6.4 Applying the Nursing Process to Administering Cardiovascular and Renal Medic
6.4 Applying the Nursing Process to Administering Cardiovascular and Renal Medications
Assessment
Understanding the mechanism of action of cardiovascular medications helps the nurse anticipate appropriate pre- and post-administration assessments to perform on a client. Before administering cardiovascular medications, nurses complete a focused cardiac assessment to establish the client‘s current health status. Based on this baseline status, the client is monitored for effectiveness of the medication, as well as for any adverse effects.
Many cardiovascular medications, such as antiarrhythmics, cardiac glycosides, antihypertensives, or diuretics, alter a client‘s blood pressure or heart rate. Therefore, the nurse assesses a client‘s blood pressure and heart rate prior to administration. Medication parameters are often included in the order by a health care provider. For example, a common medication parameter is to hold a beta-blocker if a client‘s heart rate is less than 60 beats per minute. Additionally, anti-arrhythmic medication will alter the electrical conduction of the heart, so intermittent or continuous ECG monitoring may be required during initial therapy or dose changes.
Electrolytes can play a large role in cardiac conduction and muscle function. Medications that alter electrolytes, such as loop diuretics, require a review of laboratory values before administration. Loop diuretics such as furosemide (Lasix) often cause a depletion of potassium. If a nurse administers a loop diuretic to a client who already has low serum potassium levels (called hypokalemia), worsening symptoms of hypokalemia will occur, which can cause a life-threatening arrhythmia.
Monitoring kidney function is also important when administering many cardiovascular medications. For example, diuretics can injury the kidneys. A nurse should be aware of cardiovascular medications that are affected by impaired kidney function or cause injury to the kidney. In addition, a nurse must appropriately assess and report abnormal kidney function laboratory values such as worsening serum creatinine and glomerular filtration rates (GFR). It is also important to assess for signs of dehydration, including fluid intake and output, for clients taking diuretics.
Anticoagulant medications cause serious risk for bleeding that can be life-threatening. Prior to administering medication that alters a client‘s coagulation, it is important to assess for signs and symptoms of unusual bleeding or bruising, such as blood in the urine or stool or bruises on the extremities. Laboratory values, such as INR, PT, PTT, or platelets, may also require review prior to administering an anticoagulant medication. Any new abnormal lab values or signs of increased bleeding and internal bleeding should be immediately reported.
Implementation
Before administering cardiovascular medication, it is vital for the nurse to determine if this specific medication is safe for this client at this time. For example, if the cli