McKenna's Pharmacology for Nursing, 2e - page 753

742
P A R T 8
 Drugs acting on the cardiovascular system
by-products to avoid hypersensitivity reactions;
active liver disease or history of alcoholic liver
disease
, which could be exacerbated by the effects
of these drugs
; current status of pregnancy or
breastfeeding
because of potential adverse effects
on the fetus or neonate
; and impaired endocrine
function,
which could be exacerbated by effects on
steroid hormones.
Perform a physical assessment
to establish a
baseline before beginning therapy and during
therapy to determine its effectiveness and evaluate
for any potential adverse effects.
Weigh the person
to establish a baseline and
evaluate for changes reflecting lifestyle changes
that accompany drug therapy.
Assess the person’s neurological status,
including level of orientation, affect and
reflexes, which show early changes related to
CNS function,
to evaluate for possible CNS
effects of the drug.
Obtain vital signs, including pulse and blood
pressure,
to identify changes
.
Inspect the abdomen for distension and auscultate
bowel sounds
for changes in gastrointestinal
motility.
Assess bowel elimination patterns, including
frequency of stool passage and stool characteristics,
to identify possible constipation.
Monitor the results of laboratory tests, including
renal and liver function tests,
to identify possible
toxicity and serum lipid levels to evaluate the
drug’s effectiveness.
Implementation with rationale
Administer the drug at bedtime
because the highest
rates of cholesterol synthesis occur between
midnight and 5 a.m., and the drug should be taken
when it will be most effective
; give atorvastatin at
any time during the day.
Monitor serum cholesterol and LDL levels before
and periodically during therapy
to evaluate the
effectiveness of this drug.
Arrange for periodic ophthalmic examinations
to
monitor for cataract development.
Monitor liver function tests before and periodically
during therapy
to monitor for liver damage
;
consult with the prescriber to discontinue the drug
if the aspartate aminotransferase (AST) or alanine
aminotransferase (ALT) level increases to three
times normal.
Ensure that the person has attempted a cholesterol-
lowering diet and exercise program for at least 3 to
6 months before beginning therapy
to ensure the
need for drug therapy.
Encourage the person to make the lifestyle changes
necessary
to decrease the risk of CAD and to
increase the effectiveness of drug therapy.
Withhold atorvastatin or fluvastatin in any
acute, serious medical condition (e.g. infection,
hypotension, major surgery or trauma, metabolic
endocrine disorders, seizures)
that might suggest
myopathy or serve as a risk factor for the
development of renal failure.
Suggest the use of barrier contraceptives for women
of childbearing age
because there is a risk of severe
fetal abnormalities if these drugs are taken during
pregnancy.
Provide comfort measures
to help the person
tolerate drug effects.
These include small, frequent
meals
to minimise nausea and vomiting
; access
to bathroom facilities
to ensure adequate bowel
evacuation
; bowel program as needed
to address
constipation
; use of food with the drug if GI
upset is severe
to decrease direct irritating effects
;
environmental controls, such as temperature and
lighting controls,
to help deal with headaches
; and
safety precautions, such as lighting control and
activity restrictions,
to protect the person if vision
changes and muscle effects occur
.
Offer support and encouragement
to help the
person deal with the diagnosis, needed lifestyle
changes and the drug regimen.
Provide thorough teaching, including the name of
the drug, dosage prescribed and administration at
bedtime for best effectiveness; measures to avoid
adverse effects, warning signs of problems and the
need for follow-up laboratory testing to monitor
cholesterol and lipid levels; importance of follow-
up renal and liver function testing; dietary and
lifestyle changes for risk reduction; and monitoring
and evaluation,
to enhance knowledge about drug
therapy and to promote compliance
.
See the Critical thinking scenario for discussion of a
person receiving an HMG-CoA inhibitor.
Evaluation
Monitor response to the drug (lowering of serum
cholesterol and LDL levels, prevention of first MI,
slowing of progression of CAD).
Monitor for adverse effects (headache, dizziness,
blurred vision, cataracts, GI upset, liver failure,
rhabdomyolysis).
Monitor the effectiveness of comfort measures and
compliance with the regimen.
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for and specific measures to avoid
them; individual understands the importance of
continued follow-up).
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