6.4 Applying the Nursing Process to Administering Cardiovascular and Renal Medications
Assessment
Understanding the mechanism of action of cardiovascular medications helps the nurse anticipate appropriate pre- and post-administration assessments to perform on a client. Before administering cardiovascular medications, nurses complete a focused cardiac assessment to establish the client‘s current health status. Based on this baseline status, the client is monitored for effectiveness of the medication, as well as for any adverse effects.
Many cardiovascular medications, such as antiarrhythmics, cardiac glycosides, antihypertensives, or diuretics, alter a client‘s blood pressure or heart rate. Therefore, the nurse assesses a client‘s blood pressure and heart rate prior to administration. Medication parameters are often included in the order by a health care provider. For example, a common medication parameter is to hold a beta-blocker if a client‘s heart rate is less than 60 beats per minute. Additionally, anti-arrhythmic medication will alter the electrical conduction of the heart, so intermittent or continuous ECG monitoring may be required during initial therapy or dose changes.
Electrolytes can play a large role in cardiac conduction and muscle function. Medications that alter electrolytes, such as loop diuretics, require a review of laboratory values before administration. Loop diuretics such as furosemide (Lasix) often cause a depletion of potassium. If a nurse administers a loop diuretic to a client who already has low serum potassium levels (called hypokalemia), worsening symptoms of hypokalemia will occur, which can cause a life-threatening arrhythmia.
Monitoring kidney function is also important when administering many cardiovascular medications. For example, diuretics can injury the kidneys. A nurse should be aware of cardiovascular medications that are affected by impaired kidney function or cause injury to the kidney. In addition, a nurse must appropriately assess and report abnormal kidney function laboratory values such as worsening serum creatinine and glomerular filtration rates (GFR). It is also important to assess for signs of dehydration, including fluid intake and output, for clients taking diuretics.
Anticoagulant medications cause serious risk for bleeding that can be life-threatening. Prior to administering medication that alters a client‘s coagulation, it is important to assess for signs and symptoms of unusual bleeding or bruising, such as blood in the urine or stool or bruises on the extremities. Laboratory values, such as INR, PT, PTT, or platelets, may also require review prior to administering an anticoagulant medication. Any new abnormal lab values or signs of increased bleeding and internal bleeding should be immediately reported.
Implementation
Before administering cardiovascular medication, it is vital for the nurse to determine if this specific medication is safe for this client at this time. For example, if the client‘s heart rate or blood pressure is below the anticipated parameters, the medication should be withheld, and the prescribing provider notified.
Nurses must also consider the effect of the medication before administering it at the scheduled time. For example, if a diuretic is prescribed before a client is sent to a diagnostic test, the test may be disrupted by the need for the client to urinate, and the medication should be rescheduled for after the procedure. A second example illustrating a significant safety concern is when a client who is scheduled for surgery is scheduled to receive an aspirin or anticoagulant. The nurse must communicate with the provider on which scheduled medications are appropriate to administer prior to upcoming procedures.
Evaluation
Nurses evaluate the client‘s response to a medication compared to what is expected. Nurses continue to monitor a client‘s blood pressure, heart rate, intake and output, edema, and other cardiac assessments to evaluate if cardiac medications are effective or if further treatment or dosage adjustment is required. The client is also continually monitored for potential adverse effects of medication, some of which can be life-threatening and require prompt notification to the prescribing provider.
Many medications require dose adjustments to produce the desired effect. For example, IV heparin is administered based on a protocol that requires dose adjustment based on PTT or aPTT lab results to achieve therapeutic range (and avoid overdosage that can cause life-threatening bleeding). Nurses are responsible for evaluating lab work results that impact the administration of medications.
Nurses also evaluate the client’s understanding of the purpose of cardiac medications and their proper use, as well as when their provider should be notified of new symptoms. Health teaching before discharge home is often required, especially if new medications are prescribed.
