Shock, Cardiac Arrest, Anaphylaxis

Question 1

Norepinephrine

Answer 1

Shock/cardiac arrest/anaphylaxis

adverse effects:
headache, palpitations, nervousness, epigastric distress,
Angina, hypertension tissue necrosis with extravasation

Nursing considerations
Vasocontrictor to increase BP and cardiac output
Reflex Brady may occur with rise in Bp
PT SHOULD BE ATTENDED AT ALL TIMES
Monitor UO
Infuse with DEXTROSE NOT SALINE
Monitor BP
Protect medication from light

Question 2

Dopamine

Answer 2

Shock/cardiac arrest/anaphylaxis

Adverse effects: 
Increased ocular pressure
Ectopic beats
Nausea
Tachycardia, chest pain, dysrhythmias

Nursing considerations:
Low dose: dilates renal and coronary arteries
High dose: vasoconstriction, increases myocardial oxygen consumption
Headache is early sx of excess
Monitor BP, peripheral pulses, UO
Use infusion pump

Question 3

Epinephrine

Answer 3

Shock/cardiac arrest/anaphylaxis

Adverse effects: nervousness, restlessness, dizziness, local necrosis of skin

RN considerations:
Stimulates alpha and beta adrenergic receptors
Monitor BP
Carefully aspirate syringe before IM and subQ doses - inadvertent IV administration can be harmful
ALWAYS CHECK STRENGTH:
1:100 INHALATION only
1:1000 PARENTERNAL administration (IM/subQ)
Ensure adequate hydration

Question 4

Isoproterenol

Answer 4

Shock/cardiac arrest/anaphylaxis

Adverse effects:
Headache, palpitations, tachycardia, changes in BP
Angina, bronchial asthma, pulmonary edema

Rn considerations:
Stimulates beta 1 and beta 2 adrenergic receptors
Used for heart block, ventricular arrhythmia so, and bradycardia
Bronchodilator used for asthma and bronchospasms
Don’t give at (hs?)–interrupts sleep patterns
Monitor BP, pulse

Question 5

Phenylephrine

Answer 5

Shock/cardiac arrest/anaphylaxis

Adverse effects:
Palpitations, tachycardia, hypertension, dysrhythmias
Angina, tissue necrosis with extravasation

Rn considerations;
Potent alpha 1 agonist
Used to treat hypotension

Question 6

Dobutamine hydrochloride

Answer 6

Shock/cardiac arrest/anaphylaxis

Adverse effects: hypertension, PVCs, asthmatic episodes, headache

rn considerations:
Stimulates beta 1 receptors
Incompatible with alkaline solutions (sodium bicarbonate)
Administer through central venous catheter or large peripheral vein using an infusion pump
Don’t infuse through line with other meds (incompatible)
Monitor ECG, BP, I/O, serum K

Question 7

Milrinone

Answer 7

Shock/cardiac arrest/anaphylaxis

Adverse effects: dysrhythmias, thrombocytopenia, jaundice

Rn considerations: positive into tropic agent
Smooth muscle relaxant used to treat severe HF

Question 8

Sodium nitroprusside

Answer 8

Shock/cardiac arrest/anaphylaxis

Adverse effect: hypotension, increased intracranial pressure

Rn considerations: dilates cardiac veins and arteries
Decreases preload and afterload 
Increases myocardial perfusion
Keep medication in dark after fixed
Use infusion pump

Question 9

Diphenhydramine HCL

Answer 9

Shock/cardiac arrest/anaphylaxis

Adverse effects: drowsiness, confusion, insomnia, headache, vertigo, photo sensitivity

Rn considerations: blocks few of histamine on bronchioles, GI tract, and BVs

Question 10

Shock/cardiac arrest/anaphylaxis meds - general

Answer 10

Indications: hypovolemic shock, cardiac arrest, anaphylaxis

Adverse effects: serious rebound effect may occur
Balance between under dosing and overdosing

Nursing considerations; 
Monitor vs
Measure UO
Assess for extravasation
Observe extremities for color and perfusion

Examples: norepinephrine, epinephrine, dopamine, phenylephrine, milrinone, dobutamine HCL, sodium nitroprusside, diphenhydramine