Vasodilators Nursing Considerations

Vasodilators Nursing Implications

Vasodilators Nursing Pharmacology

Vasodilators are medications that widen (open) blood arteries. They affect the muscles in the artery and capillary walls, preventing them from constricting and narrowing. As a response, blood flows more freely through the arteries. Blood pressure also decreases since the heart does not have to push as hard.

Specifically, doctors widely prescribe this kind of drug to treat various diseases and health disorders, along with their symptoms. High blood pressure (hypertension), congestive heart failure (CHF), and cardiac or heart pain (angina) are some of the cardiovascular disorders and other health conditions treated with these medications.

Vasodilators are available in many forms, and there are several ways to administer them; they could be taken orally, intravenously, or sublingually. In addition, vasodilators are not available over-the-counter. Therefore, patients should secure a prescription before obtaining this medication.

Indications for Vasodilators

Healthcare providers usually recommend vasodilators to prevent, manage, or help relieve symptoms in a range of illnesses, including:

  • hypertension (high blood pressure)
  • prevention of heart attack
  • cardiac pain, often known as heart pain, is a type of discomfort that occurs in the heart (angina)
  • congestive heart failure
  • pregnant women with high blood pressure (preeclampsia)
  • stroke prevention
  • heart failure prevention following a heart attack
  • cardiomyopathy
  • subarachnoid hemorrhage
  • high pulmonary blood pressure (pulmonary hypertension)
  • diabetes-related nephropathy
  • Raynaud’s phenomenon

Types and Actions of Vasodilators

Vasodilation is the expansion of blood vessels caused by relaxing the muscular walls of the blood vessels. It is a physiological process that increases blood flow to body parts deficient in oxygen and nutrients.

Vasodilation also decreases systemic vascular resistance (SVR) and increases blood flow, resulting in a fall in blood pressure. Accordingly, this is how vasodilators phenomenally function.

Several mechanisms are at work in this kind of medicine. For instance, there are four primary types of vasodilators:

  1. Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors delay (inhibit) the activity of the enzyme ACE, reducing the generation of a chemical (angiotensin) that induces blood vessels to constrict. As a result of the enlarged (dilated) blood vessels, blood pressure drops (lowers).

  2. Angiotensin receptor blockers (ARBs). ARBs are another type of medication that dilates blood vessels. They act by preventing angiotensin from binding to blood vessel smooth muscle. That is how ARB’s result in vasodilation.

  3. Calcium channel blockers (CCBs). Smooth muscle cells utilize calcium to make the arteries expand. CCBs inhibits calcium from penetrating smooth cells, permitting the artery muscles to relax. CCB’s cause the artery to dilate (open) as well. 

  4. Nitrates. Nitric oxide is the metabolite of Nitrates, and this is responsible for stimulating another chemical that relaxes the veins and arteries. Doctors commonly prescribe nitrates for the management of cardiac pain (angina). 

Side Effects and Adverse Effects of Vasodilators

The following are common Angiotensin-converting Enzyme) ACE Inhibitor side effects:

  • Unproductive cough (dry cough)
  • Hyperkalemia (Elevated potassium levels)
  • Fatigue
  • Lightheadedness caused by hypotension
  • Headaches
  • Ageusia (loss of sense of taste)

The following are common Angiotensin Receptor Blockers (ARB’s) side effects:

  • Migraine
  • Vertigo or lightheadedness
  • Lethargy
  • Hypotension (low blood pressure)
  • Vomiting
  • Nausea
  • Pain in the muscles or bones
  • Diarrhea
  • Rashes
  • Cough
  • Hyperkalemia (High potassium levels)
  •  

The following are common Calcium Channel Blockers (CCB’s) side effects:

  • Edema in the lower legs and feet
  • Rapid heartbeat (palpitations)
  • Nausea
  • Headache
  • Lightheadedness
  • Fatigue
  • Rashes or redness of the skin
  • Constipation

The following are common Nitrates side effects:

  • Arrhythmia (Irregular heartbeats)
  • Hypotension (low blood pressure)
  • Lightheadedness
  • Loss of coordination
  • Vomiting or having an upset stomach
  • Redness of neck and face

Vasodilator overdosing or vasodilator intoxication can occur if a person consumes too much of the medication. 

Acute overdose in vasodilators may result in the following:

  • tachycardia
  • postural hypotension
  • fainting
  • vomiting
  • fatigue
  • migraines
  • hot flushed skin
  • fatigue
  • ataxia- category of illnesses affecting movement, coordination, and speech (Usually happens in children)

Severe overdosing in vasodilators may result in the following:

Despite that, there is no particular antidote for vasodilator intoxication, but the oral administration of activated charcoal is permissible. Furthermore, ensuring an open airway and ventilation will be beneficial. 

Contraindications and Cautions against Vasodilators

There are several concerns and precautions associated with the use of vasodilators. Before prescribing such medication, the doctor will usually discuss it with the patients.

  1. ACE inhibitors
  • ace inhibitor hypersensitivity
  • breastfeeding or pregnancy
  • angioedema connected with ace inhibitor therapy in the past
  • renal function impairment
  • aortic valve stenosis, also known as cardiac outflow blockage, is a condition in which the aortic valve becomes obstructed.
  • bilateral renal artery stenosis hemodialysis using polyacrylonitrile membranes with high flux
  • dehydration or hypovolemia

2. ARBs

  • ace inhibitor intolerance related to hypotension, renal insufficiency, and hyperkalemia
  • angioedema or anuric renal failure (means kidneys no longer produce urine)
  • renal artery stenosis on both sides
  • low systemic blood pressures (systolic blood pressure less than 80 mm hg)
  • pregnancy.
  • if creatinine levels in the blood are significantly elevated (higher than 3 mg/dl or gfr40 ml/min).
  • if serum potassium levels are elevated (greater than 5.5 mEq per liter)

Here are some factors or conditions to look for if the prescriber considers using a calcium channel blocker:

  • medical history of heart rhythm problems
  • hypoglycemia
  • allergies to foods or dyes
  • chronic heart failure or other heart or blood vessel conditions
  • renal or liver disease
  • pregnancy/breastfeeding
  • severe hypotension
  • Parkinson’s disease
  • history of depression

There are several contraindications to using nitrates. These are as follows:

  • nitrate intolerance
  • the usage of phosphodiesterase (pde) inhibitors
  • ischemic heart disease
  • hypertrophic cardiomyopathy

Drug Interactions with Vasodilators

Using a combination of vasodilators may result in excessive blood pressure reduction. In some cases, however, taking two or more vasodilators is considered beneficial in hypertension that a single antihypertensive drug cannot manage. Below is the list of drug interactions that patients taking certain types of vasodilators may encounter:

  • ACE inhibitors increase blood potassium levels, therefore, use of potassium supplements, salt replacements (which typically contain potassium), or any drug that increases the body’s potassium levels may result in Hyperkalemia.
  • If ACE inhibitors are used with ARBs concomitantly, the risk of low blood pressure, high blood potassium, and renal complications increases.
  • If ACE inhibitors are utilized together with injectable treatment for rheumatoid arthritis, patients may experience facial redness, hypotension, nausea, and vertigo.
  • Grapefruit juice (about 200 mL) may raise CCB levels in the blood. Patients should not consume grapefruit juice within 2 to 4 hours of taking CCBs.
  • Phosphodiesterase (PDE) inhibitors enhance the blood-pressure-lowering effects of nitrates and may result in excessive blood pressure reduction. As a result, patients who use nitrate drugs should not take PDE inhibitors at the same time.

In general, patients taking any vasodilators must be extra careful before taking other medications to avoid undesirable drug interactions. 

Nursing Considerations when Administering Vasodilators

The following are some of the critical elements that the nurse should consider when completing an assessment, history taking, and examination:

  • Check for the contraindications mentioned above to this drug (e.g., drug allergy, CAD, cerebral insufficiency, and such) to avoid potential side effects.
  • Emphasize to the patient the significance of complete adherence to pharmacological therapy to guarantee optimum therapeutic benefits.
  • Educate the patient on the necessity of good lifestyle choices like regular exercise, weight loss, smoking cessation, and a low-sodium diet to enhance the benefit of vasodilator therapy

Nursing Care Plan for Patients on Vasodilators

Nursing Diagnosis for Vasodilators

  • Acute Pain (e.g., headache or migraine) related to the side effect of the drug
  • Impaired Skin Integrity related to the side effects on the skin of the vasodilators
  • Risk for Decreased Cardiac Output related to increased fluid volume excretion as a side effect of vasodilators
  • Risk for Imbalanced Fluid Volume related to patient response to drug therapy
  • Risk for Injury related to side effect of drug therapy
  • Deficient Knowledge related to drug action and side effects

Nursing Assessment

Vasodilators Nursing InterventionsRationale
Assess the patient for signs and symptoms of stroke or heart failure, such as hypertension and chest pain.To confirm the indication for administering vasodilators.
Check the patient’s allergy status.Previous allergic reaction to vasodilators may render the patient unable to take them. Alternatives to vasodilators should therefore be considered in case of allergy.
Assess if the patient is pregnant or lactating.      Vasodilators should be prescribed in caution to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn. It is advisable to avoid breastfeeding after receiving vasodilators.
Check for the status of peripheral veins prior to cannulation and administration of intravenous vasodilators. If administering oral vasodilators, assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of vasodilators is given through the right route.
Check medical history for renal impairment or persistent hypotension.Vasodilators are contraindicated in patients with persistent hypotension. Extreme caution is needed when administering vasodilators on patients with renal impairment.  
Assess the patient’s mental status while on vasodilator treatment.Excessive doses of vasodilators may result to headaches, dizziness, or vertigo.

Nursing Planning and Intervention

Vasodilators Nursing InterventionsRationale
Commence strict input and output monitoring. Observe for edema or any signs of fluid retention.Vasodilators may cause excessive fluid excretion in the body.
Administer vasodilators on empty stomach.To ensure optimal absorption and therapeutic action by vasodilators.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking vasodilators. Instruct the patient on how to self-administer oral vasodilators.To inform the patient on the basics of vasodilators, as well as to empower him/her to safely self-administer the medication.
Start stool charting if the patient develops loose stools.Some vasodilators may cause diarrhea as a side effect.
Advise the patient to immediately report any signs of dizziness or severe headaches. Encourage checking blood pressure levels at the same time of the day, on a daily basis at home.Vasodilators should be used in great caution in patients with pre-existing heart conditions. Vasodilators may cause changes in cardiac rhythm and blood pressure levels.
Perform routine blood tests to check for the patient’s renal function as ordered by the physician.Vasodilators are not ideally used in patients with renal impairment.  

Nursing Evaluation

Vasodilators Nursing InterventionsRationale
Ask the patient to repeat the information about vasodilators.To evaluate the effectiveness of health teaching on vasodilators.
Monitor the cardiovascular and neurological status of the patient.To ensure that the vasodilators did not cause any adverse events to the patient.
Monitor the patient’s response to vasodilators.To check if the vasodilators are effective, the dose needs to be adjusted, or the drug should be stopped and changed to an alternative treatment.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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