Chapter 18, Problem 1CS

(1)

Summary Introduction

To explain:

How this dose of dopamine works to help treat Mr.P’s heart failure.

Case summary:

82 years old Mr. P is receiving dopamine dose of 5mcg/kg/min for his heart failure.  Since he has hypothyroidism, he takes thyroid replacement hormone. He has the following signs.

Blood pressure: 150/88 mm Hg

Respiration rate: 92 beats/min.

His heart with ectopic beats showed sinus rhythm. When he is getting up from sleep, he experiences dyspnea. He has edema in his lower legs.

(2)

Summary Introduction

To determine:

What to think about is there any concern at this time and explain the reason and what should be done?

Case summary:

The heart monitor shows the signs of sinus tachycardia with 2 to 3 ectopic beats/minute. Mr. P complaints of shortness of breath at rest and says “He felt this before and had spells with my heart and he is sure it will pass”

(3)

Summary Introduction

To determine:

How quickly a response can be seen in the patient with effect to decrease in dosage?

Case summary:

The physician titrates the dopamine infusion dosage from 5 mcg to 3 mcg/kg/min, which is done immediately.

(4)

Summary Introduction

To determine:

What went wrong? What is the priority action and what treatment is expected to be given?

Case summary:

Later in the day, while making rounds, the nurse checked the insertion site of Mr.P dopamine infusion and found that infusion area was swollen. When the nurse touched, his body felt cold.