Checking HR before Giving Digoxin

[cat2007]

Hello - I am a second year nursing student (ADN). In clinical we are to check the apical HR with our stethoscopes before giving Digoxin. I work at a hospital as a nurses aide and the nurse went by the HR recorded on the BP machine.

I was just wondering if this is ok. Thanks for your advice. I have learned so much from reading this forum.

[dpipes44]

If you use a pulse ox that beeps, feel the radial pulse at the same time. If the pulse goes with the beep you should be OK. I try not to rely on monitors alone.

[Antikigirl, ASN, RN]

As part of my initial assessment I have to take a apical pulse to hear the heart...I just use that time to count! Typically Dig is given first thing in the AM, so considering that is when I work I schedule my cardiac/lung assessment during that dig med pass :). Saves time...and we have to do all we can to save time but be safe :)....

[Zee_RN, BSN, RN]

When I worked med-surg, I checked an apical pulse first. Our digoxins were always scheduled for 10AM, not 8AM, in the event that an a.m. digoxin level was pending. That way we'd have the result prior to giving the med.

[Antikigirl, ASN, RN]

When we have a dig level to be done, it is typically done at 0600. If it is delayed, then I will adapt and still do an apical before giving dig. I like heart sounds and I have been known to pick up odd sounds that the MD didn't catch :).

I also like telling my pt "yep...still ticking, so that means you are alive, which is a good thing! LOL!" Or "you got a rolex in there...cause you keep on ticking!" or "yep, got a heart in there...oh lungs too...oh I so like pts that have those! LOL!".

[HappyNurse2005, RN]

We are a tele floor, and for dig (and for beta blockers) I look at the HR on the monitor right after pulling the med and right before going into pt's room.

[UM Review RN, ASN, RN]

I would take it apically. The best reason to do this is that dig is very commonly prescribed for Atrial Fibrillation, which is a cardiac rhythm whose hallmark is irregularity. This particular rhythm is one that will play havoc with the machines, so it's quite possible to get an incorrect heart count.

On my unit, any patient who has A-Fib has to have a manual blood pressure and pulse done.

I also look at the monitor before medicating a patient, but for a bit of a different reason--it's night shift! Many patients will have a very low HR (40-50) while they're sleeping, but come up to the 60's after I startle them awake. Again, I recheck the HR just to make sure the machine is correct before giving the med.

It's just safer that way.

[Antikigirl, ASN, RN]

I agree! In the am things can be very odd as they wake up...so I take in consideration what they are doing..like sleeping or just walked to the BR and what not. That is an important part of the assessment.

Alas..some docs do get on me if I don't give it right ON THE MINUTE...but oh well, I have my justification written in my notes !

[meownsmile, BSN, RN]

I agree, id do a manual count even if there was a machine available. Ive found the machines tend to be unreliable for a variety of reasons. So with dig id just count when doing the lung/heart sounds and be done with it that way. Unless of course you have a tele monitor on.

[twinmommy+2, ADN, BSN, MSN]

I'm new but I always take a manual apical count prior to digoxin

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I take an apical. It only takes a minute.

[leslie :-D]

I take an apical. It only takes a minute.

me too.

i prefer to do all my vitals rather than any electronic device.

leslie