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What are Cardiotonics?
Drugs used 2 increase the efficiency and improve the contraction of the heart muscle which leads 2 improved blood flow 2 all tissues in the body.
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Heart Failure
- complex clinical syndrome that can result from any number of cardiac or metabolic disorders. Ex:
- Ischemic heart disease
- hypertension
- hyperthyroidism
- Any condition tht impairs the ability of the ventricle 2 pump blood can lead 2 heart failure.
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Heart failure causes a number of ______________changes as the body tries to compensate for the increased workload of the heart.
NEUROHORMONAL
- Neurohormonal responses affecting heart failure. The body activates the neurohormonal compensatory mechanisms, which result in
- increased secretion of the neurohormones by the sympathetic nervous system
- Activation of the renin-angiotensin-aldosterone (RAA) system
- Remodeling of the cardiac tissue
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The sympathetic nervous system increases the secretion of the of the catecholamines (the neurohormones epinephrine and norepinephrine), which results in?
increase heart rate and vasoconstriction
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Increases in neurohormonal activity cause a remodeling of the cardia muscle cells, leading to
Hypertrophy(enlargement) of the heart, increased need for oxygen, and cardiac necrosis which worsens the heart failure(HF)
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What are signs of Left ventricular dysfunction?
- Shortness of breath with exercise
- dry, hacking cough, or wheezing
- Orthopnea (hard 2 breath while laying flat)
- Restlessness & anxiety
*Left side of heart is usually affected first*
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What are signs of right ventricular dysfunction?
- Swollen ankles, legs, or abdomen, leading to pitting edema
- Anorexia
- Nausea
- Nocturia (frequently peeing @ night)
- Weakness
- weight gain bcuz of fluid retention
- OTHER SIGNS OF BOTH L&R
- Palpatations, fatigue, or pain when performing normal activities
- Tachycardia or irregular heart rate
- Dizziness or confusion
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What are actions, uses, a/r, contr/prec of
Cardiotonics
aka:
Digoxin(lanoxin)
cardiac glycosides or digitalis glycosides
Action = increase cardiac output.
Uses = heart failure, Atrial fibrillation(rapid contractions, quivering of heart)
A/R = headache, weakness, drowsiness, visual disturbances, Arrhythmias, GI upset and anorexia, digitalis toxicity(toxic drug effect)
Contrainindicated = ventricular failure, ventricular tachycardia, or AV block.
Precaution in = electrolyte imbalances, hypokalemia, hyperkalemia, hypomagnesemia, severe carditis, heart block, myocardial infarction, severe pulmonary diseas, acute glomerulonephritis, impaired renal or hepatic function
*Taken w/food but high-fiber meals decrease absorption*
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Miscellaneous Inotropic drugs
Inamrinone
Milrinone - used more and more effective, less a/r
Used in short term management of severe HF. Does not cure HF but control signs & symptoms.
Route = IV nurse monitors closely
Nurse = monitors heart rate, b/p continously w/administration of either drug. If hypotension occurs discontinue rx and rate of administration is reduced.
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What preadministration assessments does the nurse need to do b4 giving a cardiotonic drug?
- NURSE actions B4 therapy:
- Take b/p, apical-radial pulse rate, respiratory rate (done b4 each dose given)
- Ausculate lungs
- Examine EXT 4 edema
- Check jugular veins 4 distention
- Measuring weight
- Ispect sputum (noting appearance frothy, pink-tinged, clear, yellow)
- Looking 4 signs of other problems like cyanosis, SOB, mental changes
- Review labs renal, hepatic function tests, CBC, Serum enzyme, electrolyte levels
- ongoing assessment:
- If pulse is below 60bpm in adults or greater than 100bpm nurse withholds rx and notifies dr. unless written order giving different guidelines 4 withholding rx. 4 children below 70bpm or above 90bpm withhold rx. Weigh pt daily
- I&O
- Chk 4 edema
- Electrolyte imbalances
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What is Digitalization?
- Patients started on cardiotonics are being digitalized by 2 methods
- Rapid digitalization = Loading dose
- Gradual digitalization = maintenance dose given allowing therapeutic drug blood levels 2 accumulate gradually
*digitalization is giving a series of doses until drug begins 2 exert full therapeutic effect*
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What are Nursing duties during digitalization?
- Take b/p, pulse, respiratory rate every 2 to 4hrs or as ordered
- Measure serum levels (digoxin) level below 2.0 report
- rpt any signs of digitalis toxicity - anorexia, nausea, vomiting, abd pain, visual disturbances(blurred, yellow, or green vision and white halos, borders around drk objects, arrhythmias
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If the nurse gives a cardiotonic by IV or IM, oral
- IV
- administer the rx slowly
- assess administration site 4 redness or infiltration
- IM
- rotate injection sites
- IM injections not recommended 4 these drugs
- Oral
- Doesn't have 2 be with food
- tablets can be crushed & mixed with food or fluids if pt has problems w/ swallowing.
- don't alternate btween the dosage forms.
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If client on cardiotonics has imbalanced nutrition bcuz a/r anorexia, nausea, vomiting
- NURSE does
- Alert physician
- offer frequent small meals rather thn lg meals
- suggest restictin fluids @ meals and avoid fluids 1hr b4 and after meal 2 contol nausea
- help pt w/ oral hygiene by brushing teeth or rinsing mouth
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If client on cardiotonics has activity imbalance bcuz weakness or drowsiness
- Nurse does:Encourage client 2 increase daily activities gradually as tolerance increases
- Plan activities as tolerance increases
- Adequate rest periods are planned during the day
- Assist with activities and ambulation
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Educating the pt and family
- Nurse includes Don't discontinue rx w/out checking w/ dr.
- Don't miss a dose or double up
- Take drug @ same time of day
- Take pulse b4 taking drug below 60 or above 100 don't take drug
- Avoid antiacids and nonprescription cough, allergy, antidiarrheal, and diet drugs
- Contact dr. of dig tox signs
- Carry medical identification of diseas
- Keep drug in original container
- Keep all f/u appts.
- Follow dietary recommendations if any
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