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What are Cardiotonics?
Drugs used 2 increase the efficiency and improve the contraction of the heart muscle which leads 2 improved blood flow 2 all tissues in the body.
- complex clinical syndrome that can result from any number of cardiac or metabolic disorders. Ex:
- Ischemic heart disease
- Any condition tht impairs the ability of the ventricle 2 pump blood can lead 2 heart failure.
Heart failure causes a number of ______________changes as the body tries to compensate for the increased workload of the heart.
- Neurohormonal responses affecting heart failure. The body activates the neurohormonal compensatory mechanisms, which result in
- increased secretion of the neurohormones by the sympathetic nervous system
- Activation of the renin-angiotensin-aldosterone (RAA) system
- Remodeling of the cardiac tissue
The sympathetic nervous system increases the secretion of the of the catecholamines (the neurohormones epinephrine and norepinephrine), which results in?
increase heart rate and vasoconstriction
Increases in neurohormonal activity cause a remodeling of the cardia muscle cells, leading to
Hypertrophy(enlargement) of the heart, increased need for oxygen, and cardiac necrosis which worsens the heart failure(HF)
What are signs of Left ventricular dysfunction?
- Shortness of breath with exercise
- dry, hacking cough, or wheezing
- Orthopnea (hard 2 breath while laying flat)
- Restlessness & anxiety
*Left side of heart is usually affected first*
What are signs of right ventricular dysfunction?
- Swollen ankles, legs, or abdomen, leading to pitting edema
- Nocturia (frequently peeing @ night)
- weight gain bcuz of fluid retention
- OTHER SIGNS OF BOTH L&R
- Palpatations, fatigue, or pain when performing normal activities
- Tachycardia or irregular heart rate
- Dizziness or confusion
What are actions, uses, a/r, contr/prec of
cardiac glycosides or digitalis glycosides
Action = increase cardiac output.
Uses = heart failure, Atrial fibrillation(rapid contractions, quivering of heart)
A/R = headache, weakness, drowsiness, visual disturbances, Arrhythmias, GI upset and anorexia, digitalis toxicity(toxic drug effect)
Contrainindicated = ventricular failure, ventricular tachycardia, or AV block.
Precaution in = electrolyte imbalances, hypokalemia, hyperkalemia, hypomagnesemia, severe carditis, heart block, myocardial infarction, severe pulmonary diseas, acute glomerulonephritis, impaired renal or hepatic function
*Taken w/food but high-fiber meals decrease absorption*
Miscellaneous Inotropic drugs
Milrinone - used more and more effective, less a/r
Used in short term management of severe HF. Does not cure HF but control signs & symptoms.
Route = IV nurse monitors closely
Nurse = monitors heart rate, b/p continously w/administration of either drug. If hypotension occurs discontinue rx and rate of administration is reduced.
What preadministration assessments does the nurse need to do b4 giving a cardiotonic drug?
- NURSE actions B4 therapy:
- Take b/p, apical-radial pulse rate, respiratory rate (done b4 each dose given)
- Ausculate lungs
- Examine EXT 4 edema
- Check jugular veins 4 distention
- Measuring weight
- Ispect sputum (noting appearance frothy, pink-tinged, clear, yellow)
- Looking 4 signs of other problems like cyanosis, SOB, mental changes
- Review labs renal, hepatic function tests, CBC, Serum enzyme, electrolyte levels
- ongoing assessment:
- If pulse is below 60bpm in adults or greater than 100bpm nurse withholds rx and notifies dr. unless written order giving different guidelines 4 withholding rx. 4 children below 70bpm or above 90bpm withhold rx. Weigh pt daily
- Chk 4 edema
- Electrolyte imbalances
What is Digitalization?
- Patients started on cardiotonics are being digitalized by 2 methods
- Rapid digitalization = Loading dose
- Gradual digitalization = maintenance dose given allowing therapeutic drug blood levels 2 accumulate gradually
*digitalization is giving a series of doses until drug begins 2 exert full therapeutic effect*
What are Nursing duties during digitalization?
- Take b/p, pulse, respiratory rate every 2 to 4hrs or as ordered
- Measure serum levels (digoxin) level below 2.0 report
- rpt any signs of digitalis toxicity - anorexia, nausea, vomiting, abd pain, visual disturbances(blurred, yellow, or green vision and white halos, borders around drk objects, arrhythmias
If the nurse gives a cardiotonic by IV or IM, oral
- administer the rx slowly
- assess administration site 4 redness or infiltration
- rotate injection sites
- IM injections not recommended 4 these drugs
- Doesn't have 2 be with food
- tablets can be crushed & mixed with food or fluids if pt has problems w/ swallowing.
- don't alternate btween the dosage forms.
If client on cardiotonics has imbalanced nutrition bcuz a/r anorexia, nausea, vomiting
- NURSE does
- Alert physician
- offer frequent small meals rather thn lg meals
- suggest restictin fluids @ meals and avoid fluids 1hr b4 and after meal 2 contol nausea
- help pt w/ oral hygiene by brushing teeth or rinsing mouth
If client on cardiotonics has activity imbalance bcuz weakness or drowsiness
- Nurse does:Encourage client 2 increase daily activities gradually as tolerance increases
- Plan activities as tolerance increases
- Adequate rest periods are planned during the day
- Assist with activities and ambulation
Educating the pt and family
- Nurse includes Don't discontinue rx w/out checking w/ dr.
- Don't miss a dose or double up
- Take drug @ same time of day
- Take pulse b4 taking drug below 60 or above 100 don't take drug
- Avoid antiacids and nonprescription cough, allergy, antidiarrheal, and diet drugs
- Contact dr. of dig tox signs
- Carry medical identification of diseas
- Keep drug in original container
- Keep all f/u appts.
- Follow dietary recommendations if any