Chapter 24 NUR 203 Update to Pharmacology

Which patient is the best candidate to receive nesiritide (Natrecor) therapy?

A patient with acutely decompensated HF who has dyspnea at rest

During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as:

serum potassium level of 2.0 mEq/L

Classes of medications used in the treatment of heart failure are?

Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Beta blockers, and diuretics

Major adverse effect digoxin (Lanoxin)

CV: bradycardia or tachycardia, hypotension CNS: headache, fatigue, confusion, convulsions EENT: colored vision (i.e. green, yellow, or purple), halo vision GI: anorexia, nausea, vomiting, diarrhea

A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect?

Digoxin 1 mg IV push now; then 0.25 mg IV daily

What does digoxin do to help with heart failure?

It increases the force of myocardial contraction (positive inotropic effect) and slows heart rate (negative chronotropic effect).

A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication?

Positive inotrope

A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern?

Serum potassium level of 2.9 mEq/L

milrinone and nesiritide

Use an infusion pump (never gravity infusion) monitor input and output, heart rate and rhythm, BP, daily weights, respirations etc.

digoxin (Lanoxin)

Used for heart failure, atrial fibrillation and atrial flutter. Action: Increases the force of myocardial contraction (positive inotropic effect). Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Slowing of heart rate (negative chronotropic effect).

A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply)

delayed AV node conduction reduced heart rate decreased myocardial automaticity

How is an overdose of digoxin (Lanoxin) treated?

digoxin immune Fab (Digifab)

First line treatment for heart failure is?

diuretics

When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect?

dysrhythmia

When teaching the patient about the signs and symptoms of a cardiac glycoside toxicity, the nurse should alert the patient to watch for

flickering lights or halos around lights

Anasarca

general swelling of the whole body

Positive chronotropic drugs

increase heart rate

Positive dromotropic drugs

increase speed of cardiac electrical conduction

Positive inotropic drugs

increase the force of myocardial contraction

Only available phosphodiesterase inhibitor

milrinone (Primacor)

The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication?

nesiritide (Natrecor)

The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply)

positive inotropic effects vasodilation positive chronotropic effects

A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to

prevent stimulation of the heart by catecholamines

Apical pulse

pulse heard with stethoscope at the apex of the heart

nesiritide (Natrecor)

synthetic version of human B-type natriuretic peptide. Vasodilation of both arteries and veins, diuresis and natriuresis (urinary sodium loss). Used in ICU as final effort in life-threatening HF

The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which the ACE inhibitors exert their therapeutic effect in a patient in HF is

to inhibit aldosterone secretion.

milrinone (Primacor) major adverse effects

ventricular arrhythmias, hypotension, dysrhythmias and thrombocytopenia (deficiency of platelets which causes easy bruising)

The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone?

ventricular dysrhythmia