NURS 2516 Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

lisinopril Prinivil antihypertensives 10 mg po 0600 q AM
Range: 5 mg once
daily for 2 days,
then 10 mg daily
Peak Onset Duration For IV meds, compatibility with IV drips and /or solutions
6 hr 1 hr 24 hr N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
ACE inhibitors block the conversion of angiotensin I to the Hypersensitivity, Cross-sensitivity among ACE inhibitors may occur,
vasoconstrictor angiotensin II. ACE also inactivates the vasodilator Angioedema (hereditary or idiopathic), Renal impairment, hepatic
bradykinin and other vasodilatory prostaglandins. ACE inhibitors impairment, hypovolemia, hyponatremia, elderly patients, concurrent
also increase plasma renin levels and reduce aldosterone levels. Net diuretic therapy (initial dose reduction recommended for most agents),
result is systemic vasodilation Cerebrovascular or cardiac insufficiency, Surgery/anesthesia
(hypotension may be exaggerated), Family history of angioedema
HTN, Reduction of risk of death or development of heart failure Common side effects
after myocardial infarction cough, hypotension, taste disturbances, proteinuria
Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) Monitor BUN, creatinine, and electrolyte levels periodically. Serum
potassium may be ↑ and BUN and creatinine transiently ↑, whereas
Additive hypotension with other antihypertensive agents sodium levels may be ↓. If ↑ BUN or serum creatinineconcentrations
Increased risk of hyperkalemia with concurrent use of potassium occur, dose reduction or withdrawal may be required. May rarely cause
supplements slight ↓ in hemoglobin and hematocrit. May cause ↑ AST, ALT, alkaline
phosphatase, serum bilirubin, uric acid, and glucose. May cause positive
ANA titer.
Be sure to teach the patient the following about this
medication
Instruct patient to take medication as directed at the same time each day,
even if feeling well. Take missed doses as soon as possible but not if
almost time for next dose. Do not double doses. Warn patient not to
discontinue ACE inhibitor therapy unless directed by health care
professional.
Caution patient to avoid salt substitutes or foods containing high levels
of potassium or sodium unless directed by healthcare professional
Caution patient to change positions slowly to minimize hypotension,
particularly after initial dose. Patients should also be advised that
exercising in hot weather may increase hypotensive effects
Advise patient to consult health care professional before taking any OTC
medications, especially cold remedies
May cause dizziness. Caution patient to avoid driving and other activities
requiring alertness until response to medication is known
Advise patient to inform health care professional of medication regimen
prior to treatment or surgery
Instruct patient to notify health care professional if rash; mouth sores;
sore throat; fever; swelling of hands or feet; irregular heart beat; chest
pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue;
difficulty swallowing or breathing occur ; or if taste impairment or skin
rash persists. Persistent dry cough may occur and may not subside until
medication is discontinued. Consult health care professional if cough
becomes bothersome. Also notify health care professional if nausea,
vomiting, or diarrhea occurs and continues
Emphasize the importance of follow-up examinations to monitor
progress

Nursing Process- Assessment
(Pre-administration assessment)
Monitor blood pressure and pulse frequently during
initial dose adjustment and periodically during therapy.
Notify health care professional of significant changes.
Monitor weight and assess patient routinely for
resolution of fluid overload (peripheral edema,
rales/crackles, dyspnea, weight gain, jugular venous
distention)
Encourage patient to comply with additional interventions for
hypertension (weight reduction, discontinuation of smoking, moderation
of alcohol consumption, regular exercise, and stress management).
Medication controls but does not cure hypertension
Instruct patient and family on correct technique for monitoring blood
pressure. Advise them to check blood pressure at least weekly and to
report significant changes to health care professional
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease in blood pressure without
Hypotension, if rash; mouth sores; sore throat; appearance of side effects
fever; swelling of hands or feet; irregular heart Reduction of risk of death or
beat; chest pain; dry cough; hoarseness; development of heart failure after
swelling of face, eyes, lips, or tongue; or if myocardial infarction
difficulty swallowing or breathing occurs.
Persistent dry cough may occur and may not
subside until medication is discontinued.
Consult health care professional if cough
becomes bothersome. Also notify health care
professional if nausea, vomiting, or diarrhea
occurs and continues