The assessment cues and anticipated nursing actions
Describe the assessment cues and anticipated nursing actions a nurse would anticipate for a client
experiencing digoxin toxicity.
Compare and contrast key information and nursing considerations for the following medications utilized
for heart failure
Sample Solution
Assessment Cues
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Additional Nursing Considerations
- Nausea and vomiting
- Diarrhea
- Anorexia
- Abdominal pain
- Headache
- Fatigue
- Confusion
- Visual disturbances (e.g., blurred vision, yellow halos)
- Cardiac arrhythmias (e.g., bradycardia, tachycardia, atrial fibrillation, ventricular fibrillation)
- Hypotension
- Monitor vital signs, including heart rate, blood pressure, and respiratory rate.
- Monitor electrocardiogram (EKG) for arrhythmias.
- Assess for signs and symptoms of digoxin toxicity.
- Obtain laboratory tests, including serum digoxin level, potassium level, and magnesium level.
- Administer medications to treat digoxin toxicity, such as Digibind or activated charcoal.
- Provide supportive care, such as intravenous fluids and electrolytes.
| Medication | Action | Nursing Considerations |
| Digoxin | Cardiac glycoside that increases the force of myocardial contraction and slows the heart rate. | Monitor for signs and symptoms of digoxin toxicity, especially if the client is taking other medications that can interact with digoxin, such as diuretics, potassium-sparing diuretics, and amiodarone. |
| Enalapril | Angiotensin-converting enzyme (ACE) inhibitor that dilates blood vessels and lowers blood pressure. | Monitor for hypotension, especially when starting treatment or increasing the dose. Educate the client about the signs and symptoms of hypotension and what to do if they experience them. |
| Furosemide | Loop diuretic that increases urine output and lowers blood pressure. | Monitor for dehydration, electrolyte imbalances, and ototoxicity. Educate the client about the signs and symptoms of dehydration and electrolyte imbalances and what to do if they experience them. |
| Metoprolol | Beta-blocker that decreases heart rate and blood pressure. | Monitor for bradycardia, hypotension, and heart failure exacerbation. Educate the client about the signs and symptoms of bradycardia, hypotension, and heart failure exacerbation and what to do if they experience them. |
- Educate the client about their medications and the signs and symptoms of side effects.
- Encourage the client to adhere to their medication regimen and to follow up with their healthcare provider regularly.
- Provide support and counseling to the client and their family.