Wednesday, December 11, 2019

Sodium Levels Increases

Question: Discuss about the Sodium Levels Increases. Answer: Introduction: Digoxin specifically acts by inhibiting sodium-potassium adenosine triphosphatase (Na+/K+ ATPase) in the myocardium. As a result, intracellular sodium levels increases which produces sodium and calcium reverse exchange through sodium-calcium exchanger. In healthy situation, 3 sodium ion exchanges for 1 calcium ion. Due to this reversal, more calcium ions get imported for actiin and myosin proteins. This increase in the intracellular calcium increases heart rate. As a result there is increase in the duration of the phase 4 and phase 0 of the cardiac action potential. Digoxin is specifically used for atrial fibrillation and atrial flutter and infrequently used for the treatment of heart failure. There is insufficient diastolic filling time due to increased ventricular rate. Digoxin is helpful in reducing this ventricular rate by reducing conduction rate in AV node and results in the increase in the refractory period. It results in the augumentation in the filling and augumentation in t he pumping activity of the heart. Digoxin also act by indirectly acting on the autonomic nervous system. It produces autonomic actions by producing vagomimetic action and baroreceptor sensitization. Vagomimetic action increases effect of digoxin on SA and AV node. Baroreceptor sensitization produces augumented afferent inhibitory activity and decreased sympathetic nervous system and rennin-angiotensin system activity (Ziff and Kotecha, 2016).. Frusemide is mainly used to treat edematous condition due to cardiac failure, liver scarring and renal disease. Mechanism of action of frusemide is similar to other loop diuretics like bumetanide, ethacrynic acid and torsemide. It produces its action by inhibiting Na+-K+-2Cl symporter (cotransporter) (NKCC2) in the thick ascending limb of loop of Henle. As a result, there is inhibition of reabsorption of sodium, chloride and potassium. This inhibition of reabsorption can be achieved by competing with Cl binding site. Potassium recycling through renal outer medullary potassium channel results in the positive lumen voltage gradient which leads to the reabsorption of the magnesium and calcium. By virtue of this, frusemide prevents generation of hypertonic renal medulla. As a result, water has minimal osmotic driving force which lead to the augumented urine production. There is decreased water reabsorption in the blood due to action of frusemide and decreased blood volume. Frusemide also acts by increasing the generation of prostaglandins which produces vasodilatation and augumented blood supply to the kidney. There is the possibility of fluid retention in cases of heart failure, liver cirrhosis and renal failure. Frusemide act by increasing the urine excretion as a result there is removal of fluid form the body (Lilley et al., 2015). For removing peripheral intravenous cannula following steps should be followed. Inform patient about little discomfort. Gloves and apron should be put on and hands should be disinfected. Old dressing should be removed. Area should be disinfected. Cannula should be kept in situ. Gauze should be folded to create absorbent pad. Gauze should be kept on the cannula insertion site. Cannula should be withdrawn and gentle pressure should be applied on the insertion site. This gentle pressure should be continued until bleeding stopped. As sterile guaze should be applied on the site. Cannula removal should be documented (Koutoukidis and Stainton, 2016) References: Koutoukidis, G. and Stainton, K. (2016). Essential Enrolled Nursing Skills for Person-Centred Care. Elsevier Health Sciences. Lilley, L. L., Collins, S. R., and Snyder, J. S. (2015). Pharmacology and the Nursing Process. Elsevier Health Sciences. Ziff, O.J., and Kotecha, D. (2016). Digoxin: The good and the bad. Trends in Cardiovascular Medicine, 26(7), 585-95.

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