20.2 Nutrition and Chronic Musculoskeletal and Integumentary Illness
3 min read•june 18, 2024
ACE inhibitors are a crucial class of medications that target the renin-angiotensin-aldosterone system. By blocking the conversion of angiotensin I to angiotensin II, they help lower blood pressure and improve cardiovascular health.
These drugs are commonly used to treat hypertension, heart failure, and prevent complications after heart attacks. While generally well-tolerated, ACE inhibitors can cause side effects like dry cough and require careful monitoring of blood pressure and kidney function.
Renin-Angiotensin-Aldosterone System (RAAS) and ACE Inhibitors
Mechanism of ACE inhibitors
Block conversion of angiotensin I to angiotensin II by inhibiting angiotensin-converting enzyme (ACE)
Angiotensin II acts as a potent vasoconstrictor increases blood pressure (BP)
Stimulates release of aldosterone leads to sodium and water retention
Reducing angiotensin II levels causes:
Vasodilation decreases peripheral vascular resistance lowers BP (amlodipine)
Reduced aldosterone secretion increases sodium and water excretion decreases blood volume (furosemide)
Increase bradykinin levels contributes to vasodilation and BP reduction
Blood Pressure Regulation and RAAS
Renin is released by the kidneys in response to decreased blood pressure
Renin converts angiotensinogen to angiotensin I
ACE converts angiotensin I to angiotensin II
Angiotensin II causes vasoconstriction and increases blood pressure
RAAS affects nephron function, regulating sodium and water reabsorption
ACE inhibitors improve endothelial function, promoting cardiovascular health
Common ACE inhibitors and indications
Captopril (Capoten)
Hypertension
Heart failure
Post-myocardial infarction (MI)
Enalapril (Vasotec)
Hypertension
Heart failure
Lisinopril (Prinivil, Zestril)
Hypertension
Heart failure
Post-MI
Ramipril (Altace)
Hypertension
Cardiovascular risk reduction (stroke prevention)
Benazepril (Lotensin)
Hypertension
Chronic kidney disease (CKD)
Adverse effects of ACE inhibitors
Common adverse effects:
Dry cough due to increased bradykinin levels
Hypotension especially with first dose or in volume-depleted patients (diuretics)
Hyperkalemia due to reduced aldosterone secretion
Renal dysfunction particularly in patients with pre-existing renal impairment or renal artery stenosis
Angioedema (rare but potentially life-threatening)
Swelling of face, lips, tongue, and throat
More common in African American patients
Drug interactions:
Potassium supplements and potassium-sparing diuretics (spironolactone) increased risk of hyperkalemia
NSAIDs (ibuprofen) may attenuate antihypertensive effect increase risk of renal dysfunction
Lithium increased lithium levels and toxicity risk
Contraindicated in pregnancy due to potential fetal harm (oligohydramnios)
Nursing considerations for ACE inhibitors
Assess BP, renal function, and electrolytes (especially potassium) before initiating therapy and periodically during treatment
Monitor for signs and symptoms of angioedema such as swelling of face, lips, tongue, or throat
Instruct patients to seek immediate medical attention if angioedema occurs
Advise patients to report persistent dry cough as this may necessitate switching to another antihypertensive class (ARBs)
Educate patients on importance of adhering to prescribed dosing schedule and not discontinuing medication without consulting healthcare provider
Instruct patients to rise slowly from sitting or lying positions to minimize risk of orthostatic hypotension
Encourage patients to maintain healthy lifestyle including low-sodium diet (), regular exercise, and stress management
Advise patients to avoid potassium supplements and salt substitutes containing potassium unless prescribed by healthcare provider
Educate patients on signs and symptoms of hyperkalemia such as muscle weakness, fatigue, and irregular heartbeat
Stress importance of regular follow-up appointments to monitor BP, renal function, and electrolytes
Key Terms to Review (31)
Acrodermatitis Enteropathica: Acrodermatitis enteropathica is a rare, inherited disorder characterized by a deficiency in the absorption of the essential trace mineral zinc. This deficiency leads to a variety of skin, gastrointestinal, and neurological symptoms that can have significant impacts on an individual's overall health and well-being.
Anti-Inflammatory Diet: An anti-inflammatory diet is a dietary approach that focuses on consuming foods with anti-inflammatory properties to help reduce inflammation in the body. This type of diet is often recommended to support various health conditions, including pulmonary, gastrointestinal, and musculoskeletal disorders, where inflammation plays a key role.
Bone Density: Bone density refers to the amount of bone mineral content per unit volume or area of bone. It is a measure of the strength and health of an individual's bones, which is crucial for maintaining musculoskeletal and integumentary wellness across the lifespan and managing chronic musculoskeletal and integumentary illnesses.
Bone Remodeling: Bone remodeling is the dynamic process by which bone tissue is continuously renewed and reshaped throughout an individual's lifetime. It involves the coordinated activity of bone-forming cells (osteoblasts) and bone-resorbing cells (osteoclasts) to maintain the structural integrity and strength of the skeletal system. This term is crucial in understanding the impact of nutrition on the musculoskeletal and integumentary systems, as well as strategies to improve musculoskeletal and integumentary wellness and manage related chronic conditions.
C-Reactive Protein: C-reactive protein (CRP) is a protein produced by the liver in response to inflammation in the body. It serves as a biomarker, providing information about the overall level of inflammation and the risk of certain health conditions, particularly cardiovascular disease.
DASH Diet: The DASH (Dietary Approaches to Stop Hypertension) diet is a eating plan focused on reducing blood pressure and promoting overall cardiovascular health. It emphasizes the consumption of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products, while limiting sodium, saturated fats, and added sugars.
Eczema: Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by red, itchy, and scaly rashes. It is a common integumentary disorder that can significantly impact an individual's quality of life and is often associated with other chronic musculoskeletal conditions.
Inflammation: Inflammation is the body's natural immune response to various stimuli, such as injury, infection, or irritation. It involves the activation of the body's defense mechanisms to remove harmful agents and initiate the healing process. Inflammation plays a crucial role in maintaining overall health and wellness across various bodily systems, including the endocrine, cardiovascular, pulmonary, gastrointestinal, musculoskeletal, and integumentary systems.
Malnutrition: Malnutrition is a condition resulting from an unbalanced intake of nutrients, either through deficiency or excess. It adversely affects bodily functions and overall health.
Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.
Malnutrition Universal Screening Tool: The Malnutrition Universal Screening Tool (MUST) is a simple and effective screening tool used to identify adults who are malnourished or at risk of malnutrition. It is particularly relevant in the context of chronic musculoskeletal and integumentary illnesses, as these conditions can significantly impact nutritional status and lead to malnutrition if not properly managed.
Mini Nutritional Assessment: The Mini Nutritional Assessment (MNA) is a validated screening tool used to identify malnutrition or risk of malnutrition in older adults. It evaluates various factors including dietary intake, weight loss, mobility, psychological stress, and body mass index (BMI).
MNA (Mini Nutritional Assessment): The Mini Nutritional Assessment (MNA) is a screening and assessment tool used to identify malnutrition or risk of malnutrition in older adults. It evaluates an individual's nutritional status based on anthropometric measurements, dietary intake, and subjective assessments to provide a comprehensive evaluation of nutritional health.
Muscle mass: Muscle mass refers to the total amount of muscle tissue in the body, crucial for movement, strength, and overall physical health. It plays a significant role in metabolic function and disease prevention.
MUST: MUST is a term that denotes a requirement or an obligation that must be fulfilled. It indicates a necessary or essential action or condition that cannot be overlooked or disregarded. In the context of nutrition and wellness, MUST highlights the critical importance of certain strategies, interventions, or considerations that are essential for achieving optimal outcomes.
Nutritional Deficiencies: Nutritional deficiencies refer to the lack or inadequate intake of essential nutrients required for proper bodily functions, growth, and development. These deficiencies can have significant impacts on an individual's health and well-being, particularly in the contexts of interdisciplinary teams in nursing practice, chronic hematologic illnesses, and chronic musculoskeletal and integumentary illnesses.
Osteoarthritis: Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, and impaired joint function. It is a common chronic musculoskeletal condition that can significantly impact an individual's quality of life and integumentary system.
Osteocalcin: Osteocalcin is a protein produced by osteoblasts, the cells responsible for bone formation. It is a key regulator of bone metabolism and plays a crucial role in the overall health and function of the musculoskeletal and integumentary systems.
Osteoporosis: Osteoporosis is a chronic, progressive skeletal disorder characterized by a decrease in bone mass and deterioration of bone tissue, leading to an increased risk of fractures. This condition is closely linked to various aspects of nutrition, including protein, vitamins, minerals, and supplements, as well as its impact on the musculoskeletal and integumentary systems across the lifespan.
Parathyroid Hormone: Parathyroid hormone (PTH) is a polypeptide hormone produced by the parathyroid glands that plays a crucial role in regulating calcium and phosphate homeostasis in the body. It is a key player in maintaining the balance of these minerals, which is essential for the proper functioning of the renal, musculoskeletal, and integumentary systems.
Pressure Ulcers: Pressure ulcers, also known as bedsores, are localized injuries to the skin and underlying tissue that typically occur over bony prominences due to prolonged pressure, shear, friction, or a combination of these factors. They are a significant concern in nursing practice and can have serious consequences for patients' health and quality of life.
Protein Synthesis: Protein synthesis is the biological process by which cells construct proteins. It involves the transcription of genetic information from DNA into RNA and the subsequent translation of RNA into functional proteins, which are essential for the structure, function, and regulation of the body's tissues and organs.
Psoriasis: Psoriasis is a chronic, autoimmune skin condition that causes the rapid buildup of skin cells, resulting in thick, scaly, and often inflamed patches on the skin. This term is particularly relevant in the context of understanding the impact of nutrition on the musculoskeletal and integumentary (skin) systems, as well as implementing and evaluating nutritional strategies to address musculoskeletal and integumentary wellness, and the role of nutrition in chronic musculoskeletal and integumentary illnesses.
Rheumatoid Arthritis: Rheumatoid arthritis is an autoimmune disorder that causes chronic inflammation in the joints, leading to pain, swelling, and stiffness. It is a progressive condition that can significantly impact an individual's mobility and quality of life if not properly managed.
Rickets: Rickets is a condition caused by a deficiency of vitamin D, calcium, or phosphate, resulting in impaired bone mineralization and growth in children. It is characterized by soft, weak, and deformed bones.
Scurvy: Scurvy is a nutritional deficiency disease caused by a lack of vitamin C, also known as ascorbic acid. It is characterized by a range of symptoms that affect various bodily systems, including the hematological, musculoskeletal, and integumentary systems.
Serum Albumin: Serum albumin is a type of protein found in the blood plasma that plays a crucial role in maintaining fluid balance, transporting various molecules, and supporting overall health. It is the most abundant protein in the human body and is closely linked to several important physiological processes.
Standardized nutritional risk assessment tool: A standardized nutritional risk assessment tool is a systematic method used to identify individuals at risk of malnutrition or nutritional deficiencies. It helps healthcare professionals develop appropriate nutritional interventions and monitor progress over time.
Subjective Global Assessment: Subjective Global Assessment (SGA) is a comprehensive evaluation tool used to assess a patient's nutritional status by considering their medical history, physical examination, and subjective factors. It is a widely used method to identify individuals at risk of malnutrition or those who require nutritional intervention.
Vitamin D: Vitamin D is a fat-soluble vitamin that plays a crucial role in maintaining overall health and wellness. It is often referred to as the 'sunshine vitamin' because the body can synthesize it when the skin is exposed to sunlight. Vitamin D is essential for the regulation of calcium and phosphorus levels in the body, supporting strong bones and teeth, and it also has important functions in various other physiological processes.
Wound healing: Wound healing is the complex process by which the skin or other body tissue repairs itself after injury. It involves a series of overlapping phases including hemostasis, inflammation, proliferation, and remodeling.