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Discussion

Digoxin Care Plan help?

I am brand new to this site! I am trying to do a digoxin care plan for my Pharm class. I have to come up with two nursing Diagnosis's. Here is the scenario. 78 yr old male on maintenance digoxin (0.5mg/d) reports nausea, no appetite, loose stools off and on. Serum K+ = 3 mEq/L. I have chosen Risk for fluid volume deficit as one diagnosis, but I can't think of a second one. I was thinking activity intolerance AEB by hypokalemia, but I am not sure if I can use that since the pt never "voices" any fatigue or activity intolerance. Any suggestions will be greatly appreciated! TIA! :)

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    Risk for impaired nutrition,

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    • Author

    So Risk for activity intolerance would not be appropriate right?

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    Increased risk for Dig toxicity d/t low potassium also. Low potassium can cause high dig levels as can fluid imbalance (loose stool). I wouldn't put activity intolerance although it could leed to that but mainly I would concentrate on the possibility of dig toxicity. ( I am a new graduated nurse but this is my try :)

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    • Author

    Ok, if I went with that what would be some goals? PT will not experience dig toxicity? I am sorry but I am only in my second semester and I am still struggling with nursing care plans. Thank you for your help!!

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    You could do risk for activity intolerance. Sounds like digoxin toxicity which would result in decreased output. Nursing diagnosis are so annoying; uh!

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    Increased risk for Dig toxicity ......I don't believe that is an approved NANDA impairment, is it?

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    moved to the General Nursing Student Discussions forum

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    i found this on another thread from daytonite who was a great teacher on this forum:

    activity intolerance
    (page 3,
    nanda-i nursing diagnoses: definitions & classification 2007-2008
    )

    definition
    :
    insufficient physiological or psychological energy to endure or complete required or desired daily activities

    (does this sound like your patient's problem?)

    defining characteristics (symptoms):
    abnormal blood pressure response to activity, abnormal heart rate to activity, electrocardiographic changes reflecting arrhythmias, electrocardiographic changes reflecting ischemia, exertional discomfort, exertional dyspnea, verbal report of fatigue, verbal report of weakness

    related factors (etiology):
    bed rest, generalized weakness, imbalance between oxygen supply and demand, immobility, sedentary lifestyle

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    the patient is already toxic...N&V is a sign of dig toxicity (that's the only time to really care about N&V, along with colchicine) and is complaining of anorexia, another sign of dig toxicity. Therefore, the patient is not "at risk" for dig toxicity because it has already happened.

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    Ok, if I went with that what would be some goals? PT will not experience dig toxicity? I am sorry but I am only in my second semester and I am still struggling with nursing care plans. Thank you for your help!!

    pt will return to therapeutic range by 03/10/2011

    Teaching - pt will state causes of dig toxicity by 03/10/2011

    pt will state how to recognize dig toxicity by 03/10/2011

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    Risk for impaired nutrition,

    Decreased cardiac output d/t possible dysrhythmias from electrolyte balance

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