Autonomic Nervous System Regulation
4.4 Clinical Reasoning and Decision-Making for ANS Regulation
The next sections will focus on medications related to regulating the autonomic nervous system. Before we do that, it is important to re-examine the nursing process in guiding the nurse who administers ANS medications. The nursing process consists of assessment, diagnosis, outcome identification, planning, implementation of interventions, and evaluation. Because diagnosis, outcome identification, and planning are specifically tailored to the individual client, we will broadly discuss considerations related to assessment, implementation of interventions, and evaluation when administering antimicrobials.
Assessment
Recognizing cues…
Recall that assessment is all about recognizing and analyzing “cues” from your conversations and physical assessment of your clients.
Many types of medications stimulate or inhibit specific ANS receptors. By knowing the effects, it becomes easy for the nurse to recognize side effects resulting from the stimulation or inhibition of ANS neuroreceptors. Medications that stimulate ANS receptors often impact the heart, lungs, and blood vessels, so the nurse must often monitor blood pressure, heart rate, and lung sounds carefully for expected therapeutic effects and side effects. Anticholinergics cause muscle relaxation and can cause urinary retention, constipation, and dry mouth. The nurse should anticipate and assess for these side effects, and manage them as needed for client comfort.
Planning
Next, plan (refine your hypothesis), and take action.
When planning your care, remember to prioritize and refine your hypotheses based on your client assessment.
Common goals include:
- Client will understand the effects of their medication, and the importance of adhering to the medication regimen.
- Client’s vital signs will be within the desired range.
Implementation of Interventions
A nurse should be aware of parameters to administer or withhold medications affecting the autonomic nervous system. If the order parameters are unclear, the nurse should withhold the medication following safe administration guidelines, and notify the prescriber. For example, when no parameters are provided, blood pressure medications should not be administered if the client’s apical heart rate is less than 60 beats per minute and/or the systolic blood pressure is less than 100 mmHg.
Report any marked vital signs, changes or suspected adverse effects.
Implement fall precautions, when needed, based on anticipated side effects of ANS medications.
Evaluation
Finally, evaluate the outcomes of your action.
It is always important for nurses to know the reason why a medication is ordered for a specific client, so evaluation of therapeutic effectiveness can be documented. For example, if the purpose of medication is to improve urine flow, then improvement should be seen and documented. Otherwise, the side effects may not warrant the use of the medication.