stepped – a. 有步骤的
lifestyle modification -- 改变生活方式
Smoking cessation -- 戒烟
blood volume -- 血容量
combined effect – 协同效应，联合作用
fixed combination drug – 复合药物
nitroprusside – n. 硝普钠
Nipride – n. 硝普钠制剂商品名
“RN-ISPN考试复习要点提示”
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——————RN/ISPN Review ——————
Stepped Care Approach to Treating Hypertension
高血压治疗步骤
The importance of treating hypertension has been proven in numerous research studies. If hypertension is controlled the patient’s risk for CV death and disease is reduced. The risk for developing CV complications is directly related to the patient’s degree of hypertension. Lowering the degree of hypertension lowers the risk.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension, from the National Institutes of Health, established a stepped care approach to treating hypertension that has proved effective in national studies. It is still the basis for good patient care when it comes to treating hypertension.
Step 1: Lifestyle Modifications Are Instituted
步骤1：改变生活方式
Weight reduction 减轻体重
Smoking cessation 戒烟
Moderation of alcohol intake 减少饮酒
Reduction of salt in diet 减少饮食用盐
Increase in physical activity 增加体育活动
Step 2: Inadequate Response
步骤2：治疗不充分时
Continue lifestyle modifications. If measures in step 1 are not sufficient to lower BP to an acceptable level, then drug therapy is added:
继续改变生活方式。如果步骤1不足以使BP降到可接受程度，则增加药物疗法：
Diuretic (decreases serum sodium levels and blood volume)
利尿剂（降低血清钠水平和血容量）
ACE inhibitor (blocks the conversion of angiotensin I to angiotensin II)
ACE抑制剂（阻断血管紧张素I转化为血管紧张素II）
Calcium-channel blocker (which relaxes muscle contraction) or other autonomic blockers
钙通道阻滞剂（松弛肌肉收缩）或其他自主神经系统阻滞剂
Angiotensin II receptor blocker (blocks the effects of angiotensin on the blood vessel)
血管紧张素II受体阻滞剂（阻断血管紧张互对血管的效应）
Step 3: Inadequate Response
步骤3：治疗不充分时
Consider change in drug dose or class, or addition of another drug for combined effect. (Note: Fixed combination drugs should only be used when the patient has been stabilized on each drug separately.)
考虑改变药物剂量或药物类别，或增加药物以获得协同效应。（注意：只有在患者每种药物稳定情况下才可使用复合药物）
Step 4: Inadequate Response
步骤4：治疗不充分时
All of the above measures are continued. 继续上述所有措施
A second or third agent or diuretic is added if not already prescribed. 如尚未处方，可添加第2种或第3种药物或利尿剂
Hypertensive treatment is further complicated by the presence of other chronic conditions including diabetes, age, etc. The Joint National Committee published evidence-based recommendations for the treatment of hypertension to help prescribers select an antihypertensive agent in light of complicating conditions. A patient’s response to a given antihypertensive agent is very individual, so the drug of choice for one patient may have little to no effect on another patient.
1. Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?
A. Have the patient record dietary intake for 3 days.
B. Give the patient a detailed list of low-sodium foods.
C. Teach the patient about foods that are high in sodium.
D. Help the patient make an appointment with a dietitian. 2. The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN?
A. Titrate nitroprusside to maintain BP at 160/100 mm Hg.
B. Evaluate effectiveness of nitroprusside therapy on BP.
C. Set up the automatic blood pressure machine to take BP every 15 minutes.
D. Assess the patient's environment for adverse stimuli that might increase BP.
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 Answer 1. A. Have the patient record dietary intake for 3 days. Rationale: The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patient's baseline should occur first. 2. C. Set up the automatic blood pressure machine to take BP every 15 minutes Rationale: LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.
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