Dopamine RN Review

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

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

— 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
–Increases contractility and heart rate, stroke volume and cardiac output
High Dose: Alpha1 Agonist
–Vasoconstriction increasing afterload, peripheral resistance and blood pressure.

–Tachycardia and VFIB
–MAO – intensifies the effects of dopamine
–Buergers Disease
–Raynaud’s Disease
–Hx of Blood Clots

–Arrhytmia specially svt and vt’s
–Pulmonary vasoconstriction
–increased oxygen demand of the myocardium
–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
–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.

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