Page 128 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 113

TABLE 3–6 Preload Enhancers and Reducers
Action Use Precautions
Preload Enhancers (Vasopressors)
Dopamine Constriction of In hypotensive 1. Must have volume
the peripheral crisis, heart replacement before
veins failure and car- therapy
diac arrest 2. Still practiced but
being questioned
3. Monitor the site for
extravasation; large-
bore IVs are preferable
for use
Levophed Similar to epi- To elevate BP in 1. Monitor the BP every
(norepineph- nephrine in shock states, 2–5 minutes when
rine) action especially in beginning infusion
At high doses, hypotension 2. Monitor MAP (keep
increases vaso- due to cardio- around 80 mm Hg),
constriction of genic shock VS, CVP, and urinary
alpha receptors output
3. Use large-bore IV as
severe vasoconstric-
tion can result in Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
smaller peripheral IVs
4. Observe for extrava-
sation. Regitine can be
injected into tissues to
prevent necrosis
Preload Reducers (Vasodilators)
Diuretics like Tablets, IV To remove 1. Monitor the patientʼs
Lasix push, or contin- excessive fluid BP; do not give if
(furosemide) uous drip to help the below 90 systolic
heart work with 2. Check the potassium
less demand level before giving
3. Monitor the urinary
output for diuretic
effects
Aldosterone Blocks aldoster- In hyperten- 1. Relatively few
inhibitors like one secretion on sion, heart fail- 2. Can cause hyper-
spironolactone distal tubule, ure, to rid the kalemia, especially if
(Aldactone) or therefore body of excess given with an ACE
amiloride increasing water fluid inhibitor or ARB
(Midamor) excretion and Also helps 3. Contraindicated in
decreasing decrease ven- severe renal and
sodium tricular remod- hepatic disease
retention eling 4. Drowsiness, lethargy,
or headache can occur