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Nursing

Nursing

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Mechanism of Action of the Thiazide Diuretics and their Clinical Indications

Diuretics are drugs that enhance the removal of solutes such as sodium chloride from the body. Thiazine drugs include hydrochlorothiazide, metolazone, benzthiazide, chlorothiazide, chlorothalidone, indapamide, cyclothiazide, and chlorthalide among others. The drugs act by inhibiting the co-transportation of sodium and chloride ions in the distal convoluted tubules (Sarafidis, Georgianos, & Lasaridis, 2010). This is made possible due to the reduction of intracellular sodium ion after thiazides block sodium ions from entering. Though thiazides hardly cause hypercalcemia due to the reabsorption, they can lead to it as a result of other grounds, such as sarcoidosis or carcinoma. They also enhance the loss of potassium and magnesium, but limit the removal of calcium from the body. Some thiazides inhibit carbon anhydrase. Like carbonic anhydrase inhibitors, thiazides contain sulfonamide group that is not substituted.

Clinical indications for thiazide diuretics include hypertension where they are used for treatment of HTN (Sica et al., 2011). They produce a vasodilatory effect. When used in chronic cases, their effect may not be felt, since there will be an increased reabsorption of sodium in the proximal tubules. Their vasodialatory effect continues and may lead to effective management of chronic hypertension; therefore, it is beneficial. They are also clinically indicated in mild heart failure and resistance edema when combined with loop diuretics (Sica et al., 2011), idiopathic hypercalciuria, and diabetic insipidus that mostly affect nephrons. All thiazides can be taken using the mouth, but act differently. Chlorothiazide dissolves in lipids; therefore, must be provided in large quantities. It takes a lot of time to be absorbed in the body and also to act in the body. Indapamide’s active state is emptied by kidneys; therefore, applying its diuretic effect in the convoluted tubule. Thiazides may result in toxicity, such as hyperlycemia, hyperlipidemia, hyponatremia, allergic reactions, weakness, paresthesias, and fatigability. Though thiazides have been testified to cause impotence, the situation is likely to relate to the reduction of volume.

Mechanism of Action and Clinical Indications of Statins

Statins act by inhibiting HMG-CoA reductase and are more effective at reducing the level of LDL-cholesterol than other drugs that regulate lipids (Weissert, 2012). Examples of statins include rosuvastatin, pravastatin, fluvastatin, atorvastatin, and simvastatin. When the level of cholesterol becomes low in the liver, LDL receptor is improved and uptake of LDL from the liquid part of the blood occurs; thereby, preventing the progress of atheroma. Statins also have the effects that do not relate to cholesterol including promoting the working of endothelial and properties that are against inflammation. They also reverse atheroma and reduce the chances of occurrence of fibrillation.

Statins should be administered to the grownups suffering from CVD including stroke, angina, acute coronary syndrome, and monogenic lipid disorder. For prevention purposes, statins should be administered to all persons under the age of 84, who are of a high risk of contracting cardiovascular disease, all grownups above 40 years with type 1 diabetes, or those, who have been with diabetes for over ten years. Atorvastatin should be administered as a preventive drug to people with chronic kidney disease. In some instances, statins should be administered to people of all ages with cardiovascular danger plus various health problems, such as metabolic syndrome, hypertension, TChol concentration level more than 6 mmol/L, or those having a strong history of the same concentration level in their family. Statins are associated with the loss of memory, confusion, and liver injury. It may also lead to the risk of increased level of sugar in blood and progress of type 2 diabetes. It is also associated with damaging muscles (Chatzizisis et al., 2010). Since it can be used for ppreventive purposes, it relieves people of low economic status from the burden of treating diseases, such as cardiovascular disease and diabetes, which are very expensive to treat.

Conflict and How It Was Handled

I was once involved in the conflict with my fellow APN at work regarding reporting time to change one another with shifts. Since nursing involves working during the night and day, my colleague and I were to take over from each other or relieve one another by working either during the day or night. I was of the view that the person working during the day should be relieved earlier enough or work for shorter time, since he or she attends more patients, who report during the day, than the patients that report during the night. My colleague resisted and was of the view that we should work 12 hours each day either during the day or night. Before a resolution was reached, we turned to having bad relationship with each other. We informed our manager about the issue and she decided to utilize collaboration as a method of resolving conflict to solve the problem. Collaboration tries to work with both parties in order to come up with a solution that would satisfy all parties (Mary, 2012). All of us including our manager listened compassionately and ensured that a sound resolution was found. Furman (2010) indicates that companionate listening is a commanding skill in creating peace. While this type of resolution solved the problem, it utilized a lot of our time and needed all of us to be committed for its effectiveness. All of us were satisfied with the resolution made, as it tried to strike a balance of the needs of both of us. We, therefore, felt that we were heard and that the solution obtained was long lasting and would enhance a long lasting relationship between us. In order to improve both the situation and the outcome, and since the issue in question does not only affect the two of us, but also other APNs, the manager should have involved other APNs in the facility in order for the problem not to reoccur among other APNs in future.

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