Nursing Process Focus:
Patients Receiving Quinidine (Quinidex)
Potential Nursing Diagnoses
Assessment
 Cardiac Output, Risk for decreased, related
Prior to administration:
to cardiac changes secondary to adverse
 Assess patient for chest pain,
effects of drug therapy
dysrhythmias, and vital signs (initially and
 Nutrition, Risk for imbalance related to
throughout therapy)
gastrointestinal disturbances caused by
 Obtain complete medical history, including
medication
allergies, especially heart block, digitalis
 Fluid volume, Risk for deficient, related to
toxicity, heart failure, and hypotension.
diarrhea secondary to adverse effect of
Include blood studies: cardiac enzymes,
medication
Digoxin level, electrolytes, CBC. Obtain
EKG.
 Obtain patient’s drug history to determine
possible drug interactions and allergies.
Planning: Patient Goals and Expected Outcomes
The patient will:
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Avoid sudden chest pain and dyspnea
Demonstrate a regular heart rhythm with a normal rate
Maintain normal bowel pattern
Maintain adequate nutritional status
Implementation
Interventions and (Rationales)

Assist in monitoring cardiac rate and
rhythm, continuously if administering
medication IV. (IV route is used when
rapid therapeutic effects are needed
therefore constant monitoring is needed to
detect any potential serious arrhythmias.
May cause cardiotoxicity including
asystole because this medication can cause
a reduction in conduction throughout all
the regions of the heart.)
 Ensure that EKG is performed. (Changes
precede this and show:
Increase in PR and QT intervals
>50% widening of QRS complex
Presence of ventricular tachycardia
Presence of ventricular fibrillation)
 Monitor EKG frequently if medication is
given orally. (Medication may cause
complete heart block.)
Patient Education/Discharge Planning
Instruct patient and caregivers:
 Need for constant monitoring
 Potential complications of drug therapy

Instruct patient and caregivers regarding
need for frequent EKG readings.
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Monitor for diarrhea, which occurs in
approximately 1/3 of patients. (Related to
the fact that quinidine is related to quinine
in structure and action. Diarrhea may be
intense.)

Monitor for signs of arterial embolism,
including sudden chest pain and dyspnea.
Report immediately. (Patient is usually
placed on coumadin for 3-4 weeks prior to
administration of quinidine to prevent
arterial embolism, a complication of atrial
fibrillation.).
Instruct patient
Monitor for signs of digoxin toxicity.
Report immediately. (Digoxin may be
 Regarding signs and symptoms of digoxin
prescribed to prevent quinidine from
toxicity and to report immediately
increasing ventricular rate; however, when
 To report change in heart rhythm to the
used concurrently, quinidine can double
health care provider.
digoxin levels.)
 Not to miss any doses of their medication
Determine patient’s diet and cultural
 Instruct patient to avoid adding vegetables,
background. (A diet high in vegetables,
fruit, and milk beyond recommended daily
citrus fruit and milk may increase the
requirements.
chance of toxicity by delaying the
excretion of this medication.)
Evaluation of Outcome Criteria
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Instruct patient to:
 Take medication with food to minimize
gastrointestinal upset, although food may
delay absorption of quinidine.
 Report occurrence of diarrhea to health
care provider
 Instruct patient to immediately report any
sudden chest pain or dyspnea to the health
care provider.
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Nursing Process Focus:
Patients Receiving Propranolol (Inderal)
Potential Nursing Diagnoses
Assessment
 Injury, Risk for, related to dizziness
Prior to administration:
secondary to decreased blood pressure
 Assess for cardiac arrhythmias, including
 Tissue perfusion, Risk for Ineffective,
supraventricular tachycardia, ventricular
related to decreased cardiac output related
tachycardia, and tachycardia secondary to
to arrhythmia
digoxin toxicity.
 Gas exchange, Risk for Impaired, related to
 Assess for chest pain, palpations, vitals
side effects of medication
signs (initially and throughout therapy).
 Knowledge deficient, related to drug action
 Obtain complete medical history,
and side effects
including, allergies, cardiac, endocrine,
depressive disorders. Include the following
blood studies: CBC, electrolytes, glucose,
cardiac enzymes.
 Compare EKG at baseline to throughout
therapy.
 Obtain patient’s drug history to determine
possible drug interactions and allergies.
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate a change in heart rhythm
 Exhibit a decrease in cardiac arrhythmias
 Demonstrate expected outcomes of drug therapy and list reportable side effects.
 Maintain adequate tissue perfusion
Implementation
Interventions and (Rationales)
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Monitor for cognitive dysfunction and
depression in the elderly, as well as
hallucinations and psychosis (more likely
with higher doses). (These reactions appear
to be related to the lipid solubility of this
medication and its ability to cross the
blood-brain barrier.)
Monitor for proper medication use.
(Abrupt discontinuation of medication may
cause myocardial infarction, severe
hypertension and ventricular arrhythmias
because of a potential rebound effect.)
Patient Education/Discharge Planning
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Advise patient regarding potential
cognitive side effects and to report any
signs of depression to the health care
provider.
Instruct patient to:
 Never discontinue the medication abruptly
and to take the medication exactly as
prescribed.
 Take the medication even if feeling well
 Take pulse prior to taking the medication.
If pulse is irregular, instruct patient to
withhold medication and contact the
health care provider immediately
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Monitor for hypotension. (Medication may  Instruct patient to change position slowly
lower blood pressure as a result of
to avoid dizziness.
decreased cardiac output.)
Instruct patients with Type I Diabetes Mellitus
Monitor for hypoglycemia. (There is an
to:
increased incidence of hypoglycemia in
patients with Type I Diabetes Mellitus
 Check blood sugar regularly
because this medication may inhibit
 Report unusually low blood sugar reading
glycogenolysis).
to the health care provider.
Monitor for diarrhea. (This side effect may  Instruct patient to take medication with
be related to the medication’s effect on the
food to decrease GI upset.
vascular smooth muscle receptors.)
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Nursing Process Focus: Patients Receiving Amiodarone (Cardarone)
Potential Nursing Diagnoses
Assessment
 Cardiac output, Risk for decreased, related
Prior to administration:
to cardiac arrhythmias
 Assess for ventricular fibrillation, recurrent
 Injury, Risk for, related to adverse effects
unstable ventricular tachycardia (initially
of medication
and throughout therapy).
 Gas exchange, Risk for Impaired related
 Obtain complete medical history,
to pulmonary damage secondary to side
especially cardiac and liver disease, lung
effects of medication
disorders, and eye disorders including

Nutrition, Risk for imbalanced related to
blood studies: liver function tests. Obtain
gastrointestinal distress secondary to side
baseline eye exam.
effects of medication
 Obtain patient’s drug history to determine
possible drug interactions and allergies.
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate ability to measure own pulse.
 Describe the need to change positions slowly to prevent postural hypotension.
 Remain free of physical injury
 Maintain adequate nutrition
 Demonstrate adequate respiratory function
Implementation
Interventions and (Rationales)
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Patient Education/Discharge Planning
Auscultate lung sounds frequently.
(Pulmonary toxicity can occur and may be
fatal. Occurs most frequently with oral
dosing because absorption is highly
variable. Lung tissue which receives good
blood flow appears to receive a greater
effect from the medication.)
Monitor heart rate and rhythm. (May
worsen the arrhythmia it is trying to treat.
May also cause bradycardia, heart block
and cardiac arrest because it slows
conduction and increases the refractory
period.)
Monitor liver enzymes. (Drug may cause
liver disease because this medication has a
high lipid solubility and is distributed
extensively to the liver.)
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Advise patient to notify the health care
provider at the first sign of shortness of
breath or cough.
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Instruct patient to report change in heart
rate and rhythm to health care provider.
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Observe for changes in visual acuity. (May
cause optic neuritis which may lead to
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Instruct patient regarding signs and
symptoms of liver disease such as jaundice,
right upper quadrant pain, dark urine and
clay colored stool and to report these
symptoms to health care provider
immediately
Instruct patient to report any vision
changes to the health care provider
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blindness. This is caused by corneal
immediately.
microdeposits.)
Instruct patient to:
Monitor blood pressure throughout drug
therapy. (Hypotension is common early in
 Change positions slowly to reduce
therapy and is related to the dilating action
incidence of dizziness
of this medication on peripheral blood
 Monitor blood pressure and report
vessels.)
abnormalities to the health care provider
Instruct patient to:
Observe for occurrence of common side
effects. (Common side effects include
 Take medication with food to minimize
dizziness, headache, insomnia related to
gastrointestinal distress.
the antiadrenergic properties of this
 To cover the skin well when in direct
medication. Gastrointestinal distress and
sunlight and to wear sunglasses. The
photosensitivity also commonly occur).
elderly are particularly sensitive to the
Report to health care provider.
sun.
Advise patient to:
Monitor for concurrent digoxin and
anticoagulant use. Amiodarone increases
 To report changes in cardiac rhythm
digoxin levels in the blood and enhances
 To report occurrence of abnormal bleeding
the actions of anticoagulants.
or bruising.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes are met (see “Planning”).
Nursing Process Focus: Patients Receiving Verapamil (Calan)
Potential Nursing Diagnoses
Assessment
 Injury, Risk for, related to dizziness
Prior to administration:
secondary to hypotension
 Assess for dysrhythmias, heart rate,
 Gas exchange, Impaired, related to side
and radial pulse (initially and
effects of medication
throughout therapy).

Cardiac output, Risk for Decreased, related
 Obtain complete medical history,
to hypotension and bradycardia secondary to
including allergies, especially cardiac,
side effects of medication
renal, liver and respiratory diseases
 Nutrition, Risk for Imbalanced, related to
including blood studies: BUN,
nausea secondary to medication
creatinine, liver function tests.
 Obtain patient’s drug history to
determine possible drug interactions
and allergies.
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate relief of shortness of breath and dizziness
 Exhibit expected outcome of drug therapy and list reportable side effects
 Demonstrate blood pressure monitoring and pulse measurement prior to medication.
 Remain free of physical injury
 Maintain adequate nutritional status
Implementation
Interventions and (Rationales)
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Observe for side effects such as
hypotension and bradycardia.
(Verapamil causes a decrease in total
peripheral resistance which can
significantly lower blood pressure.
Bradycardia can result because
Verapamil slows SA and AV node
conduction.)
 Monitor for signs of pulmonary edema
and shortness of breath (related to
dilation of the coronary arteries).
 Monitor serum liver enzymes level
(Verapamil may cause an elevation in
liver enzymes.)
Monitor renal status
 Monitor BUN and creatinine levels
(Verapamil may cause renal damage.)
 Monitor intake and output.
Patient Education/Discharge Planning
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Instruct patient to take own blood pressure
prior to taking medication and if blood
pressure is less than 90/60, hold medication
and notify the health care provider
immediately.
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Advise patient to notify health care provider
of any breathing difficulties.
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Instruct patient concerning the importance
of having lab work done because
medications may cause severe liver damage.
Instruct patient:
 Concerning the importance of having lab
work done because medications may cause
severe renal and kidney damage.
 To report changes in urinary output to the
health care provider.
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Advise patient to:
 Take medication with food if gastric
distress is a problem.
 Maintain regular bowel habits. Advise
patient to increase fruits and fiber in the
diet.
Observe for signs of digoxin toxicity.
 Instruct patient to notify health care
(Causes increased digoxin and
provider of all medications taken and to
quinidine levels when used with
notify health care provider if there is a
diltiazem.)
change in cardiac rhythm
Evaluation of Outcome Criteria
Monitor bowel pattern for occurrence
of constipation. (Verapamil often
causes nausea and constipation).
Evaluate effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).