INTRODUCTION

Critically ill patients frequently require multiple infusions of potent inotropic and vasoactive drugs to achieve and maintain hemodynamic stability. The critical care nurse is required to make rapid, independent decisions when titrating these drugs, often resulting in profound consequences. 

This seminar begins with a review of cardiac physiology and progresses to a detailed description of the most relevant hemodynamic parameters. Practical aspects of infusion management are addressed, with emphasis on issues relating to patient safety. Specific drugs are reviewed, and clinical scenarios are incorporated to facilitate practical application.

This seminar offers an invaluable opportunity for both novice and experienced nurses to update, verify, and intensify their knowledge of this critically important and challenging topic.

	If a patient is receiving continuous infusions of dobutamine and Levophed, what hemodynamic parameters provide the most useful information regarding the appropriate drug to manipulate in the event of a sudden drop in blood pressure?
	What advantage does milrinone have over dobutamine in managing the patient with heart failure?
	In which of the following situations might Nipride be indicated in a hypotensive patient?  a. SVR       2200 b. PAWP    22 c. MAP       0 d. RVEDVI  90
	Mr. C is a 70-year-old man who had a triple coronary artery bypass 3 days ago. He is now hemodynamically unstable and is receiving dopamine and Nipride. Should calculation of Mr. C's infusion rates be based on his admission weight or current daily weight?
	When precepting a new nurse, what essential safety precautions regarding "drip titration" should be addressed?
	Phosphodiesterase inhibitors do not affect the autonomic nervous system. How do they work?
	Prior to initiating inotropic infusions, what intervention is essential in treating hypotension?
	Initiation of an inotropic infusion would be least appropriate in the patient with which of the following?  a. CO          3.5          PAWP     12 b. RVEDVI    130         BP        75/50 c. CVP         3             PAWP      5 d. CI           2.0          SVR       1500
	What special considerations are essential to safely titrate inotropic and vasoactive drugs in the geriatric patient?
	Which of the following drugs is likely to increase blood pressure with the least cost in terms of myocardial oxygen demand?  a. Dobutamine b. Dopamine c. Levophed d. Vasopressin

Presented by:
Laura E. Luecke,
R.N., B.S.N., CCRN

 Seminar approved by:

American Association
 of Critical-Care Nurses

6.0 contact hours
Category A

 Provider approved by:

  California Board of
  Registered Nursing
    CEP 6910