alert – v. a. 提醒，使警觉
mark – v. 留意，做标记于
chart – n. 图表，病例表
prominent – a. 显著的，突出的
reverse – v. 逆转，颠倒
volume expansion – 容积扩张
renin – n. 肾素
“RN-ISPN考试复习要点提示”
帮助您尽快理清复习思路，准确抓住复习重点，是ISPN/RN考试复习的一大利器！
——————RN/ISPN Review ——————
Nursing Considerations for Patients Receiving Angiotensin- Converting Enzyme Inhibitors
血管紧张素转化酶抑制剂使用患者的护理考虑
Assessment: History and Examination 评估：病史与体检
Assess for the following conditions, which could be cautions or contraindications to use of the drug: Any known allergies to these drugs to prevent hypersensitivity reactions; impaired kidney function, which could be exacerbated by these drugs; pregnancy or lactation because of the potential adverse effects on the fetus or neonate; salt/volume depletion and heart failure, which could be exacerbated by these drugs.
Assess baseline status before beginning therapy to determine any potential adverse effects. This includes body temperature and weight; skin color, lesions, and temperature; pulse, BP, baseline electrocardiogram (ECG), and perfusion; respirations and adventitious breath sounds; bowel sounds and abdominal examination; and renal function tests, complete blood count with differential, and serum electrolytes.
Encourage patient to implement lifestyle changes, including weight loss, smoking cessation, decreased alcohol and salt in the diet, and increased exercise, to increase the effectiveness of antihypertensive therapy.
鼓励患者改变生活方式，包括减轻体重、戒烟、减少饮酒和吃盐、增加运动，以增强抗高血压疗法效果
Administer on an empty stomach 1 hour before or 2 hours after meals to ensure proper absorption of the drug.
餐前1小时或餐后2小时空腹服药，确保药物充分吸收
Alert the surgeon and mark the patient’s chart prominently if the patient is to undergo surgery to alert medical personnel that the blockage of compensatory angiotensin II could result in hypotension after surgery that would need to be reversed with volume expansion.
Give the parenteral form of enalapril only if an oral form is not feasible; transfer to an oral form as soon as possible to avoid an increased risk for adverse effects.
若口服型不适应，可用非口服型依那普利；尽快换用口服型药，以避免不良效应风险增加
Consult with the prescriber to reduce the dose in patients with renal failure to account for their decreased production of renin and lower-than-normal levels of angiotensin II.
咨询处方医师减少肾衰患者剂量，应对肾素分泌减少和血管紧张素水平低于正常这一情况
Monitor the patient carefully in any situation that might lead to a drop in fluid volume (e.g., excessive sweating, vomiting, diarrhea, dehydration) to detect and treat excessive hypotension that may occur.
对于任何可能导致液体容量下降的情况（如，大量出汗、呕吐、腹泻、脱水），应密切监护患者，发现并治疗任何可能出现的低血压过度
Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals; access to bathroom facilities; bowel program as needed; environmental controls; safety precautions; and appropriate skin care as needed.
Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.
Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and the importance of continued follow-up).
评价宣教计划效应（患者可以说出药物名称、剂量、需要留意的不良效应、具体的避免措施及继续随访的重要性）。
Monitor the effectiveness of comfort measures and compliance with the treatment regimen.
监测舒适措施效果及治疗方案依从性。
——————Video ——————
Angiotensin II Receptor Blockers
——————Tests ——————
1. The nurse is teaching a client about how angiotensin II receptor blockers (ARBs) work. Which statement below BEST describes how these medications work on the body?
A. “They prevent Angiotensin II Type I Receptors from binding with Angiotensin II.”
B. “These medications prevent the activation of Angiotensin II Type II Receptors from binding with Angiotensin II.”
C. “They inhibit angiotensin-converting-enzyme (ACE) from converting an Angiotensin I to Angiotensin II.”
D. “These medications prevent Angiotensin II Type I Receptors from binding with angiotensin-converting-enzyme (ACE).” 2. A physician writes a new medication order for a client who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the client’s scheduled medication list is an ARB?
A. Metoprolol
B. Losartan
C. Lisinopril
D. Nicardipine
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. “They prevent Angiotensin II Type I Receptors from binding with Angiotensin II.” Rationale: ARBs prevent Angiotensin II Type I Receptors from binding with Angiotensin II. Remember ACE Inhibitors inhibit angiotensin-converting-enzyme (ACE) from converting Angiotensin I to Angiotensin II. 2. B. Losartan Rationale: Remember ARBs end with “SARTAN”. Losartan is an ARB.
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