Do you think the hemodynamic values reported previously reflect poor left ventricular function or fluid overload, and why?

Question

K.Z. is receiving continuous IV infusions of norepinephrine (Levophed) and dobutamine. Why is K.Z. receiving these medications?

What are your responsibilities when administering norepinephrine and dobutamine to K.Z.?

Answer 1

Poor left ventricular function. If K.Z. were fluid overloaded and had adequate ventricular function, all
of the numbers would be elevated. A decrease in CI and an elevation of the rest of the values indicate
poor left ventricular function.

To increase CO. The norepinephrine is a vasopressor that increases central blood pressure, thereby
increasing myocardial oxygenation and decreasing the workload on the heart. Dobutamine
stimulates myocardial adrenergic receptors, thereby increasing CO without significantly increasing
heart rate.

• Monitor the efficacy and side effects of both drugs.
• Norepinephrine enhances myocardial force, thus increasing CO. The major side effects of
norepinephrine are anxiety, bradycardia, and palpitations.
• The desired effects of dobutamine are increased CO and stroke volume and decreased PCWP
and systemic vascular resistance (SVR). The major side effects of dobutamine are hypertension
and hypotension, palpitations, dysrhythmias (particularly tachycardia and premature ventricular
contractions), nausea and vomiting, and dyspnea.
• Monitor urine output.
• Monitor blood pressure continuously and maintain per ordered parameters.
• Monitor ECG continuously, watching for dysrhythmias.
• Maintain the integrity of the IV and monitor the IV site closely for signs of infiltration. Infiltration of
these vasopressors may lead to tissue necrosis and sloughing.