Following A. Electrolyte status.norepinephrine (Levophed) administration, it is essential to the nurse to assess:
A. Electrolyte status.
B. Color and temperature of toes and fingers.
C. Capillary refill.
D. Ventricular arrhythmias.
Correct Answer: B. Color and temperature of toes and fingers.
Because decreased perfusion is a side effect of norepinephrine (Levophed), the nurse must check circulation frequently. Vasoconstriction secondary to alpha1 stimulation can result in reflex bradycardia via the baroreceptor reflex, which is generally not compensated for by the beta1 activity. The overall result is that cardiac output may decrease, or at most stay the same, despite beta1 agonism. Electrolytes and ventricular arrhytmias are not specific for norepinephrine.
Option A: Blood pressure requires close monitoring whenever vasopressors such as norepinephrine are in use; this is possible via invasive or non-invasive measurement techniques. If following non-invasive measurements, then it is recommended to obtain values every 2 to 3 minutes during initial titration and then at least every 5 minutes following the determination of the appropriate maintenance dose.
Option C: Capillary refill is not a reliable indication of perfusion in a shocking state.
Option D: At the same time, the increase in systemic vascular resistance increases the work of the heart by increasing afterload, thereby increasing myocardial oxygen demand. Because of these phenomena, the benefits of norepinephrine for cardiogenic shock are still unclear but merit consideration under certain conditions.