Heart rate assessment

Ms. Stovall, age 66 years, is hospitalized for congestive heart failure. She is improving but has been complaining offeelings of anxiety. Her respirations are 32 min, heart rate 88 bpm, and blood pressure 118 j60 mm Hg. The primary health care provider prescribes alprazolam 0.25 mg PO TID. What precautions would the nurse expect to be taken because of Ms. Stovall s age Discuss what assessment findings would indicate increased anxiety. 

Assess the patient s general appearance, use of accessory muscles, respiratory rate, heart rate, lung sounds, pulsus paradoxus, PEF, and oxygen saturation. 

Assess the effectiveness of (3-blocker therapy by measuring heart rate. Heart rate reduction of 25% from baseline or to 55 to 60 beats/minute is desirable. Ask the patient specific, directed questions regarding adverse effects of p-blockers inquire about symptoms of orthostatic hypotension (e.g., lightheadedness, dizziness, or fainting). 

Monitor vital signs (i.e., temperature and heart rate) and laboratory assessments (i.e., WBC count) daily to assess resolution of infection and efficacy of pain medications. When possible, interview the patient to obtain additional information about pain control. 

At each follow-up visit, compliance with a healthy lifestyle should be determined, as well as measurement of physical parameters, including weight, blood pressure, and heart rate. Waist circumference should be measured intermittently. A complete assessment also would include identification of adverse drug reactions or drug interactions if weight-loss medications have been initiated. 

Heart rate, cardiac rhythm, and blood pressure should be assessed and documented throughout the resuscitation attempt and after each intervention. Determination of the presence or absence of a pulse is paramount to deciding which interventions are appropriate. 

Cardiac index and blood pressure must be sufficient to ensure adequate organ perfusion, as assessed by alert mental status, creatinine clearance sufficient to prevent metabolic azotemic complications, hepatic function adequate to maintain synthetic and excretory functions, a stable heart rate and rhythm, absence of ongoing myocardial ischemia or infarction, skeletal muscle and skin blood flow sufficient to prevent ischemic injury, and normal arterial pH (7.34 to 7.47) with a normal serum lactate concentration. These goals are most often achieved with a cardiac index greater than 2.2 L/min/m2, a mean arterial blood pressure greater than 60 mm Hg, and PAOP of 25 mm Hg or greater. 

Endpoint. An indicator measured in a patient or biological sample to assess safety, efficacy, or another trial objective. Some endpoints are derived from primary endpoints (e.g., cardiac output is derived from stroke volume and heart rate). Synonyms include outcome, variable, parameter, marker, and measure. See surrogate endpoint in the text. Also defined as the final trial objective by some authors. 

Malik, M. (2001) Problems of heart rate correction in assessment of drug-induced QT interval prolongation. Journal of Cardiovascular Electrophysiology, 12, 411—420. 

Regulatory guidance for non-clinical cardiovascular safety pharmacology testing is given in the ICH S7A and B.25,42 The effects of an NCE on blood pressure, heart rate, and the ECG should be evaluated. Furthermore, in vivo, in vitro, and ex vivo evaluations, including methods for (assessing) repolarization and conductance abnormalities, should... 

Tattersall, M.L., Dymond, M., Hammond, T., and Valentin, J.P., Correction of QT values to allow for increases in heart rate in conscious beagle dogs in toxicology assessment, /. Pharmacol. Toxicol. Method, 53, 11-19, 2006. 

In black-tailed deer, Odocoikus hemionus columbianus, fecal odors of sympatric predators (coyote, C. latrans, and mountain lion, Fdis concolor) in vials next to food pellets inhibited feeding, while those of allopatric predators (lion, Fdis leo, snow leopard, Uncia uncia) do not, or very little (Miiller-Schwarze, 1972 Fig. 12.3). Note that mammals discriminate between the odors of sym- and allopatric predators, while fish and rattlesnakes do not (pp. 359 and 364). Free-ranging adult female wapiti, Cervus elaphus canadensis, respond to the odors of dog urine, and cougar and wolf feces (presented as water slurry) with increased heart rates. It was concluded that the main effect of predator odors may be for assessing the risk of predation (Chabot etal, 1996). 

The ICH guideline lists the assessment of effects on blood pressure, heart rate and ECG. In vivo, in vitro and/or ex vivo evaluations, including methods for electrical repolarisation and conductance abnormalities, should also be considered. These abnormalities can be associated with risks for fatal ventricular arrhythmias called Torsade de pointes. 

Heart beat regularity and heart rate are assessed with the embryo still within the intact yolk sac. 

Blood pressure, heart rate, BUN, and serum creatinine levels to assess renal function... 

Contradicting results were reported for GFJ when administered with caffeine. One study reported no changes in AUC, blood pressure, and heart rate (173). A second study reported increases in AUC and half-life. However, no assessment of pharmacodynamic parameters was performed (89). Furthermore, GFJ increased the fraction absorbed and the percentage of excreted dextromethorphan (28). The above-mentioned interactions can be considered weak regarding the overall exposure. Furthermore, dextromethorphan has a broad therapeutic window. The interactions of GFJ with caffeine and dextromethorphan do not seem to be of clinical relevance. 

L. Cloarec-Blanchard, C. Funck-Brentano, A. Carayon, and P. Jaillon. Rapid development of nitrate tolerance in healthy volunteers assessment using spectral analysis of short-term blood pressure and heart rate variability. J. Cardiovasc. Pharmacol. 24 266-273, 1994. 

Two parallel groups of healthy volunteers received 20 mg of citalopram (n = 12) or placebo (n = 6) once daily for 10 d in a randomized, double-blind fashion, followed by concomitant selegiline, 10 mg once daily for 4 d. The safety of this drug combination was assessed by measurements of blood pressure, heart rate, body temperature, and inquiries for adverse events. Blood samples were taken for the analysis of serum concentrations of selegiline, citalopram, and their metabolites. In addition, plasma was obtained to measure prolactin, epinephrine, norepinephrine, and 3,4-dihydroxyphanolglycol (DHPG), the urinary excretion of norepinephrine and 5-hydroindoleacetic acid (5-HIAA), the urinary metabolite of serotonin. 

Kelling et al. (1987) assessed the effects of 2,3,7,8-TCDD on cardiac function tests in male Sprague-Dawley rats 7 days after single oral doses of 6.25, 25, or 100 g/kg. At 100 g/kg (near-lethal dose), an increased sensitivity to the inotropic (left atrium) and chronotropic (right atrium) effects of isoproterenol were observed. Three daily oral doses of 40 g/kg caused decreased heart rate, depressed blood pressure, and increased myocardial peroxidase activity in rats (Hermansky et al. 1988). All of these effects may have been secondary to the modulation of adenylate cyclase activity at -adrenergenic receptors as a result of hypothyroidism (Hermansky et al. 1987). 

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