Dopamine RN Review

Dopamine
Tradenames: Dopastat, Intropin, Revimine
Classification: Autonomic Nervous System Agent; Apha and Beta Adrenergic sympathomimetic; Vasopressor
Pregnancy Class: C

Baylor Concentration:
–Standard concentration- 800mg/500ml
–Max Concentration- 3200mg/500ml

Uses:
–Low cardiac output
–hypotension
–Poor peripheral perfusion when adequate intravascular volume and stable rhythm
–treat shock, kidney failure, trauma, Surgery,

MOA:
— Alpha1 Agonist
–positive inotrope catecholamine
–increases urine output without increasing creatinine clearance in a number of settings.
–Improves the pumping strength of the heart by stimulating beta1 receptors and improves blood flow to the kidneys by stimulating Alpha1 receptors

Low Dose: Dopamine Receptor Agonist
–1-5 mcg/kg/min
–Vasodilatation of capillary beds, reduced systemic vascular resistance and increased cardiac output
–predominantly stimulates DA1 and DA2 receptors in renal, mesenteric and coronary beds causing vasodilatation
–SE: Tachyrythmia
Medium Dose: Beta1 Agonist
–5-10mcg/kg/min
–Increases contractility and heart rate, stroke volume and cardiac output
High Dose: Alpha1 Agonist
–10-15mcg/kgmin
–Vasoconstriction increasing afterload, peripheral resistance and blood pressure.

Contraindications:
–Tachycardia and VFIB
–MAO – intensifies the effects of dopamine
–Buergers Disease
–Raynaud’s Disease
–CAD
–Hx of Blood Clots
–Asthma
–Pheochromocytoma

SE/AR
–Arrhytmia specially svt and vt’s
–Pulmonary vasoconstriction
–tachycardia
–increased oxygen demand of the myocardium
–hypertension
–local is ischemia and necrosis if extravasation of PIV
–inactivated in alkaline solutions
–painful difficult urination; blood in urine
–weakness, confusion, urinating less than the usual or not at all
–weak shallow breathing
–burning, pain, or swelling around the iv needle
–cold feeling, cyanosis in your hands and feet
–darkening or skin changes in your hands or feet.

10Roberts Nursing Considerations:
–Starting, Titrating, Weaning and Discontinuing gtt needs v/s q15x4, q30x2, q1x1 then q4 or each dosage change
–Needs a back up line and must be used with central line.
–Max dose 15mcg/kg/min
–2RN checks during titration,starting,changing bag and DC
–must be admitted in telemetry or icu or acute care unit
–Patient needs to be in the ICU if drip is more than 5mcg/kg/min
–Must be administered using iv pump.
–Actual weight on the day of initiation should be used for calculations.
–Patient admitted with their own infusion pump needs to be shifted to BUMC iv pump within 24 hours.
—Get the dose and dosing weight of the Dopamine infusion then Obtain an order.
—Change infusion using BUMC concentration as soon as possible

–Cardiovascular failure and shock occur when tissue oxygen delivery is inadequate to meet tissue
oxygen demand.
–Early recognition of the signs of shock is difficult.
–Early treatment of shock is crucial to avoid irreversible cellular hypoxia.
–Cardiac output and arterial oxygen content must be optimized before commencing vasoactive
therapies.
–Inotropes increase myocardial contraction and cardiac output.
–Vasopressors increase systemic vascular resistance.
–Patients on inotropes and vasopressors should be managed on a critical care unit.
–Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage.
–Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation).
–Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.

My AT&T Unlimited Data Plan

Recently I received a mail from AT&T saying that they will retain my grandfathered unlimited data plan for my iPhone but with one catch they will increase my rate from $70 to $75 all inclusive and to me that’s not bad since I really use a lot of data from watching movies and youtube.

and now the unlimited plans is coming back to AT&T and I think that’s great!

 

American Girl Doll Truly Me #60

 

 

Recently my daughter got her wish come true— a Truly Me American Doll #60 and she loved it very much!

 

How to fry dried fish!

This is how to fry dried fish one commenter asked if its ok to microwave them, yes it’s ok and will be ready to eat but it will make a smell that you don’t like your visitors or other people don’t like and actually it makes if you microwave it first prior to frying it, it will make the dried fish crispy and faster to fry.

Fastest way to get Heart Transplanted

Go and see a cardiologist at Baylor University Medical Center if you get approved for heart transplant taking into consideration you have good insurance backing and financial backing and you are not high risk for cardiac surgery then you can be transplanted probably in a month or weeks.

Sunnyvale TX

Intersection of Collins Ave and Stoney Creek Blvd…

Sunnyvale TX
Stoney Creek at Sunnyvale TX (click the photo for better quality)

Stoney Creek Community is the only new community in Sunnyvale that HOA has a gym for residents.



 
100th Heart Transplant since last 14 months… though Heart Transplant in Dallas started in 1980’s…
 

Baylor University Medical Center at Dallas nations busiest heart and lung transplant facility…

Circa 2013… Baylor University Medical Center is the nations busiest heart transplant facility in the United States. With the new matching process it brings down 18days for status 1A reciepient to get a heart.

So if you want to shorten short shorter  wait time for heart transplant go to Dallas Baylor University Medical Center…