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.

Hospital Shares of Stocks

I’m just wondering how much do a doctor need to come up to own a share of stock or to be a partner in a hospital or surgery centers.




Thanks to The Springs Fellowship Church

Thanks for these, from Baylor…

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I was working at the Triage Area of the Emergency Department of Baylor University Medical Center in Dallas and someone showed up from the Springs Fellowship Church and gave us these bagful of goodies to keep us awake all night. Everyone was so delighted to see the gift and Thanks for thinking of us and we are reminded that God loves us and everyone. Supervisor Shared it to everyone who was working that night.

Thanks to The Springs Fellowship Church

Thanks for these, from Baylor…

20120227-073204.jpg

20120227-073215.jpg
I was working at the Triage Area of the Emergency Department of Baylor University Medical Center in Dallas and someone showed up from the Springs Fellowship Church and gave us these bagful of goodies to keep us awake all night. Everyone was so delighted to see the gift and Thanks for thinking of us and we are reminded that God loves us and everyone. Supervisor Shared it to everyone who was working that night.

Clinique by Katy Perry

Katy Perry poster at Dillard’s for Purr a perfume by Clinique

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Christmas decor at Baylor

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Christmas decor at Baylor University Medical Center lobby. Baylor doesn’t spend so much on Christmas decor the streets are never lighted, one exception the Baylor Heart and Vascular Hospital usually line its hospital facade with lights and this decor just doesn’t stand, I guess Baylor is on austerity measure.

Baylor Address:
Baylor University Medical Center website
3500 Gaston Ave
Dallas, TX 75246



Careflight

Careflight is the best emergent para transit in North Texas

They have top of the line ambulances and helicopters

I always see them here at Baylor University Medical Center picking up patients and delivering patients.



List of Dallas Hospitals

Baylor University Medical Center 3500 Gaston Ave, Dallas, TX Operator: 214 820 1600 Emergency Room: 214 820 2501
Charlton Methodist Hospital 3500 W. Wheatland Road, TX 214-947-7777
Children’s Medical Center of Dallas 1935 Motor Street, Dallas 214-456-7000
Dallas Veterans Affairs Medical Center 4500 S. Lancaster Road 214-742-8387
Doctors Hospital 9330 Poppy Drive 214-324-6100
Forest Park Medical Center 11990 North Central Expressway 972 234 1900
Green Oaks Psychiatric Hospital 7808 Clodus Fields 972-991-9504
LifeCare Hospital of Dallas 6161 Harry Hines 214-525-6300
Baylor Uptown (aka Mary Shiels Hospital) 3515 Howell St. 214-443-3000
Medical City Children’s Hospital 7777 Forest Lane 972-566-8888
Medical City Dallas 7777 Forest Lane 972-566-7000
Methodist Medical Center 1441 N. Beckley Avenue 214-947-8181
North Central Surgery Center (Carrol Clinic) 214 265 2810
Parkland Memorial Hospital 5201 Harry Hines 214-590-8000
Presbyterian Hospital of Dallas 8200 Walnut Hill 214-345-6789
Renaissance Hospital Dallas 2929 S. Hampton Rd 214-623-4400
RHD Memorial Medical Center 7 Medical Parkway 972-247-1000
St. Paul Medical Center 5909 Harry Hines 214-645-5555
Texas Scottish Rite Hospital for Children 2222 Welborn 214-559-5000
Timberlawn Psychiatric Hospital 4600 Samuell Blvd 800-426-4944
Vibra Specialty Hospital 1950 Record Crossing 214-638-1500
Zale Lipshy University Hospital 5151 Harry Hines 214-645-5555

Baylor All Saints Medical Center – Fort Worh (817) 926-2544
Baylor Medical Center at Carrollton (972) 492-1010
Baylor Medical Center at Frisco (214) 407-5000
Baylor Medical Center at Garland (972) 487-5000
Baylor Medical Center at Irving (972) 579-8100
Baylor Medical Center at McKinney (469) 742-9782
Baylor Medical Center at Southwest Fort Worth (817) 346-5700
Baylor Medical Center at Trophy Club (817) 837-4600
Baylor Medical Center at Waxahachie (972) 935-9095
Baylor Regional Medical Center at Grapevine (817) 481-1588
Baylor Regional Medical Center at Plano (469) 814-2000
Baylor Plano THE HEART HOSPITAL (469) 814-3278
Baylor Specialty Hospital Dallas (214) 820-9720
Baylor University Medical Center at Dallas (214) 820-0111
Centennial Medical Center Frisco (972) 963-3333
Children’s Medical Center of Dallas (214) 456-7000
Children’s Medical Center at Legacy (469) 303-7000
Cook Children’s Medical Center Fort Worth (682) 885-4000
Cook Children’s Northeast Hospital (817) 605-2500
Dallas Medical Center Farmers Branch (972) 247-1000
Dallas Regional Medical Center in Mesquite (214) 320-7000
Dallas Womens Hospital of Mesquite (972) 270-3300
Denton Community Hospital (940) 898-7000
Doctors Hospital at White Rock Lake (214) 324-6100
Ennis Regional Medical Center (972) 875-0900
HCA Denton Regional Medical Center (940) 384-3535
HCA Las Colinas Medical Center (972) 969-2000
HCA Medical Center of Arlington (817) 465-3241
HCA Medical Center of Lewisville (972) 420-1000
HCA Medical Center of McKinney (972) 547-8000
HCA Medical Center of Plano (972) 596-6800
HCA Medical City of Dallas (972) 566-7000
HCA North Hills Hospital (817) 255-1000
HCA Plaza Medical Center of Fort Worth (817) 877-5292
Huguley Memorial Medical Center (817) 293-9110
John Peter Smith Hospital of Fort Worth (817) 921-3431
Kindred Hospital Arlington (817) 548-3400
Kindred Hospital Dallas (214) 355-2600
Kindred Hospital Fort Worth (817) 332-4812
Kindred Hospital Fort Worth Southwest (817) 346-0094
Kindred Hospital Mansfield (817) 473-6101
Kindred Hospital White Rock (214) 324-6562
Lake Pointe Medical Center Rowlett (972) 412-2273
Lifecare Hospital of Dallas (214) 525-6300
Lifecare Hospital of Fort Worth (817) 370-6078
Lifecare Hospital of Plano (214) 473-8822
Mesquite Specialty Hospital (972) 216-2300
Methodist Charlton Medical Center (214) 947-7777
Methodist Dallas Medical Center (214) 947-8181
Methodist Mansfield Medical Center (682) 622-2000
Methodist McKinney Hospital (972) 569-4500
Methodist Midlothian Health Center (972) 775-7410
Methodist Richardson Medical Center (972) 498-4000
Methodist Richardson Medical Center Bush/Renner (469) 726-6700
North Texas VA Medical Center (214) 857-1399
Parkland Memorial Hospital (214) 590-8000
Plano Specialty Hospital (972) 758-5200
Regency Hospital of North Dallas – Carrollton (972) 236-6800
Select Specialty Hospital of DeSoto (972) 780-6500
Select Specialty Hospital of North Dallas (469) 862-1400
South Hampton Community Hospital of Dallas (214) 623-4400
Texas Health Arlington Memorial Hospital (817) 960-6100
Texas Health Harris Methodist Azle (817) 444-8600
Texas Health Harris Methodist Cleburne (817) 641-2551
Texas Health Harris Methodist Fort Worth (817) 250-2000
Texas Health Harris Methodist Hurst-Euless-Bedford (817) 848-4000
Texas Health Harris Methodist Southlake (817) 748-8700
Texas Health Harris Methodist Southwest Fort Worth (817) 433-5000
Texas Health Presbyterian Allen (972) 747-1000
Texas Health Presbyterian Dallas (214) 345-6789
Texas Health Presbyterian Denton (940) 898-7000
Texas Health Presbyterian Flower Mound (469) 322-7000
Texas Health Presbyterian Kaufman (972) 932-7200
Texas Health Presbtyerian Plano (972) 981-8000
Texas Health Presbyterian Rockwall (469) 698-1000
Texas Health Specialty Hospital (817) 250-5500
Texas Regional Medical Center of Sunnyvale (972) 892-3000
Texas Specialty Hospital of Dallas (214) 637-0000
UT Southwestern Medical Center (214) 645-5555
UT Southwestern Medical Center North (214) 645-5555
UT Southwestern – St. Paul Hospital (214) 645-5555
UT Southwestern – Zale-Lipshy Hospital (214) 645-5555
Weatherford Regional Medical Center (817) 341-2273



Transplant infections how to avoid it

These are things to avoid if you have been transplanted to prevent infection:

  • wear surgical mask all the time
  • avoid close contact with children who got live-virus vaccine within a month
  • wear gloves and mask e
    When gardening
  • avoid going to public spaces
  • avoid pets and litter
  • thoroughly clean, wash fresh fruits and vegetables
  • good hand washing is a must and keep hands away from face
  • avoid people who has infection or flu
  • cover mouth when coughing and sneezing and throw tissues in the trash
  • don’t share eating utensils with someone who is ill
  • avoid handling animal waste or poop
  • no vaccination unless done at the transplant clinic
  • Continue reading Transplant infections how to avoid it

    Transplant Rejection

    At work I usually have the chance to take care of newly transplanted heart and lung patients… And whenever I have a chance to tell them about what transplant is all about; I always don’t forget to tell them about transplant rejection signs and symptoms which I did to my patient tonight; and those are:

  • anything that is out of norm don’t consider it normal
  • flulike symptoms like fever, joint pains, coughing, coarse breath, edema
  • infection
  • weight gain over 2 lbs in 2 days
  • shortness of breath
  • fatigue
  • high blood sugar levels
  • sores or wounds that does not heal
  • Continue reading Transplant Rejection

    Beautiful Skin

    According to Nicholas Perricone: Cut on sugars and get a lot of Omega-3’s so that you will have beautiful skin…

    Because sugar is inflammatory to the body, if you have lots of those. If you want me to explain that pls leave a comment.

    And Omega-3’s are anti-inflammatory and that’s why it is good to your skin and make you younger and maintain your beautiful skin.

    Continue reading Beautiful Skin

    Pfizer losing patent for Lipitor this November 2011

    I used to own the stocks of Pfizer then I sold it I don’t know why; well probably the company wasn’t giving me value that time.

    But I think this time will upset the shareholders again, because Pfizer is losing their patent for Lipitor which brings around 10 billion dollars a year; and Ranbaxy’s exclusive manufacturing rights will end this May; and this will bring the price down to probably $30 to $50 per 30 days compared to $200, and I think it will bring the cost down more since there are lots of generic drug manufacturers competing for this.

     

    Continue reading Pfizer losing patent for Lipitor this November 2011

    Safety

    Nursing here in the US is so much concerned about patient safety, primarily because of legislations and recommendations of Joint Commission on Accreditation of Healthcare Organization as well as CMS and Medicare.

    Patient safety includes prevention from falls. Safety of patients when getting medications. Safety of patients when they are handled by healthcare professionals. It also includes safety from outside/external influences etc.
    and almost a whole lot more, which everything you do and move you do, plan to do… With all this helps the nurse

    Kendall DL Lead Wires

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    Kendall DL Lead Wires

     

    The Kendall DL Lead Wires are used on telemetry units here in the US to prevent transfer of communicable diseases and microorganisms, in short for infection prevention, especially MRSA which is almost common to patients who have stayed in the health care facilities for a long time, and also used to for patients with CDifficile and others…

    They are disposable so you can just toss it away when patients get discharged.

     

    Maple Glazed Salmon

    I have been looking for this recipe, here it is, I think this is perfect for the Christmas celebration… Here’s the link to the recipe: http://allrecipes.com/Recipe/maple-salmon/detail.aspx

    I hope you will like it too.