Page 133 - Critical Care Nursing Demystified

118 CRITICAL CARE NURSING DeMYSTIFIED

TABLE 3–8 Afterload Reducers
Drug Action Use Precautions
Dobutamine See Table 3–7
(Dobutrex)
Milrinone Phosphodiesterase Positive ino- 1. Not actively titrated
(Primacor) inhibitor tropic therapy 2. Always use infusion
Increases contractil- in HF pump
ity by blocking 3. Assess VS, SaO
breakdown of cyclic 2
AMP 4. Observe for
hypotension and
Produces ventricular dys-
vasodilation rhythmias
Reduces afterload
Morphine See Table 3–6 MI to lower See Table 3–6
sulfate the workload
on the left
ventricle
Nitroglycerin See Table 3–6 Drops the BP See Table 3–6
and therefore
workload of
the heart 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.

Medical CV Conditions Requiring Critical Care

Hypertensive Emergencies

What Went Wrong?
6 Hypertensive crisis is a condition where the blood pressure (BP) soars
abnormally high and does not respond to the usual treatment. Nurses are famil-
iar with chronic hypertension (HTN) and its stages where the systolic blood
pressure goes beyond 120 mm Hg. But critical care nurses need to be familiar
with hypertensive emergencies.
There are two types of hypertensive emergencies: hypertensive urgency and
hypertensive crisis. In hypertensive crisis, there is target organ damage. Damage
to the heart, brain, blood vessels, and kidneys results from an unrelieved high
BP, so health care providers must lower the BP at once to prevent further pro-
gressive damage to these structures. The patient must be admitted to the inten-
sive care unit so that complications from HTN emergencies like stroke, acute
MI, abdominal aortic aneurysm (AAA), and seizures can be prevented.