Allergy to protamine sulfate.

Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. Manifestations of allergic reactions include hypotension, bronchospasm, and skin and mucous membrane reactions. The severity of the adverse responses may vary from mild to causing death. Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed.

Hypertension: diagnosis, acute antihypertension therapy, and long-term management.

Hypertension remains a major modifiable risk factor for coronary heart disease, cerebrovascular disease, peripheral vascular disease, and renal disease. Although great strides have been made in increasing patient awareness, lifestyle changes, and compliance with treatment protocols, hypertensive emergencies and hypertensive urgencies remain a major concern. Unless treated promptly, irreversible target organ damage will ensue. Therefore, patients with acutely elevated blood pressure, regardless of cause, must be evaluated expeditiously, and appropriate treatment must be initiated. Nurses must be able to assess and monitor patients and their progress and recognize signs and symptoms of complications related to hypertension. Once blood pressure control has been achieved, nurses initiate patient education. However, long-term management must not only include blood pressure monitoring and patient education, but also emphasize lifestyle changes.