Edema is a swelling caused by excess fluid trapped in the soft tissues of the body. Edema, if present, is more noticeable in the periphery, i. e the legs, the ankles and the feet. It can also affect other parts of the body, like the face and hands. Also, congestive cardiac failure, hepatic diseases or nephropathies can cause edema. Edema might arise consequent upon standing or sitting in a place for a long period of time. edema might arise as a result of venous pooling in the periphery, as a result of incompetent or varicose venous valves.
Venous pooling can arise as a result of increased total peripheral resistance (TPR) brought about by cardiovascular overload. This can be brought about by Hypertensive states. Some drugs, like Calcium Channel Blockers cause ankle edema. 2. What is the mechanism of some of the signs Francine presented with: nystagmus, retinopathy, headache, dizziness. Nystagmus: Rapid, involuntary side-to-side movement of the eye. The eye can also move up and down. It nay be part of the Vestibulo-Ocular movement. It may also be indicative of an underlying pathology. Retinopathy: means damage to the retina of the eyes.
It is usually due to an insufficiency in the blood supply to the retina. Headache: as a result of raised intracranial pressure. it might be due to dilatation of cerebral vessels. The vasodilatation might be secondary to release of prostaglandins and vasodilatory substances in the vascular system. Dizziness: can occur as a result of hypoxia. Inadequate perfusion of the lungs leading to accumulation of metabolites in the blood, leading to a high PCo2. 3. What is the action of the drugs being used? Nitroprussside: It is a drug of choice in hypertensive emergencies. (e. g malignant hypertension)
It causes the liberation of Nitric Oxide, which is a potent vasodilator. It reduces the Total Peripheral Resistance and Venous return. The reduction in total peripheral resistance significantly reduces the preload. Also, the reduction in venous return reduces afterload. These effects would definitely reduce the overload in the cardiovascular system, the blood pressure would reduce. Nitroprusside is contraindicated in patients with renal failure simply because the route of elimination of the drug’s metabolite is via the Kidneys. thicyanate is a metabolite of the drug and it is a very toxic substance.
It is excreted via the kidneys. Accumulation in the body system causes serious problems. Captopril is an Angiotensin-Converting enzyme Inhibitor. It is used in cardiovascular disorders like hypertension and congestive heart failure (CCF). It causes vasodilatation and its action of inhibiting Angiotensin-Converting Enzyme results in the renal effects. However, the adverse drug profile of ACE inhibitors generally is also present in Captopril. Dry cough is common; also, dysgeusia and rashes are likely to occur in patients taking this drug. Other adverse reactions include myalgia, dizziness and hyponatremia.
Also, hypotension can occur. An excessively high dosage, also, can lead to Hypokalemia. This is due to the reduction in aldosterone production. The drug has a short half-life hence, the two to three times daily regimen. This however, may reduce compliance in patients. 5. How does atherosclerotic disease influence the patient’s risk of myocardial infarction during a hypertensive episode? Artherosclerosis reduces the perfusion of the region where there is the narrowing of the vessels. This leads to ischemia of the tissue involved. This eventually leads to myocardial infarction.
What advice would you offer to Francine in the form of patient education prior to her being released from the hospital? As a hypertensive patient, she should go off cigarettes. Compliance to her drug regimen is important if she is to use the remainder of her life in relatively good health. She should decrease her intake of foods with high caloric value. A weight of 140 lbs is okay for her.
1. http://www. rxlist. com/cgi/generic/captop. htm 2. www. drugs. com/captopril. html 3. www. rxlist. com/cgi/generic/nitroprusside. htm 4. www. webmd. com/hypertension-high-blood-pressure/guide/blood-pressure-basics