Before you administer selective beta-blockers, measure your patient’s apical and radial pulses. When using a nonselective beta-blocker, obtain his baseline pulse rate and blood pressure before each administration. Also, if he has impaired renal function, anticipate a reduced dosage.
Administer atenolol by slow I.V. push, not to exceed 5 mg over 5 minutes, or dilute it in 10 to 50 ml of D5W, dextrose 5% in normal saline, or normal saline. To administer esmolol, begin with an I.V. bolus dose of 0.5 to 1.0 mg/kg followed by an infusion. Dilute it in D5W, Ringer’s solution, or sodium chloride, and administer it at a rate of 50 to 100 micron g/kg/minute with an infusion pump. Also, if your patient’s blood pressure is less than 100/60 mm Hg, notify the physician before giving esmolol.
Usually, oral forms of selective and nonselective beta-blockers can be given before meals and at bedtime, as prescribed. They can be taken with food to reduce GI upset. Also, the tablets can be crushed or swallowed whole.
However, the patient should take pindolol with or immediately after meals. If orthostatic hypotension is severe, he should take this drug at bedÂtime.
Administer nadolol with at least 8 ounces of water. Propranolol should also be administered with 8 ounces of water but on an empty stomach. And don’t give propranolol with aluminum-containing antacids because they decrease the drug’s absorption in the intestine.
When using either selective or nonselective beta-blockers, frequently measure your patient’s blood pressure for hypotension. Depending on his status, monitor his pulse rate, rhythm, and quality at least every 4 hours. Also, watch for signs of heart failure.
If your patient has diabetes, monitor his blood glucose levels. Also, monitor his fluid balance by measuring intake and output and by obtaining daily weights. Report any significant changes to his physician.
Check the patient’s skin turgor and mucous membranes for signs of dehydration, especially if he’s elderly. If he develops any CNS effects such as confusion, institute safety precautions.
Instruct your patient to take his drug exactly as prescribed. Also, tell him to avoid using OTC nasal decongestants or cold preparations because they contain alpha-adrenergic stimulants and can cause adverse reactions such as arrhythmias.
Teach the patient how to take his own blood pressure and pulse and tell him to notify his physician about abnormal findings. He should report difficulty breathing, night coughing, or swelling of the legs. Tell him to also report any complaints of dizziness, confusion, depression, and fever. If he’s experiencing dizziness, instruct him to avoid activities such as driving. And warn him against abruptly discontinuing his beta-blocker therapy because he may develop life-threatening adverse effects .