Report tachycardia, chest pain, or confusion (excess anticholinergic effect).
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with symptomatic bradycardia (heart rate 38, blood pressure 80/50, dizziness) is being treated. Which medication does the nurse anticipate administering first?
Answer: A. Atropine 1 mg IV is the first-line drug for symptomatic bradycardia; it blocks vagal tone to increase heart rate. If atropine is ineffective, transcutaneous pacing or dopamine/epinephrine infusions are next. Adenosine and beta blockers would worsen bradycardia.
Question 2 of 3
A nurse is reviewing the medication history of a client newly prescribed ipratropium. Which reported allergy requires the nurse to clarify the order with the provider?
Answer: B. Ipratropium is derived from atropine and is contraindicated in clients with hypersensitivity to atropine. It should also be used cautiously in those allergic to soy or peanuts when older formulations contain soya lecithin. An allergy to atropine is the most important to clarify before administering this anticholinergic.
Question 3 of 3
A client in stable monomorphic ventricular tachycardia with a pulse is prescribed an antiarrhythmic. Which medication does the nurse anticipate administering?
Answer: B. Amiodarone is a first-line antiarrhythmic for stable ventricular tachycardia with a pulse. Atropine is used for symptomatic bradycardia, adenosine is for stable narrow-complex supraventricular tachycardia, and digoxin is not used to acutely terminate VT.
Keep the streak going with more questions like these, each with a full rationale.
What is atropine?
It is the first-line drug for symptomatic bradycardia and is used to dry secretions and reverse cholinergic (organophosphate) poisoning.
Key points to remember
- It is the first-line treatment for symptomatic bradycardia, increasing heart rate by blocking the vagus nerve.
- Anticholinergic effects include dry mouth, blurred vision, urinary retention, constipation, and flushing.
- It is the antidote for cholinergic crisis and organophosphate or nerve-agent poisoning.
- It is contraindicated in glaucoma because it raises intraocular pressure.
- It reduces secretions and is used preoperatively for that purpose.
Nursing priorities
- Monitor heart rate and rhythm continuously when treating bradycardia.
- Assess for urinary retention and palpate the bladder, especially in older men.
- Monitor for anticholinergic toxicity and provide eye protection for blurred vision.
- Have the patient void before administration when giving preoperatively.
- Keep emergency equipment available during IV administration.
Patient teaching
- Expect dry mouth; use sugarless gum or sips of water.
- Avoid overheating because sweating is reduced.
- Report difficulty urinating, eye pain, or rapid heartbeat.
Red flags: report now
- Report tachycardia, chest pain, or confusion (excess anticholinergic effect).
- Report inability to void or severe eye pain (urinary retention, acute glaucoma).
- Use cautiously and report worsening symptoms in patients with glaucoma or BPH.
References
Clinical references for this topic
