Medication or Drug Class




Bronchodilators Antibiotics

Varies with drug Varies with drug

Beta2-adrenergic agonists, anticholinergics

Trimethoprim-sulfamethoxazole amoxi-cillin are example

Relieve bronchospasm Manage respiratory infections

Other Medication: Acute cor pulmonale with acute right ventricular failure may require fluid loading and vasoconstrictors such as epinephrine administration. Massive pulmonary embolism may require thrombolytic agents. Oxygen therapy, diuretics, vasodilators, low-dose digitalis, theophylline, antidysrhythmic agents, and anticoagulation therapy may be used in long-term management.


The patient requires bedrest and assistance with the activities of daily living if hypoxemia and hypercapnia are severe. Provide meticulous skin care. Reposition the bedridden patient frequently to prevent atelectasis. Reinforce proper breathing strategies for the patient: breathe in through the

248 Coronary Artery Disease (Arteriosclerosis)

nose and out slowly through pursed lips, using abdominal muscles to squeeze out the air; inhale before beginning an activity and then exhale while doing the activity, such as walking or eating.

Nurses can teach patients to control their anxiety, which affects their breathlessness and fear. Teach the patient the use of relaxation techniques. Because patients are continually breathless, they become anxious if they feel rushed; focus on providing a calm approach. Help reduce the patient's fear of exertional dyspnea by providing thoughtful care that builds trust. Encourage the patient to progress in small increments.

Because of the exertion that talking requires, many patients with cor pulmonale may not be able to respond adequately in conversation. Try to understand the patient's reluctance to "tire out," and become familiar with reflective techniques that allow a patient to respond briefly. Integrate your teaching into the care to avoid the need to give the patient too much information to assimilate at the time of discharge.

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