Report significant tachycardia, new or worsening dysrhythmias, or chest pain immediately.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client in cardiogenic shock is prescribed dobutamine. The nurse understands the primary purpose of this drug is to:
Answer: A. Dobutamine is a beta-1 adrenergic agonist that increases myocardial contractility (positive inotropy), improving cardiac output in cardiogenic shock. It is not given to lower the heart rate, cause vasoconstriction primarily, or reduce contractility.
Question 2 of 2
The nurse is monitoring a client receiving IV dobutamine for acute decompensated heart failure. Which finding indicates a therapeutic response to this inotrope?
Answer: A. Dobutamine is a beta-1 agonist positive inotrope that increases myocardial contractility and cardiac output. A therapeutic response includes improved cardiac output reflected by warmer extremities, improved urine output, and decreased signs of congestion. Increasing crackles, falling urine output, and worsening peripheral cyanosis indicate inadequate cardiac output rather than improvement.
Keep the streak going with more questions like these, each with a full rationale.
What is dobutamine?
It increases myocardial contractility and cardiac output with relatively little effect on heart rate or blood pressure. It is a high-alert drug given by titrated infusion and is often used to improve forward flow in low-output states.
Key points to remember
- Primarily a beta-1 agonist that increases contractility and cardiac output, improving heart failure symptoms.
- Increases myocardial oxygen demand and can cause tachycardia, dysrhythmias, and chest pain.
- Administered only as a titrated IV infusion via pump with continuous cardiac monitoring.
- May lower blood pressure through mild vasodilation, so volume status must be adequate.
- Tolerance and reduced effect can develop with continuous infusions beyond about 72 hours.
- Incompatible with alkaline solutions such as sodium bicarbonate.
Nursing priorities
- Continuously monitor ECG, heart rate, and blood pressure and titrate to hemodynamic goals.
- Assess heart failure response: lung sounds, urine output, peripheral perfusion, and weight.
- Use an infusion pump and verify a patent IV site, monitoring for infiltration.
- Report sustained heart rate increases greater than about 10 percent of baseline or new dysrhythmias.
Red flags: report now
- Report significant tachycardia, new or worsening dysrhythmias, or chest pain immediately.
- Marked rise or drop in blood pressure during infusion warrants provider notification.
- Never mix with or run alongside sodium bicarbonate.
References
Clinical references for this topic
