Name of Drug Dopamine 250/200 mL @15cc/hr

General Action Inotropics, Vasopressors, Therapeutic: adrenergics

Specific Action Small doses (0.53 mcg/kg/min) stimulate dopaminergic receptors, producing renal vasodilation. Larger doses (210 mcg/kg/min) stimulate dopaminergic and beta1-adrenergic receptors, producing cardiac stimulation and renal vasodilation. Doses greater than 10 mcg/kg/min stimulate alphaadrenergic receptors and may cause renal vasoconstriction. Therapeutic Effects: Increased cardiac output, increased blood pressure, and improved renal blood flow.

Indications Adjunct to standard measures to improve: Blood pressure, Cardiac output, Urine output in treatment of shock unresponsive to fluid replacement.

Contraindications Contraindicated in: Tachyarrhythmias Pheochromocytoma Hypersensitivity to bisulfites (some products). Use Cautiously in: Hypovolemia Myocardial infarction Occlusive vascular diseases

Adverse Reaction CNS: Headache. EENT: Mydriasis (High Dose). Resp: Dyspnea. CV: Arrhythmias, Hypotension, Angina, ECG Change, Palpitations, Vasoconstriction. GI: Nausea, Vomiting. Local: Irritation At IV Site.

Nursing Responsibilities Assessment Monitor blood pressure, heart rate, pulse pressure, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for pulse, blood pressure, or ECG changes for adjusting dose or discontinuing medication. Monitor urine output frequently throughout administration. Report decreases in urine output promptly. Palpate peripheral pulses and assess appearance of extremities routinely during dopamine administration. Notify physician if quality of pulse deteriorates or if extremities become cold or mottled. If hypotension occurs, administration rate should be increased. If hypotension continues, more potent vasoconstrictors (norepinephrine) may be administered. Implementation High Alert: IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dose calculations and infusion pump settings. Correct hypovolemia with volume expanders before initiating dopamine therapy. Extravasation may cause severe irritation, necrosis, and sloughing of tissue. Administer into a large vein and assess administration site frequently. If extravasation occurs, affected area should be infiltrated liberally with 10-15 ml of 0.9% NaCl containing 5-10 mg of phentolamine. Reduce proportionally

for pediatric patients. Infiltration within 12 hr of extravasation produces immediate hyperemic changes. . Patient/Family Teaching Explain to patient the rationale for instituting this medication and the need for frequent monitoring. Advise patient to inform nurse immediately if chest pain; dyspnea; numbness, tingling, or burning of extremities occurs. Instruct patient to inform nurse immediately of pain or discomfort at the site of administration.