Name of Drug

Mode of Action
Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increased in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis is also may be involved in the hypertensive action.

Route and Dosage Ideal :

Adult: HPN: 25mg PO bid or tid; if satisfactory response is not noted within 1 2wks, increase dosage to 50mg bid, tid; usual range is 25150mg bid-tid PO with mild thiazine diuretic. Do not exceed 450mg/day.

Indication
Treatment of hypertension alone or in combination with thiazine-type diuretics Treatment of CHF in patient unresponsive to conventional therapy; used with diuretics and digitalis Treatment of diabetic nephropathy Treatment of left ventricular dysfunction after MI. Unlabelled uses management of hypertensive crises: treatment of rheumatoid arthritis diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma renal crisis; Bartters syndrome

Contraindication
Contraindicated

Side effects
Itching

Adverse Reactions
CV: Tachycardia,

Nursing Responsibility
Take the drug as prescribed by the physician. Explain for possible side effects that may present. Report for presences of any adverse effect immediately. Ask the pt if she had an allergy to this drug. Assess for history of allergy to captopril and History of angioedema. Use cautiously in patients with CHF, impaired renal function, salt or fluid volume depletion, or in pregnant or lactating women. Administer 1 hr before or Or 2 hrs. before meals. Watch out for excessive perspiration, or diarrhea; may cause hypotension Reduce dosage in patients with impaired Renal function. Watch out for excessive perspiration, or diarrhea; may cause hypotension Reduce dosage in patients with impaired renal function Instruct patient to limit activities to those that do not require alertness and precision.

Generic name: Captopril

with allergy to Captopril, history of Angiodema Use cautiously with impaired renal function; CHF; Salt or volume depletion, lactation, pregnancy.

Protein urine

in

the

angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt or volume-depleted patients Dermatologic: Rash, pruritus, pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia GI: Gastric irritation, aphthous ulcers, peptic ulcers,dysgeusia, cholestati c jaundice, hepatocellular injury, anorexia, constipation GU: Proteinuri a, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Other: Cough, malaise, dry mouth, lymphadenopathy

Skin flushing Increased heart rate tachycardia chest pain Heart palpitations Decrease in blood cells used to fight infections. Dizziness

Brand name: Apo-Capto (CAN), Capoten, GenCaptopril (CAN), Novo-Captopril (CAN), Nu-Capto (CAN)

Actual:
tablet: 25 mg PO bid

Classification: Angiotensincoberting enzyme (ACE) inhibitor Antihypertensive

NURSING CARE PLAN Cues Subjective: Wala ko kabalo nga may UTI gali ko, as verbalized by patient. Need P H Y S I O L O G I C A L NEED Nursing Diagnosis
Deficit knowledge related to Information misinterpretation secondary to incomplete information presented.

Objective
At the end of 8hours nursing intervention, patient and SO will verbalize understanding of the disease process and its treatment regimen

Nursing Intervention
Determine clients ability or readiness and barriers to learning. Assess the level of the clients capabilities and the possibilities of the situation. Provide information relevant only to the situation State objectives clearly in learners terms Identify outcomes (result) to be achieved. Provide access information for contact person Provide an environment that is conducive to learning Provide mutual goal settings and learning contracts Involve with others who have same problems/needs/concerns Begin with information the client already knows and move to what the client does not know, progressing from simple to complex

Rationale
-individual may not be physically, emotionally or mentally capable at this time. -may need to help SOs and caregivers to learn. -to prevent overload -to meet learners needs

Evaluation
Goal Met. Client and SO verbalized understanding of the importance of disease modification and medication compliance to avoid further aggravation of the clients condition.

Objective: Self-esteem

Scientific data:
Absence or deficiency of cognitive information related to specific topic [ Lack of specific information necessary for clients/SOs to make informed choices regarding condition/treatment or lifestyle changes].

-to answer questions or validate information postdischarge

-clarifies expectations of teacher and learner. -provides role model and sharing of information -can arouse interest/limit sense of being overwhelmed.

NURSING CARE PLAN Cues Subjective: Gasakit akong dughan, as verbalized by patient. Need P H Y S I O L O G I C A L NEED Nursing Diagnosis
Acute pain related to vascular pressure, possibly evidenced by verbal report.

Objective
After 8 hours of nursing intervention, the patient will able to reduce the pain from level 3 to level 1 of pain and report for the absence of pain

Nursing Intervention
Note clients locus of control internal or external) Placed patient on complete bed rest during anginal episodes. Placed patient on semi-Fowlers position Monitored vital signs q 5 mins during initial anginal attack. Note when pain occurs Review procedure and expectations and tell client when treatment may cause pain Encourage adequate rest periods Discuss impact pain on lifestyle/independence and ways to maximize level of functioning Identify specific signs and symptoms and changes in pain characteristics requiring medical follow-up Encourage diversional activities (e.g, TV, radio, socialization with others). Provide comport measures

Rationale
-individuals with external locus of control may little or no responsibility for pain management. -reduces myocardial oxygen demand to minimize risk of tissue injury -relieves shortness of breath and decreases Myocardial workload..

Evaluation
Goal met. Patient demonstrated relief of pain as evidenced by: > verbal reports of absence of pain > absence of restlessness and grimacing

Scientific data:
Unpleasant sensory and emotional experience arising from actual or pontential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months.

Objective: Pain scale of 3 Facial grimace when they breath

-to medicate prophylactically, as appropriate. -to reduce concern of the unknown and associated muscle tension - to prevent fatigue

-to promote pharmacological management.

non pain

NURSING CARE PLAN Cues Subjective: Na budlayan ko mag ginhawa, as verbalized by patient. Need P H Y S I O L O G I C A L NEED and Nursing Diagnosis Impaired gas exchange related to outer blood flow and decreased ovular exchange evidenced by restlessness and confusion Objective At the end of 8hours nursing intervention, the patient will able to understand interventions appropriately. Nursing Intervention
Evaluate pulse oximerry to determine oxygenation; evaluate lung volume and forced vital capacity Elevate head of bed/position the client appropriately, provide airway adjuncts and suction, as indicated Maintain adequate I/O, but avoid fluid overload Use sedation judiciously Encourage adequate rest and limit activities to within client tolerance. Promote calm/restful environment Provide psychological support, active-listen questions/concerns Minimize blood loss from procedures (e.g, tests, hemodialysis) Keep environment allergen/pollutant free Review risk factors, particularly environmental/employment related Instruct in the use or relaxation, stress-reduction techniques, as appropriate.

Rationale
-to assess for respiratory insufficiency

Evaluation

Goal met. Patient verbalized understanding causative factors and -provide optimal chest appropriate expansion and drainage of interventions. secretion
-for mobilization of secretions -to avoid depressant effects o respiratory functioning -helps limit oxygen needs/consumption

Scientific data:
Excess or deficit in oxygenation and carbon dioxide elimination at the alveoli-capillary membrane [This may be an entity of its own, but also may be an end result of other pathology with an interrelatedness between airway clearance and/or breathing pattern problems.]

Objective: Restlessness confusion

-to reduce anxiety

-to limit adverse effects of anemia -to reduce irritant effect of dust and chemicals on airways -to promote prevention/management of risk

NURSING CARE PLAN Cues Subjective: Gina problemahan ko abi ang kasal namon, as verbalized patient. Need P H Y S I O L O G I C A L NEED Nursing Diagnosis Anxiety related to perceived threat of death as evidenced by restlessness Objective Nursing Intervention
Monitor vital signs

Rationale
-to identify physical responses associated with both medical and emotional conditions - which can point to the clients level of anxiety

Evaluation
Goal met. Patients verbalized awareness of feeling of anxiety and expressed anxiety.

Objective: Restlessness

After 8hours of nursing intervention, the patients will able identify or aware of having anxiety and Scientific data: Vague uneasy feeling express of discomfort or feeling of dread accompanied anxiety.
by an autonomic response ( the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an altering signal that warns of warns of impending danger and enables the individual to take measure to deal with threat.

Observe behaviors Be available to client for listening and talking. Assist client to develop self-awareness of verbal and nonverbal behaviors Provide accurate information about the situation Encourage client develop an exercise/activity program Refer to individual or group therapy, as appropriate Provide comport measures Modify procedure as much as possible

-helps client to identify what is reality based -which may serve reduce level of anxiety by relieving tension -to deal with chronic anxiety states

-to limit degree of stress and avoid overwhelming child or anxious adult - to avoid the contagious Establish a therapeutic effect/transmission of relationship, conveying anxiety empathy and unconditional positive regard

NURSING CARE PLAN Cues Subjective: Pirmi galingen akon na ulo, as verbalized by the patient. Need
P H Y S I O L O G I C A L NEED

Nursing Diagnosis
Decreased cardiac output related to altered heart rate/rhythm as evidenced by Postpartum hypertension

Objective
After 8hours of nursing interventions, the patient had no elevation in blood pressure above normal limits and will maintain blood pressure within acceptable limits.

Nursing Intervention
Monitor BP every1-2 hours, or every5 minutes during active titration of vasoactive drugs. Monitor ECG for dysrrhythmias, conduction defects and for heart rate. Suggest frequent position changes

Rationale
-changes in BP may indicates
changes in patient status requiring prompt attention - decrease in ardiac output may result in changes in cardiac perfusion causing dysrhythmias -it may decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing -caffeine is a cardiac stimulant and may adversely affect cardiac function - Changes in behavior and mental status can be early signs of impaired gas exchange which will result from decreased cardiac output. - Sleep apnea is a common disorder in patients with chronic heart failure - Improves venous return and increases cardiac output -suggesting cardiac tamponade -helps determine underlying cause.

Evaluation
Goal met, the patient maintained an adequate cardiac output and cardiac index.

Encourage patient to decrease intake of caffeine, cola and chocolates. Observe patient for restlessness, agitation, confusion and (late stages) lethargy

Objective:
Numbness

Scientific data:
Inadequate blood pumped by the heart to meet the metabolic demands of the body.
Observe patient for sleep apnea Elevate legs when in sitting position and edematous extremities when at rest Note the presence of pulsus paradoxus, especially in the presence of distant heart sounds Review diagnostic studies Auscultate heart tones

of

extremities Shortness of breath

-hypertensive patients often have

S4 gallops hypertrophy caused by atrial

NURSING CARE PLAN Cues Need Nursing Diagnosis Objective Nursing Intervention Rationale Evaluation