dopamine (Inotropin) dobutamine (Dobutrex) Stimulate heart and ↑ force of contraction ↑ contractility + ↑ cardiac output Dobutamine preferred in managing heart failure (has a mild vasodilatory effect + does NOT ↑ HR as much as dopamine) Dopamine lower doses ↑ renal blood flow, higher doses ↑ BP Side effects tachycardia, dysrhythmias (PVC, VT), tissue necrosis if extravasation Vasodilator BiDil Combination of hydralazine (apresoline) and isosorbide dinitrate (Isordil) Used to treat African Americans with heart failure ↓ symptoms and hospitalizations attributed to heart failure Side effects headache, dizziness, orthostatic hypotension, lupus, peripheral neuropathy DO NOT take with Viagra or similar drugs Vasodilator nesiritide (Natrecor) New IV drip used for decompensated CHF ↑ B-type natriuretic peptide (BNP) ↓ PWCP + vasodilation + mild diuretic action = ↓ dyspnea Side effects hypotension, dysrhythmias (V Tach) Monitor cardiac rhythm and vital signs frequently 18. Justify the purpose of pulmonary artery pressure (PAP Pg. 750) monitoring and the intra-aortic balloon pump (Pg. 761). (SLO 2,4) Pulmonary artery pressure monitoring Swan-Ganz catheter or PA catheter Flow-directed, balloon-tipped catheter is inserted into a central vein (internal jugular or subclavian vein) and threaded into right atrium, then right ventricle, then pulmonary artery Systolic pulmonary artery pressure usually equal to right ventricular systolic pressure Used to evaluate left ventricular and overall cardiac function Measures pressure in right atrium, pulmonary artery, and left ventricle Obtains CVP, pulmonary artery pressure, pulmonary artery wedge pressure (PAWP), cardiac output, and cardiac index measurements Normal PA systolic pressure = 15 – 30 mmHg Normal PA diastolic pressure = 5 – 15 mmHg Left sided heart failure = ↑ pulmonary artery pressure Left ventricular failure, pericardial tamponade = ↑ PAWP Hypovolemia = ↓ PAWP Cardiac index cardiac output/m 2 of body surface area Intra-aortic balloon pump (IABP) mechanical circulatory support device Used for clients with large MIs, evidence of pump failure, after cardiac surgery, or to treat cardiogenic shock after MI temporarily takes over function of heart to allow injured myocardium to heal ↑ coronary artery + cerebral + renal perfusion Catheter with a 30 – 40 mL balloon introduced into aorta via femoral artery Balloon catheter connected to a console that regulates inflation and deflation of balloon 28
Inflates during diastole = ↑ perfusion of coronary and renal arteries Deflates just prior to systole = ↓ afterload and cardiac workload During most acute period balloon inflates and deflates with each heart beat (1:1 ratio) Improved client condition = IABP weaned to inflate—deflate at varying intervals to continually ↓ amount of support as heart muscle recovers 19. Explain differences in nursing care for clients with tissue and mechanical valve replacement surgery. (SLO 2,4) (Pg.
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- Fall '19
- stable angina, acute myocardial infarction, infarction, Acute coronary syndrome