Dobutamine

INTRODUCTION

Indications

Short-term (<48 hr) management of heart failure caused by depressed contractility from organic heart disease or surgical procedures.

Action

Stimulates beta₁(myocardial)-adrenergic receptors with relatively minor effect on heart rate or peripheral blood vessels. Therapeutic Effects: Increased cardiac output without significantly increased heart rate.

Adverse Reactions/Side Effects

CNS: headache. Resp: shortness of breath. CV: hypertension, increased heart rate, premature ventricular contractions, angina pectoris, arrhythmias, hypotension, palpitations. GI: nausea, vomiting. Local: phlebitis. Misc: hypersensitivity reactions, including skin rash, fever, bronchospasm, or eosinophilia; nonanginal chest pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea, chest pain) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess any signs of phlebitis, including localized pain, redness, or swelling in the affected area. Report these signs to the physician or nursing staff. Avoid ambulation and exercise to the affected extremity while awaiting further tests and evaluation.

Interventions

• Design and implement aerobic exercise and endurance training programs to improve myocardial pumping ability and reduce symptoms of CHF.

• Because of an increased risk of cardiac arrhythmias, use caution during aerobic exercise and endurance conditioning Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.), or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control CHF even if they are asymptomatic.

• Instruct patients to weigh themselves every day, and call their physician if they gain 3 or more lb in 1 day or more than 5 lb in 1 week. Sudden weight gain may indicate fluid buildup due to worsening heart failure.

• Counsel patients about additional interventions to help control cardiac dysfunction, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache or GI problems (nausea, ...