Assessment and Evaluation for Patients Receiving a Phosphodiesterase Inhibitor
磷酸二酯酶抑制剂使用患者的评估与评价
A．Assessment评估
l Assess for contraindications or cautions: Any known allergies to this drug or to bisulfites to avoid hypersensitivity reactions; acute aortic or pulmonic valvular disease, acute MI or fluid volume deficit, and ventricular arrhythmias, which could be exacerbated by these drugs; and current status of pregnancy and lactation to prevent potential adverse effects to the fetus or baby.
评估有无禁忌症或注意事项：对该药或亚硫酸氢盐的已知过敏，以避免超敏反应；急性主动脉或肺瓣膜疾病、急性MI或液体常量缺乏、室性节律异常，这些药物可能加重病情；当前的妊娠和哺乳状况，以阻止潜在的胎儿或婴儿不良效应。
l Perform a physical assessment to establish baseline status before beginning therapy, determine the effectiveness of therapy, and evaluate for any potential adverse effects.
体格评估，确立治疗前基线状态，确定治疗效果、评价有无任何潜在的不良效应。
l Assess cardiac status closely, including pulse and blood pressure, to identify changes or the presence of adverse effects; auscultate heart sounds, noting any evidence of abnormal sounds.
密切评估心脏状况，包括脉搏和血压，确认各种变化或不良效应的存在；听诊心音，注意任何异常心音证据。
l Obtain the patient’s weight, noting any recent increases or decreases, to determine the patient’s fluid status.
获取患者体重，注意任何最新的增加或减少，确定患者体液状况。
l Inspect skin and mucous membranes for color, and check nail beds and capillary refill for evidence of perfusion.
检查皮肤和粘膜的颜色，检查甲床和毛细管再充盈情况，发现灌注证据。
l Examine the abdomen for distention; auscultate bowel sounds to evaluate GI motility.
检查腹部有无膨胀；听诊肠鸣音，以评价GI能动性。
l Assess voiding patterns and urinary output to provide a gross indication of renal function.
评估排便形态和尿排量，提供肉眼可见的肾功能指征。
l Obtain a baseline ECG to identify rate and rhythm and evaluate for possible changes.
获取基线ECG数据，确认速率和节律，评价有无可能的变化。
l Monitor the results of laboratory tests, including serum electrolyte levels, complete blood count, and renal and hepatic function tests, to determine the need for possible dose adjustment.
监测实验室试验结果，包括血清电解质水平 、全血细胞计数和肝、肾功能试验，以确定是否需要调整剂量。
B. Evaluation 评价
l Monitor patient response to the drug (alleviation of signs and symptoms of HF).
监测患者的药物反应（HF症状体征缓解）
l Monitor for adverse effects (hypotension, cardiac arrhythmias, GI upset, thrombocytopenia).
监测有无不良效应（低血压、心律异常、GI不适、血小板减少）
l Monitor the effectiveness of comfort measures and compliance with the regimen.
监测舒适措施效果和治疗方案依从性
l 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).
评价宣教计划效果（患者可说出药物名称、剂量、需要留意的不良效应、具体的避免措施及继续随访检查的重要性）
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Inotropic Effect
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1. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?
A. "I will limit my sodium intake to 5-6 grams a day."
B. "I will be sure to incorporate canned vegetables and fish into my diet."
C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches."
D. "I will limit my consumption of frozen meals." 2. Routine laboratory monitoring in clients taking ß blockers should include:
A. Sodium.
B. Glucose.
C. Thyrotropin.
D. Creatine phosphokinase.
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. D. “I will limit my consumption of frozen meals” Rationale: Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them. 2. B. Glucose. Rationale: ß blockers influence glucose metabolism. Beta-3 receptors induce the breakdown of fat cells and are less clinically relevant at present. Blockade of these receptors by beta-blocking medicines are used to treat a broad range of illnesses. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed.
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