/<90
18岁或以上的慢性肾病患者：<140/<90
Patients 18 years or older with diabetes: <140/<90
18岁及以上的糖尿病患者：<140/<90
Nonblack patients, including diabetics: Initiate treatment with a thiazide diuretic, then calcium-channel blocker, ACE inhibitor, ARB.
非黑人患者，包括糖尿病人：起始治疗采用噻嗪类利尿剂；然后采用钙通道阻滞剂、ACE抑制剂、ARB（血管紧张素受体阻断剂）。
Black patients, including diabetics: Initiate treatment with thiazide diuretic or calcium-channel blocker.
黑人患者，包括糖尿病人：起始治疗采用噻嗪类利尿剂或钙通道阻滞剂。
Patients 18 years or older with chronic kidney disease: Initiate treatment with an ACE inhibitor or ARB.
有慢性肾病的18岁及以上患者：起始治疗采用ACE抑制剂或ARB。
The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, the clinician should increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, calcium-channel blocker, ACE inhibitor, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with two drugs, a third drug from the list provided should be added and titrated. An ACEI and an ARB should not be used together in the same patient. If goal BP cannot be reached using only the drugs recommended or a contraindication or the need to use more than three drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed.
★Tests ★ 1. After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take?
A. Encourage oral fluids to prevent dry mouth or dehydration.
B. Instruct the patient to ask for help if heart palpitations occur.
C. Ask the patient to request assistance when getting out of bed.
D. Teach the patient that headaches may occur with this medication.
2. After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?
A. The patient avoids eating nuts or nut butters.
B. The patient restricts intake of dietary protein.
C. The patient has only one cup of coffee in the morning.
D. The patient has a glass of low-fat milk with each meal.
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答案 Answer
1. C. Ask the patient to request assistance when getting out of bed Rationale: Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives. 2. D. The patient has a glass of low-fat milk with each meal. Rationale: The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.
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