Action: Low-dose dobutamine (Dobutrex) and low-dose dopamine are relatively safe on med-surg units. In low doses the drugs dilate renal blood vessels, stimulating renal blood flow and glomerular filtration rate, which in turn promotes sodium excretion, often helping CHF patients improve.
Nursing Interventions: Make certain patient not taking MAO inhibitors, tricyclic depressants, phenytoin (Dilantin), and haloperidol (Haldol). Accurate I&O; assess for dizziness, nausea, vomiting, headache. Assess vital signs carefully q15min for first 2 hours, then q2h for following 4 hours, and finally once a shift. Observe carefully for extravasation, tachycardia, bradycardia, angina, palpitations, hypotension, hypertension, azotemia, and anxiety.
Inotropic Agents: Human Natriuretic Peptides Nesiritide (Natrecor)
Human Natriuretic Peptides Nesiritide (Natrecor)
Action: New class of heart failure drug known as synthetic human B-type Natriuretic Peptides (hBNPs); Nesiritide causers arterial and venous dilation, thereby decreasing systemic vascular resistance and pulmonary arterial pressures. It decreases blood pressure and promotes better left ventricle ejection and increases cardiac output. Nesiritide may also promote dieresis. It is an intravenous treatment of patients with acutely compensated CHF.
Nursing Interventions: Observe carefully for hypotension. Natrecor should not be used for patients with cardiogenic shock, or with a systolic BP < 90mmHg.