Vasopressors dopamine

The client in a code is in ventricular fibrillation and then is in sinus rhythm with PVCs. After taking vital signs the HCP orders a dopamine, vasopressor, drip at... 

MAINTAINING ADEQUATE TISSUE PERFUSION. When a patient is in shock and experiencing ineffective tissue perfusion tiiere is a decrease in oxygen resulting in an inability of die body to nourish its cells at die capillary level. If die patient has marked hypotension die administration of a vasopressor (a drug diat raises die blood pressure because of its ability to constrict blood vessels) is required. The primary health care provider determines die cause of die hypotension and then selects the best mediod of treatment. Some hypotensive episodes require die use of a less potent vasopressor, such as metaraminol, whereas at other times a more potent vasopressor, such as dobutamine (Dobutrex), dopamine (Intropin), or norepinephrine (Levoplied) is necessary. 

The nurse considers the following points when administering the potent vasopressors dopamine and norepinephrine ... 

The less potent vasopressors, such as metaraminol, also require close patient supervision during administration. The nurse follows the same procedure as that for norepinephrine and dopamine but may take blood pressure and pulse determinations at less frequent intervals, usually every 15 to 30 minutes. The nurse needs sound clinical judgment to detemrine the frequency because there is no absolute minimum or maximum time limit between detenninations. 

Is there evidence of cerebral or myocardial ischemia If yes, begin vasopressor therapy of dopamine 10 mcg/kg... 

Vasopressin causes vasoconstrictive effects that, unlike adrenergic receptor agonists, are preserved during hypoxia and severe acidosis. It also causes vasodilation in the pulmonary, coronary, and selected renal vascular beds that may reduce pulmonary artery pressure and preserve cardiac and renal function. However, based on available evidence, vasopressin is not recommended as a replacement for norepinephrine or dopamine in patients with septic shock but may be considered in patients who are refractory to catecholamine vasopressors despite adequate fluid resuscitation. If used, the dose should not exceed 0.01 to 0.04 units/min. 

Treat hypotension with IV fluids or colloid replacement, and consider use of a vasopressor such as dopamine. 

Dopamine (Intropin) [Vasopressor/Adrenergic] Uses Short-tOTn use in cardiac decompensation secondary to X contractility when no hypovolemia is present T organ p fusion (at low dose) Action Renal dose 2-5 mcg/kg/min Inotropic dose 5-10 mcg/kg/min Pressor dose >10 mcg/kg/min Dose Adults Feds. 5-20 mcg/kg/min by cont inf, start at 5 and t by 5 mcg/kg/min to 20 mcg/kg/min max to effect (mix 400 mg in 250 mL DjW to make 1600 mcg/mL) (see Table 1-3) Caution [C, ] Contra Pheochromocytoma (adrenal gland tumor), VF, sulfite sensitivity Disp Inj 40, 80, 160 mg/mL, premixed 0.8, 1.6, 3.2 mg/mL SE Tach, vasoconstriction, 4- BP, HA, N/V, dyspnea Notes >10 mcg/kg/min X renal p fiision Interactions t Effects W/ a-blockers, diuretics, ergot alkaloids, MAOIs, BBs, anesthetics, phenytoin X effects W/ guanethidine EMS Correct hypovolemia before use use microdrip set or inf pump check soln- discolored... 

Neurogenic shock is generally occur in abdominal trauma, spinal anasthesia, spinal cord injury and is managed by vasopressor agents e.g. dopamine. 

Catecholamines are sympathomimetic drugs. Dopamine and norepinephrine are used as vasopressors (antihypotensives). Epinephrine is used as a vasoconstrictor, cardiac stimulant, or bronchodilator to counter allergic reaction, anesthesia, and cardiac arrest. It is also an antiglaucoma agent. 

Treatment is generally supportive. All patients should have intravenous access, cardiac monitoring, and should be observed for hypothermia and hypotension. Gastrointestinal decontamination procedures should be used as appropriate based on the patient s level of consciousness and history of ingestion. Activated charcoal can be used to adsorb ethchlorvynol if used within an hour of the exposure. A complete blood count should be obtained to assess for anemia or thrombocytopenia. Hypotension should initially be treated by elevating the feet and administering an intravenous fluid bolus, followed by administration of vasopressors such as norepinephrine or dopamine if necessary. Pulmonary edema should be managed with positive end... 

The basis of clinical management is supportive care. The airway should be secured and protected as needed. Symptomatic patients should have intravenous access and cardiac monitoring. Accidental ingestions exceeding 500-800 mg, and all intentional overdoses, should be treated with oral activated charcoal if patients present within 60 min of exposure. Seizures should be treated with benzodiazepines, or phenobarbital if refractory. Hypotension should be treated with intravenous fluids and vasopressors (dopamine or norepinephrine) if needed. Hemodialysis or hemoper-fusion may enhance elimination of both the parent compound and metabolites, but the clinical value of... 

Hypotension not responsive to intravenous fluids should be managed with vasopressors, such as dopamine, norepinephrine, epinephrine, and/or phenylephrine. If seizures occur, benzodiazepines should be administered. Due to their pharmacokinetic characteristics, moderate volume of distribution, and low protein binding, procainamide and NAPA may be removed via hemodialysis and hemoperfu-sion. Both procainamide and NAPA serum concentrations should be obtained. Normal therapeutic ranges are procainamide, 3-14pgml NAPA, 12-35 pg ml Measurement of electrolytes, renal function tests, and arterial blood gases should be considered. 

Maintain adequate cardiovascular function—-intravenous crystalloid solutions and vasopressors (e.g., dopamine, norepinephrine) if required. 

Dopamine typically is used as an initial vasopressor agent for hemodynamic support but is limited by its ability to increase cardiac output (by only 35%). Its use is frequently complicated by tachycardia and tachydysrhythmias and occasionally by an increase in PAOP. In contrast to norepinephrine, it decreases splanchnic oxygen use. Low-dose dopamine should not be used to prevent renal failure. 

Dopamine is frequently the initial vasopressor used in septic shock. Doses of 5 to 10 mcg/kg per minute are initiated to improve MAP. Most studies in patients with septic shock have shown that at these doses dopamine increases Cl by improving contractility and heart rate, resulting primarily from its effects. It increases arterial pressure and SVR as a result of both the increased cardiac output and, at higher doses (>10 mcg/kg per minute), as a result of the i effects. 

The clinical utility of dopamine as a vasopressor in the setting of septic shock is limited because large doses frequently are necessary to maintain cardiac output and blood pressure. At doses exceeding 20 mcg/kg per minute, there is limited further improvement in cardiac performance and regional hemodynamics. Its clinical use frequently is hampered by tachycardia and tachydysrhythmias, which may lead to myocardial ischemia. Although tachydysrhythmias theoretically should not be expected to occur until 5 to 10 mcg/kg per minute of dopamine, these fii effects are observed with doses as low as 3 mcg/kg per minute. They seem to be more prevalent in patients... 

Furthermore, tolerance to the vasodilatory effects of dopamine after 24 to 48 hours is evident in nonohguric patients with sepsis syndrome and has been reported in others. The lack of response to dopamine in septic shock patients on vasopressors and the tolerance that develops in responders to low-dose dopamine may be explained in part by time- and disease-dependent desensitization of the dopamine receptors this may not occur in those with sepsis syndrome or normal volunteers. Furthermore, differences in the extent of preexisting vasodilation and the pathophysiology of renal dysfunction in oliguric and septic shock patients also may contribute to the inconsistent responses seen to the administration of low doses of dopamine. 

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