Mrs. Waltraud is receiving digoxin and Lasix daily. Today, she complains of nausea, and her apical pulse is 130 and irregular. Which of the following nursing interventions is the most appropriate?
A. Hold the digoxin and check the patient’s potassium level.
B. Remove the orange juice from the patient’s tray.
C. Identify the patient as high risk for hyperkalemia.
D. Assess the patient for other signs of hypernatremia.
Correct Answer: A. Hold the digoxin and check the patient’s potassium level.
The patient is experiencing hypokalemia and is at risk for digitalis toxicity. Nausea and irregular pulse are signs of digitalis toxicity. Electrolytes must also be evaluated; hypokalemia, hypercalcemia, and hypomagnesemia are known to worsen the effects of toxicity. The inhibition of the sodium-potassium ATPase leads to hyperkalemia and can be used as a marker of toxicity severity.
Option B: Hydration, oxygenation, and close monitoring are necessary. The ECG has to be continuously monitored for dysrhythmias. All electrolyte disturbances need to be corrected. Digoxin concentration does not necessarily correlate with clinical symptoms of toxicity however digoxin concentrations may be used for calculating the amount of antidote therapy.
Option C: The most common trigger of digoxin toxicity is hypokalemia, which may occur as a result of diuretic therapy. Dosing errors are also a common cause of toxicity in the younger population.
Option D: Clinical signs of toxicity include gastrointestinal, neurological and the most concerning cardiac. Most symptoms are nonspecific findings and include a headache, malaise, insomnia, altered mental status, abdominal pain, nausea, and vomiting.
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