Vasopressors Nursing Considerations

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Vasopressors Nursing Implications

Vasopressors Nursing Pharmacology

Vasopressors are a class of drugs that increase blood pressure and promote tissue perfusion through vasoconstriction.

These are potent medications that are widely used in critical conditions and medical emergencies involving severely low blood pressure levels such as in shock and during surgeries.

Vasopressor drugs are mostly naturally occurring compounds such as norepinephrine, epinephrine, vasopressin, dopamine, phenylephrine, and dobutamine.

These drugs are commonly administered intravenously; however, oral, intravascular, and topical forms are also available.

Intravenous vasopressors can cause immediate effects and must be given carefully under strict medical supervision.

Regular monitoring of vital signs, renal function, fluid status, and peripheral perfusion are included in the care of patients in vasopressor treatment.

Indications for Vasopressors

Vasopressors are potent agents used to increase blood pressure when initial treatments fail.

They are usually prescribed in critical care and emergency situations where severely low blood pressure is a problem.

The following conditions associated with low blood pressure and reduced peripheral perfusion may require the use of vasopressors:

  • Septic shock
  • Cardiogenic shock. Dobutamine and norepinephrine are the first line of treatment in cardiogenic shock cases. Phenylephrine is the second line of treatment.
  • Anaphylactic shock. Epinephrine is the drug of choice in cases of anaphylactic shock.
  • Cardiac arrest
  • Neurogenic shock. The first vasopressor to be given in this condition is dopamine, followed by norepinephrine.
  • Toxic drug overdose with shock. Norepinephrine is the first choice of vasopressors followed by phenylephrine.
  • Hemorrhagic shock. Volume resuscitation is the advised first line of treatment in cases of hemorrhagic shock. The use of norepinephrine comes second.
  • Volume resuscitation
  • Refractory heart failure
  • Hypotension with tachycardia and tachyarrhythmia
  • Hyperdynamic septic shock

Actions of Vasopressors

Vasopressor drugs have different mechanisms of action depending on the type of drug.

The drugs can be categorized into three groups: alpha-adrenergic, beta-adrenergic, and dopaminergic.

Alpha-adrenergic vasopressors work by stimulating the alpha-adrenergic receptor 1. These receptors are found on the cardiac muscle cell membrane. When stimulated, vasoconstriction, relaxation of gut smooth muscles, increase in saliva production, and hepatic glycogenolysis occur.

On the other hand, beta-adrenergic receptors are found on the cardiac muscle cell membrane. When stimulated, they affect heartbeat, relax gut smooth muscles, promote hepatic glycogenolysis, and induce muscle tremors.

Vasopressors also act on DA 1 and 2 receptors. Vasopressors act on the DA1 receptors to mediate renal, coronary, and mesenteric arterial vasodilation and natriuretic response.

The DA2 receptors which are found on nerve endings react to vasopressors by inhibiting norepinephrine and prolactin release, as well as promoting vasoconstriction.

Side Effects and Adverse Effects of Vasopressors

The following are the known side effects and adverse effects of vasopressors:

  • Arrhythmia
  • Cyanosis around the lips or fingertips
  • Burning pain, irritation, or discoloration of the skin
  • A feeling of sudden numbness, weakness, or cold sensation anywhere in the body
  • Difficulty breathing
  • Low urine output (oliguria) or completely no urine output (anuria)
  • Problems with speech, vision, or balance
  • Signs of severe high blood pressure such as severe headache, ringing in the ears, blurring of vision, confusion, anxiety, chest pain, and seizures
  •  Anaphylactic reaction
  • Fungal infection
  • Acidosis
  • Hyperglycemia
  • Peripheral ischemia
  • Thromboembolic events such as deep vein thrombosis

Contraindications and Caution for Vasopressors

Vasopressors are strong agents that require caution when used. The following contraindications and cautions should be considered when using vasopressors:

  • Allergy to the drug or any component of the drug
  • Pregnancy – vasopressors should be used with great caution in pregnant women. It is advisable to avoid breastfeeding after receiving vasopressors.
  • Caution in the treatment of shock – vasopressors are widely used to increase blood pressure and tissue perfusion in cases of shock. However, different types of shock require different types of vasopressors. Dopamine is not recommended as the first line of treatment in cases of shock due to its high association with mortality and dysrhythmias.
  • Caution in the use of halogenated hydrocarbons, which are drugs likely used as anaesthetic agents.
  • Pheochromocytoma or uncorrected tachyarrhythmia – adrenergic vasopressors should be avoided
  • Dobutamine is contraindicated for use in idiopathic hypertrophic subaortic stenosis. Also, some organizations avoid its use in cases with recent myocardial infarction or history of uncontrolled blood pressure, aortic dissection, or large aortic aneurysm.
  • Phenylephrine must be used with extreme caution due to reflex bradycardia caused by unopposed vagal action on the heart.
  • Treatment for deep vein thrombosis is normally started when receiving vasopressors due to its high association with thromboembolic events.
  • Vasopressors must be used with caution in people with diabetes. Vasopressors act on alpha- and beta-adrenergic receptors which can cause hepatic glycogenolysis. Hepatic glycogenolysis refers to the process that breaks down glycogen into glucose which may raise blood glucose levels and cause serious complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).

Drug Interactions with Vasopressors

Vasopressors are naturally occurring compounds; therefore, unwanted reactions are rarely recorded. Dobutamine is used with great caution when given with monoamine oxidase inhibitors (MAOI) due to possible toxicity. Reducing the dose of dobutamine is recommended.


Nursing Care Plans for Patients on Vasopressors

Possible Vasopressors Nursing Diagnosis

Nursing Assessment

Vasopressors Nursing InterventionsRationales
Assess the patient for signs and symptoms of severe hypotension, shock, or perfusion problems.To confirm the indication for administering vasopressors.
Check the patient’s allergy status.Previous allergic reaction to vasopressors may render the patient unable to take them. Alternatives to vasopressors should therefore be considered in case of allergy.
Assess if the patient is pregnant or lactating.                                                        Vasopressors should be prescribed in caution to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn. It is advisable to avoid breastfeeding after receiving vasopressors.
Check for the status of peripheral veins prior to cannulation and administration of intravenous vasopressors.
If administering oral vasopressors, assess the patient’s mucous membranes and his/her ability to swallow.
To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of vasopressors is given through the right route.
Check the patient’s serum glucose levels.Vasopressors can increase serum glucose levels. Caution is highly warranted in patients with diabetes, as vasopressors raise blood glucose levels and cause serious complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).  
Check medical history for myocardial infarction, reflex bradycardia, subaortic stenosis, pre-uncontrolled blood pressure, aortic aneurysm, pheochromocytoma or uncorrected tachyarrhythmia.Dobutamine is contraindicated for use in idiopathic hypertrophic subaortic stenosis. Also, some organizations avoid its use in cases with recent myocardial infarction or history of uncontrolled blood pressure, aortic dissection, or large aortic aneurysm. Phenylephrine must be used with extreme caution due to reflex bradycardia caused by unopposed vagal action on the heart.  
Assess and monitor the capillary refill of extremities. Check for any pre-existing vascular diseases.To check for presence of peripheral vasoconstriction while on vasopressor regimen. Unmonitored use of vasopressors in patients with pre-existing vascular disease may result to gangrene of extremities.
Assess the patient’s mental status while on vasopressor treatment.Excessive doses of vasopressors may result to water intoxication. This may cause headaches, sleepiness, drowsiness, and confusion.

Nursing Planning and Intervention

Vasopressors Nursing InterventionsRationales
Create a weight chart and weigh the patient daily. Observe for edema or any signs of fluid retention.Vasopressors may cause excessive fluid retention in the body.
Administer vasopressors with meals.To ensure optimal absorption and therapeutic action by vasopressors.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking vasopressors. Instruct the patient on how to self-administer oral vasopressors.To inform the patient on the basics of vasopressors, as well as to empower him/her to safely self-administer the medication.
Monitor the patient’s input and output.Vasopressors may cause fluid retention as evidenced by edema/ swelling.
Collect urine sample from the patient and perform and urine dipstick.To check for any changes in specific gravity of the urine. The patient may not be responding to the treatment if the specific gravity continues to be low.
Advise the patient to immediately report any signs of dizziness, irregular heartbeat, or severe headaches. Demonstrate how to manually check for pulse for one full minute and how to assess irregularity in pulses. Encourage checking blood pressure levels at the same time of the day, on a daily basis at home.Vasopressors should be used in great caution in patients with pre-existing heart conditions. Vasopressors may cause changes cardiac rhythm and blood pressure levels.
Routinely check for the blood glucose level of the patient, especially if they are diabetic.Vasopressors can increase serum glucose levels.  

Nursing Evaluation

Vasopressors Nursing InterventionsRationale
Ask the patient to repeat the information about vasopressors.To evaluate the effectiveness of health teaching on vasopressors.
Monitor the cardiovascular and neurological status of the patient.To ensure that the vasopressors did not cause any cardiac arrythmias, water intoxication, or other adverse events to the patient.
Monitor the patient’s response to vasopressors.To check if the vasopressors are effective, the dose needs to be adjusted, or the drug should be stopped and changed to an alternative treatment.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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