The nurse is caring for a patient in cardiogenic shock who is being treated with an infusion of dobutamine (Dobutrex)
The physician's order calls for the nurse to titrate the infusion to achieve a cardiac index of >2.5 L/min/m2 . The nurse measures a cardiac output, and the calculated cardiac index for the patient is 4.6 L/min/m2 . What is the best action by the nurse?
a. Obtain a stat serum potassium level.
b. Order a stat 12-lead electrocardiogram.
c. Reduce the rate of dobutamine (Dobutrex).
d. Assess the patient's hourly urine output.
C
Dobutamine (Dobutrex) is used to stimulate contractility and heart rate while causing vasodilation in low cardiac output states improving overall cardiac performance. The patient's cardiac index is well above normal limits, so the rate of infusion of the medication should be reduced so as not to overstimulate the heart. There is no evidence to support the need for a serum potassium or 12-lead electrocardiogram. Assessment of hourly urine output is important in the care of the patient in cardiogenic shock, but it is not a priority in this scenario.
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