Question

As the nurse begins administering norepinephrine, for each potential adverse effect listed below, identify how the nurse will monitor for the adverse effect:

Potential Adverse Effect	What will the nurse monitor to identify if the Adverse Effect is occurring?
Diminished renal perfusion
Decreased liver perfusion
Cardiac dysrhythmias
Increased myocardial oxygen requirement
Hyperglycemia, hypokalemia, hypophosphatemia
Severe hypertension and reflex bradycardia
Limb ischemia
Extravasation at infusion site

Answer 1

Identification o the adverse effects is crucial part of treatment as early identification results in improved care and prevents complication. Below are the ways the nurse can monitor the adverse effects of norepinephrine :

a) Diminished renal perfusion : Intake , output chart provides the status of renal perfusion. If output is very less compared to intake, it indicates diminished renal perfusion.

b) Decreased liver perfusion : Increase in lactic acid levels , yellowish tinge in the cornea of the eyes.

c) Cardiac dysrhythmias : ECG changes in the Holter monitoring.

d ) Increased myocardial oxygen requirement : Low levels of SPO2 in pulse oximeter.

e) Hyperglycemia,hypokalaemia, hypophosphatemia : Increased GRBS levels, ECG changes, aleration in serum electrolytes levels.

f) severe hypertension and reflex bradycardia : Increased blood pressure along with pulse rate below 60 beats per minute.

g ) Limb ischemia : slight bluish discolouration and coldness in the extremities.

h ) Extravasation at infusion site : Swelling, redness at the cannula site .

This is how the adverse reactions of norepinephrine can be found out and treated at earliest to avoid complications.

Thank you.