Term
| Increased heart rate is oe of the effects of |
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Definition
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Term
| SNS stimulation results in |
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Definition
| bronchodilaton, vasoconstriction and decreased gastrointestinal mobility, depending upon which receptors are stimulated |
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Term
| Stimulation of beta2-adrenergic receptors results in |
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Definition
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Term
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Definition
Substances that can produce a sympathomimetic response.
I. Endogenous - epinephrine, norepinephrine, dopamine
II. Synthetic - dobutamine, phenylephrine |
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Term
| positive inotropic effect |
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Definition
| an increase in the force of contraction of the heart muscle (myocardium) |
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Term
| positive chronotropic effect |
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Definition
| an increase in heart rate |
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Term
| positive dromotropic effect |
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Definition
| an increase in the conduction of cardiac electrical impulses through the atriventricular node, which results in the transfer of nerve action potentials from the atria to the ventricals. Ultimately leads to a systolic heartbeat (ventricular contractions) |
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Term
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Definition
| indicated for the prevention of bronchospasms, not for treatment of acute symptoms. Dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in pts older than 12 |
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Term
| A pt comes into the clinic claiming tha the is "addicted" to his OTC nasal spray. What do you expect is happening to him? |
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Definition
| rebound nasal congestion. excessive use of nasal decongestants causes it. follow directions given by dr. |
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Term
| When making rounds at the change of shift, you notice that a restless pt's IV dobutamine infusion has infiltrated. What should you do? What do you think will be ordered? |
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Definition
| The infusion should be STOPPED IMMEDIATELY! The site should be assessed and physician notified. The nurse should expect to inject the site of infiltration with phentolamine, which will hopefully counteract the severe vasoconstriction that the dobutamine causes in the area. These actions work to prevent skin and tissue sloughing. |
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Term
| During administration of adrenergic drugs, adverse effects such as |
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Definition
| cardiac irregularities, hypertension, and tachycardia may occur. Stopping the drug should cause the toxic symptoms to subside quickly because of the drug's short half-life. |
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Term
| A pt on a dopamine drip tells the nurse that he is feeligng a little tightness in his chest. The nurse notes his pulse rate is elevated. What does nurse do next? |
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Definition
| Pt may be experiencing severe adverse effects of the adrenergic drug. Nurse should assess for cardiac rhythm irregularities and hypertension, and following the standard orders for reducing or stopping the drug if these adverse effects are noted. Dr. should be notified. |
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Term
| Nursing Implications - Assessment |
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Definition
1. assess for history of hypertension, cardiac dysrhythmias, or other cardiovascular disease
2. assess renal, hepatic, and cardiac function before treatment |
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Term
| Nursing Implications - Implementation |
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Definition
1. follow guidelines carefully
2. IV admin: check IV site for infiltration, use clear IV solutions, use infusion pump, infuse drug slowly to avoid dangerous cardiovascular effects, monitor cardiac rhythm |
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Term
| Nursing Implications - pt teaching |
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Definition
with chronic lung disease:
1. instruct pts to avoid factors that exacerbate their condition
2. encourage fluid intake up to 3000 mL/day if permitted
3. educate pts about proper dosing, use of equipment (MDI, spacer, nebulizer) and equipment care |
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Term
| Nursing Implications - Safety |
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Definition
1. Salmeterol is indicated for PREVENTION of brochospasms, not acute symptoms
2. overdose of nasal decongestants may cause rebound nasal congestion or ulcerations
3. avoid over the counter or other medications b/c of possible interactions
4. two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension |
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Term
| Nursing implications - therapeutic effects cardiovascular |
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Definition
Cardiovascular uses:
decreased edema
increased urinary output
return to normal vital signs
improved skin color and temperature
increased LOC |
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Term
| Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in HF by increasing myocardial contractility and stroke volume, HOWEVER |
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Definition
| adrenergic drugs may precipitate a MI, especially in pts with preexisting cardiac disorders. |
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Term
| Epinephrine is the drug of choice for |
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Definition
the treatment of anaphylaxis
the treatment of acute asthma |
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Term
| Dopamine is available only as an IV injectable drug and is given by |
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Definition
| continuous infusion, using an infusion pump |
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Term
| Nursing Implications - therapeutic effects - asthma |
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Definition
return to normal respiratory rate
improved breath sounds, fewer crackles
increased air exchange
decreased cough
less dyspnea
improved blood gases
increased activity tolerance |
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Term
Mr. P, 82, is receiving dopamine 5mcg/kg/min for HF. history of hypothyroidism and takes thyroid replacement hormone. yesterday his BP was 150/88, Pulse 92/min, Respiration rate 16/min. His hearth rhythm showed sinus rhythm with rare ectopic beats. no shortness of breath at rest, but dyspnea getting up to bedside commode. He has edema in lower legs at a rate of 2+
1. Explain how this dose of dopamine works to treat Mr. P's HF.
2. What would you expect to happen if the dose were set to 1 mcg/kg/min? 20 mcg;kg/min? |
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Definition
1. adrenergic receptor activity is stimulated, causing improved cardiac contractility which is desirable in HF
2. Low doses have dopaminergic effects resulting in dilation of blood vessels in the brain, heart, kidneys, and mesentery, increasing blood flow to these areas.
High doses cause alpha receptor stimulation resulting in unwanted CNS effects such as headache, restlessness, excitement, insomnia, possible cardiovascular adverse effects of chest pain, vasoconstriction, hypertension, tachycardia, and palpatations or dysrhythmias. |
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Term
Alpha 1, Beta 1, or beta2
1. pupil dilation
2. uterine muscle relaxation
3. vasoconstriction
4. increased cardiac contractility
5. constriction of bladder sphincter
6. uterine muscle contraction
7. increased heart rate
8. relaxation of bronchial smooth muscle |
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Definition
1. alpha 1
2. beta 2
3. alpha 1
4. beta 1
5 alpha 1
6. alpha 1
7. beta 1
8. beta 2 |
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Term
| Clinical Conditions for Epinephrine |
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Definition
1. emergency situations
2. primary vasoactive drug used in many advanced cardiac life support protocols
3. asthma, anaphylaxis shock
4. at high doses increases BP |
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Term
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Definition
endogenous vasoactive catecholamine
acts directly on both the alpha and beta adregenergic receptors |
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Term
| Epinephrine for anaphylaxis |
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Definition
| It has significant bronchodilatory effects via the beta 2 adrenergic receptors in the lungs |
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Term
| epinephrine - two strengths |
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Definition
| available in 1:1000 and 1:10,000 (1 mg/mL and 0.1 mg/mL be aware of differences in strength and double check |
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Term
| Cardiovascular Indications for dobutamine and dopamine |
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Definition
| Support the cardiac system during cardiac failure or shock. Through stimulatin of the beta1 receptors on heart muscle, it increases cardiac output by increasing contractility, which increases the stroke volume, esp in pts with heart failure. Dopamine at low doses dilate blood vessels in the brain, heart, kidneys and mesentery, which increases blood flow to these areas. At higher infusion it improves cardiac contractility and output, at highest doses causes vasoconstriction. Contraindicated in pts with a catecholamine secreting tumor called a pheochromocytomia. |
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Term
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Definition
| headache, restlessness, excitement,insomnia, and euphoria. chest pain, vasoconstriction, hypertension, tachycardia, palpitaitons or dysrhythmias. anorexia, dry mouth, nausea, taste changes, mild tremors, increased heart rate, sweating nausea, vomiting cramps |
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Term
| Adrenergic drugs are also called |
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Definition
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Term
| When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands these drugs produce |
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Definition
| positive inotropic, positive chronotropic and positive dromotropic effects |
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Term
| Your pt is receiving dobutamine as a continuous infusion, Titration of this medication is based upon which factors? |
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Definition
| heart rate, blood pressure, urine output |
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Term
| The nurse assesses the intravenous infusion site of a pt receiving dopamine and finds it is infiltrated. The nurse will prepare which medication to treat this infiltration. |
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Definition
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Term
| A pt using Afrin nasal spray complains of worsening cold symptoms and tells the nurse...why isn't it working? |
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Definition
| Nurse tell pt he is suffering from rebound congestion related to his use of Afrin. |
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Term
| Epinephrine, as an adrenergic (sympathomimetic) drug produces which therapeutic effect |
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Definition
| increased heart rate and contractility |
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Term
| A hypertensive crisis may occur if adrenergic drugs are given along with |
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Definition
| MAOIs (monoamine oxidase inhibitors) |
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Term
| The physician has ordered dopamine to treat a pt's hypovolemic shock secondary to severe blood loss. For the medication to be effective pt also needs |
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Definition
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