A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the client for:
A. Thrombocytopenia and weight gain
B. Anorexia, nausea, and visual disturbances
C. Diarrhea and hypotension
D. Fatigue and muscle twitching
Correct Answer: B. Anorexia, nausea, and visual disturbances
The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias. Symptoms may be mild and include nausea, vomiting, and anorexia. Visual side effects might include color changes, also known as xanthopsia. But yellow or green-tinted vision is usually associated with digoxin toxicity. Patients may also highlight blurry vision or photopsia. At toxic levels, digoxin is proarrhythmic.
Option A: An impaired ventricle is more prone to ventricular tachyarrhythmias and ectopy. Abnormally high levels of digoxin stimulate atrial activation, thus atrial tachycardias, which, in a patient on digoxin, is highly suggestive of toxicity. These atrial tachycardias are persistent and resolve with a decrease in serum digoxin levels.
Option C: Digoxin toxicity is clinically relevant as it can lead to fatal cardiac arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady digoxin therapy. The rate of toxicity increases as serum digoxin concentration reaches over 2.0 ng/ml.
Option D: Electrocardiogram changes seen with digoxin demonstrate a downsloping ST-segment depression, also known as a “reverse check” sign. The ST segments may appear “scooped” without abnormal Q waves or T wave inversions.[8] Regular intake of digoxin results in changes such as a decreased QT interval, prolongation of the PR interval and T wave inversion or flattening.
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