Digtoxicity - Nursing interventions

[motherinlaw]

I would like to know what nursing interventions would a nurse use if a patient is experiencing Digtoxicity.

I realize that I would hold the medication.

Draw labs for Electrolytes and digixon.

Monitor I & O

Perform an EKG and possibly keep the patient on telemetry

Monitor for edema and ausculate the lungs

Monitor symptoms, VS

Call the doctor.

Start an IV.

Am I missing anything else and if so what are the rationales.

Thanking everyone in advance for your comments

[SuesquatchRN, BSN, RN]

You need orders for eveything except holding the med (should have parameters for that), calling the doc, and monitoring

[nurseprnRN, BSN, RN]

what are the rationales for the things you already thought of?

[motherinlaw]

Rationales:

I realize that I would hold the medication. - due to possibility of toxicity

Draw labs for Electrolytes and digixon. - electrolytes can effect the action of dig and cause dysthimas and to find out the level of dig

Monitor I & O - monitoring for renal function

Perform an EKG and possibly keep the patient on telemetry - monitoring for dysrrhthmias

Monitor for edema and ausculate the lungs

Monitor symptoms, VS - S/E of digtoxicity

Call the doctor. - to get orders to carry out interventions and inform doctor

Start an IV. - for administration of medications

[motherinlaw]

You need orders for eveything except holding the med (should have parameters for that), calling the doc, and monitoring

Yes, I am aware of this. Tks

[motherinlaw]

what are the rationales for the things you already thought of?

rationales:

i realize that i would hold the medication. - due to possibility of toxicity

draw labs for electrolytes and digixon. - electrolytes can effect the action of dig and cause dysthimas and to find out the level of dig

monitor i & o - monitoring for renal function

perform an ekg and possibly keep the patient on telemetry - monitoring for dysrrhthmias

monitor for edema and ausculate the lungs

monitor symptoms, vs - s/e of digtoxicity

call the doctor. - to get orders to carry out interventions and inform doctor

start an iv. - for administration of medications

[jedi88]

Also you can expect an order to administer digibind which is the antidote for that situation.

[motherinlaw]

Also you can expect an order to administer digibind which is the antidote for that situation.

Tks

Are there any other interventions as a nurse that I need to do?

[SweetseRN]

Which electrolyte are you looking at most closely and why for dig tox? And what other meds are they taking that (hint, hint) many people with cardiac issues often take that can decrease a certain electrolyte that is critical for cardiac function...

If this electrolyte is low it can increase the risk for dig tox!

[#1ME]

CHF, would be Lasix, which can cause a depletion of potassium. Usually if pt is on Lasix, he will be on potassium (kdur, kcl) as well to prevent that. But, if the electrolyte potassium is High (not low), it would increase the risk for dig toxicity. Reason being elevations in potassium will slow and can potentially stop the heart. Dig slows the heart rate, thus an elevation in both can increase the risk of toxicity

[nurseprnRN, BSN, RN]

exactly backwards:nono:. low k+ increases dig toxicity.

(i was sorta hoping the op would have looked this up to respond, rather than just skating through on, "electrolytes can effect the action of dig and cause dysthimas and to find out the level of dig." as an instructor i would never accept that, because it is so patently a lazy wag and not the result of actual reading. even if all you do is look online for "dig toxicity and potassium" you'll have the real answer in .03 seconds. as to the rest, the responses were, alas, pretty much what you would expect from someone who didn't really look any of this up and was hoping we would tell her. other than the above, which is such a dangerous misconceotion i'd hate to have anyone rely on it having read it here, i have not given the answers yet, but some avenues for thoughtful reading for the op to follow. op, yes, it is true, nurses will be responsible for knowing/doing all this, and knowing why, and that's why your faculty is trying to get you to learn it.

monitor i & o - monitoring for renal function i&o is a lousy measure of renal function, because long before urine output goes away, bad things can be happening to the kidneys. what are they?

perform an ekg and possibly keep the patient on telemetry - monitoring for dysrrhthmias what are you looking for? what do you see c dig toxicity?

monitor for edema and ausculate the lungs why would you be doing that? what do you expect to hear, and why?

monitor symptoms, vs - s/e of digtoxicity of course there are symptoms, anybody could guess that. what symptoms are you, the nurse, looking for?

call the doctor. - to get orders to carry out interventions and inform doctor

start an iv. - for administration of medications

.

[nursejackiebsn]

potassium and digoxin compete for binding site on the na+/k+-atpase pump (the mechanism of action of dig is the inhibition of na+/k+-atpase pump). i also read that decreased serum magnesium may have the same effect.

s/s: fatigue, bradycardia, blurred vision (including halos), change in color vision (yellow), anorexia, nausea, vomiting, diarrhea, sob, abdominal pain, headache, dizziness, confusion, nightmares, delirium. these vary greatly from one pt to another and toxicity can be acute or chronic.

characteristic ekg changes include bradycardia, a prolonged pr interval, accelerated junctional rhythm or bidirectional ventricular tachycardia

decreased renal function: decrease in glomerular filtration rate. biochemically, renal failure is typically detected by an elevated serum creatinine level, acid/base imbalances, abnormal electrolytes such as potassium (to make it more confusing), calcium, phosphate. may see edema as well as fluid in the lungs: crackles (which may also result from dig toxicity- bradycardia). you may hear crackles because the heart is failing to move blood forward therefore fluid is backing up into the lungs.

"monitor i & o - monitoring for renal function i&o is a lousy measure of renal function, because long before urine output goes away, bad things can be happening to the kidneys. what are they?"

didn't get this far yet, but i'm thinking that it could be damage to the glomerulus? you will also see shunting of blood to the kidneys if they are not being perfused adequately, but that's a whole other can of worms.