Therapeutic: antihypertensives, diuretics
Pharmacologic: thiazide-like diuretics
Mild-to-moderate hypertension. Edema associated with CHF and other causes.
Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. Promotes excretion of chloride, potassium, magnesium, and bicarbonate. May produce arteriolar dilation. Therapeutic Effects: Lowering of blood pressure in hypertensive patients and diuresis with subsequent mobilization of edema.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, lethargy. CV: arrhythmias, hypotension. GI: anorexia, cramping, nausea, vomiting. Derm: photosensitivity, rashes. Endo: hyperglycemia. F and E hypokalemia, dehydration, hypochloremic alkalosis, hyponatremia, hypovolemia. Metab: hyperuricemia. MS: muscle cramps.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Monitor signs of fluid and electrolyte imbalances, including dizziness, drowsiness, blurred vision, confusion, lethargy, hypotension, or muscle cramps and weakness. Report excessive of prolonged symptoms to the physician.
Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
When used to treat edema, help determine drug effects by assessing peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Also monitor signs of pulmonary edema such as dyspnea and rales/crackles (See Appendix K). Document whether peripheral and pulmonary symptoms are controlled adequately by diuretic therapy.
Monitor signs of hyperglycemia such as drowsiness, fruity breath, increased urination, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.
Implement fall-prevention strategies, especially in older adults of if patient exhibits sedation, dizziness, or other impairments that affect gait and balance (See Appendix E).
Use caution during aerobic exercise, especially in hot environments. Increased sweating will cause fluid and electrolyte loss, and may exaggerate arrhythmias and diuretic side effects (dizziness, muscle cramps, and so forth).
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.
Causes photosensitivity; use care if administering UV treatments.
Remind patients to take medication as directed to control hypertension and other cardiac conditions, even if they are asymptomatic.
Counsel patients about additional interventions to help control blood pressure and cardiac dysfunction, such as regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.
Advise patient about photosensitivity, and to use sunscreens, protective clothing, ...