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Dobutamine (3-20mcg/kg/min)
• MOA: almost exclusively a Beta-1 agonist with no alpha effect, and minimal beta-2 effect
• Effect: inotropic and chronotropic effects on the heart, some decrease in peripheral vascular
resistance and some improvement of AV node conduction
• Use: to improve cardiac output and blood pressure, can be administered peripherally
• Risk: increases myocardial oxygen demand, may increase heart rate excessively
Dopamine (2-20mcg/kg/min)
Epinephrine (0.01 to 1 mcg/kg/min, or higher in very critical situations, usual dose range in cardiac
patients is 0.03-0.3, in septic patients doses may be higher)
Acute Pain:
Observe or monitor signs and symptoms associated with pain, such as BP, heart rate, temperature, color
and moisture of skin, restlessness, and ability to focus. Some people deny the experience of pain when it is
present. Attention to associated signs may help the nurse in evaluating pain.
Provide rest periods to facilitate comfort, sleep, and relaxation. The patient’s experiences of pain may
become exaggerated as the result of fatigue. In a cyclic fashion, pain may result in fatigue, which may
result in exaggerated pain and exhaustion. A quiet environment, a darkened room, and a disconnected
phone are all measures geared toward facilitating rest.
Give analgesics as ordered, evaluating effectiveness and observing for any signs and symptoms of
untoward effects. Pain medications are absorbed and metabolized differently by patients, so their
effectiveness must be evaluated from patient to patient. Analgesics may cause side effects that range from
mild to life-threatening.
Administer humidified oxygen as ordered. The failing heart may not be able to respond to increased
oxygen demands.