Question

An elderly client with chronic heart failure (HF) has been treated with digoxin 0.25 mg QD PO, furosemide 80 mg QD PO, potassium chloride 20 mEq QD PO. During morning rounds, the client complains of nausea, no appetite and that the lights are so bright and blurry. The nurse is preparing him for transfer back to the nursing home.

Vital signs: T 98, P 62, RR 18, BP 112/70, apical HR 60, SpO₂ 94% on room air. Digoxin level is 1.5 ng/mL.

• Identify 2 priority nursing assessments for this client, including 1 physical and 1 laboratory findings.
• Based upon the client’s current symptoms of anorexia and visual changes, discuss what the nurse suspects is happening.
• Describe how digoxin’s inotropic and chronotropic actions affect the heart’s function and how the nurse assesses for a therapeutic response.

• Explain why the client is prescribed potassium chloride.

• Determine whether the nurse should administer the scheduled dose of digoxin, and why or why not.

Answer 1

1.Physical assessment- look for the swelling in the hands,feet,legs and listen to the heart with stethoscope and also the lungs to check the fluid formation and increase in that.Laboratory assement- Comprehensive Metabolic Panel test for the assessment of electrolyte imbalance,kidney failure and liver diseases.2.The safe level of Digoxin for a heart failure patient is 0.5-0.9 Ng/ml but here the level is 1.5ng/ml.the symptoms which the patient is having are due to the Digoxin toxicity.3.Digoxin is competitive blocker of the Na+-K+ pump in the myocardium.Due to the blockage of this pump another pump called as sodium calcium exchanger gets blocked.and the intracellular calcium increases which inturn increase the contractility of the heart.so Digoxin is a positive chronotropic drug.Digoxin blocks the SA node and AV node so it decreases the impulse generation and transmission in the heart failure patients so in this way Digoxin is a negative chronotropic drug.A nurse should always monitor pulse for 1 full min before administering. Do not administer and notify the doctor if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Always monitor the BP time to time.Monitor ECG during IV administration and 6 hr after each dose. Notify the doctor if any arrythmias occur.Always look for Edema and auscultate for heart and lung sounds.4.The furosemide is diuretic which causes hypokalemia and Digoxin toxicity increases in the hypokalaemia so to prevent that potassium chloride is prescribed.5.The shouldn't administer the scheduled dose of Digoxin as the safe range concentration has been crossed and patient is started to have the toxicity symptoms.the nurse must inform the doctor in this case.