What is most important for the nurse to teach the patient in taking digoxin?
Cardiac glycosides are a type of organic compound that elevates the output force of the heart and reduces contraction rate through the inhibition of intracellular sodium-potassium ATPase pump channels. Digoxin is a common drug that belongs to the group of cardiac glycosides. Show
Digoxin acts on the heart muscle through a mechanism that consequently targets the sino-atrial (SA) and atrioventricular (AV) nodes as a side effect to the body by the parasympathetic stimulation of the autonomic nervous system. Due to this mechanism, digoxin helps in reducing cardiac strain, thereby assisting in the maintenance of normal heartbeats. Indications of DigoxinDigoxin is mainly used for the following medical conditions:
Forms and strength of digoxin differs depending on age group, drug indication and creatinine clearance levels. Enlisted below are the various forms and strengths of digoxin.
The following are special dosage considerations in administering digoxin: For Adults
For Pediatric Patients
Mechanism of Action of DigoxinDigoxin acts on the body through the following mechanisms:
Pharmacokinetics of DigoxinPharmacokinetics is a body of pharmaceutical knowledge focused on how an organism affects and changes a drug. As with all medications, digoxin is processed in the body when administered to achieve the goals of medical therapy. Explained below are the mechanisms of pharmacokinetics of digoxin (i.e., absorption, distribution, metabolism and elimination).
Side Effects of DigoxinCommon side effects of digoxin include the following clinical manifestations:
Adverse Reactions of DigoxinPatients who are using digoxin may have these serious adverse effects such as:
Drug Interactions of DigoxinDrug interactions of digoxin from other substances or medications are mentioned below:
Cautions for the Use of DigoxinCaution is highly encouraged when administering digoxin for patients with the following conditions due to its rapid and significant cardiac effects:
Digoxin is not recommended for patients with acute myocardial infarction (AMI) or myocarditis. When utilized for AMI patients, caution is needed for it may increase the oxygen demand of the heart. Contraindications Against DigoxinDigoxin is contraindicated in patients with known digoxin hypersensitivity and ventricular fibrillation. Digoxin ToxicityDigoxin overdose and toxicity can happen in both adult and pediatric patients. The clinical manifestations may present similarly with the adverse reactions but may be more recurrent and worse. Clinical manifestations of digoxin toxicity may occur and be frequent for serum levels above 2 ng/ml. In managing digoxin overdose and toxicity, careful consideration of the patient’s clinical picture, current electrolyte levels and thyroid function are essential factors. Signs and Symptoms of Digoxin Toxicity
Treatment for Digoxin Toxicity / Digitalis Toxicity
The treatment modality for acute digoxin toxicity includes the following:
The treatment modality for chronic digoxin toxicity includes the following:
Nursing Considerations for DigoxinThe nurse who has digoxin as part of their patient’s therapeutic regimen should be aware of the following considerations:
Digoxin is a severe skin irritant when given via the IV or IM route and may cause skin sloughing as a severe localized skin reaction. Nursing Diagnosis DigoxinPossible Digoxin Nursing DiagnosisDiarrhea related to the side effect of digoxin Nausea related to side effect of digoxin Risk for Poisoning related to possible toxicity and/or overdose of digoxin Risk for Disturbed Sensory Perception related to possible adverse effect of digoxin Deficient Knowledge related to digoxin Nursing Stat Facts Please enable JavaScript Nursing Stat FactsNursing AssessmentDigoxin Nursing InterventionsRationaleAssess the patient for signs and symptoms of mild to moderate heart failure and/or chronic atrial fibrillation.To confirm the indication for administering digoxin.Assess if the patient has a history of an acute myocardial infarction (AMI), myocarditis, ventricular fibrillation (VF), hypokalemia, or Wolf-Parkinson-White syndrome.Digoxin is generally contraindicated in patients with acute myocardial infarction (AMI) or Wolf-Parkinson-White syndrome because the drug does not help in improving the performance of the left ventricle, and may in fact cause ventricular fibrillation (VF). Studies also showed that digoxin increases the mortality risk of AMI survivors. Hypokalemia is found to be the most common trigger or cause of digoxin toxicity.Check the patient’s allergy status.Previous allergic reactions to digoxin may render the patient unable to take them. Alternatives to digoxin should therefore be considered in case of allergy.Assess if the patient is pregnant or lactating.Digoxin should be prescribed in caution to a pregnant woman as it can rapidly cross the placenta.Perform a focused physical assessment on the patient’s heart through and auscultation of heart sounds.To confirm the indication for administering digoxin. Assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.To ensure that the right form of digoxin is given.Collect bloods for potassium levels.Hypokalemia or low serum potassium levels is the most common cause of digoxin toxicity due to possible dosing errors especially in younger patients. On the other hand, hyperkalemia or high serum potassium level can reduce the effectiveness of digoxin. Nursing Planning and InterventionDigoxin Nursing InterventionsRationaleAssess the patient’s vital signs, particularly the heart rate / pulse rate prior to administering digoxin. Digoxin is ideally taken only if the patient’s heart rate or pulse rate is above 60 beats per minute.Administer digoxin with or without food, ideally at the same time each day.To ensure optimal absorption and therapeutic action by digoxin, as well as reduce possible side effects.Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking digoxin. Instruct the patient on how to self-administer digoxin.To inform the patient on the basics of digoxin, as well as to empower him/her to safely self-administer the medication.Monitor the patient’s bowel movement and commence a stool chart.Digoxin may cause diarrhea. Early detection of either side effect can help institute a bowel program and relieve them effectively.Discourage intake of banana, and other potassium-rich foods, potassium supplements, and insoluble dietary fiber with digoxin. If the patient has to eat insoluble fiber, advise to take the digoxin 1 hour before or 2 hours after eating.Foods high in potassium can cause hyperkalemia, which can reduce the effectiveness of digoxin. Insoluble dietary fiber such as bran can lower the rate of absorption of digoxin in the GI tract.Discourage alcohol consumption while on digoxin.Alcohol with digoxin can result in abnormal cardiac function and high blood pressure or hypertension. Also, alcohol can make the patient drowsier while on digoxin.Assist the patient with activities of daily living as needed. Digoxin may cause weakness, drowsiness, and/or disturbed sensory perception. Thus, helping the patient with ADLs as he/she requires is important for his/her safety.The patient may usually break or crush digoxin, unless informed otherwise by the pharmacist.The effectiveness of digoxin is not usually affected by breaking or crushing the tablets for patients with dysphagia or difficulty of swallowing.Nursing EvaluationDigoxin Nursing InterventionsRationaleAsk the patient to repeat the information about digoxin.To evaluate the effectiveness of health teaching on digoxin.Monitor the patient’s bloods: potassium levels and digoxin levels.To ensure that the digoxin did not cause any electrolyte imbalance, particularly high or low potassium levels. Digoxin test is done to monitor the levels of the drug in the blood and ensure that digoxin toxicity is avoided. Monitor the patient’s response to digoxin in terms of side effects, especially heart rate, blood pressure and GI status.To check for any arrythmias, hypertension, nausea, vomiting, diarrhea, or other GI side effects.Nursing ReferencesAckley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon Disclaimer:Please follow your facilities guidelines, policies, and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. What is the most important health teaching to client taking digoxin?Take digoxin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Digoxin helps control your condition but will not cure it. Continue to take digoxin even if you feel well.
What does a nurse need to know about digoxin?Digoxin works by inhibiting the sodium and potassium pump, which results in an increase in intracellular sodium and an influx of calcium into cardiac cells, causing the cardiac muscle fibers to contract more efficiently and increase cardiac output.
What is the most important to check when administering digoxin?A nurse should assess the apical pulse for a full minute before administering digoxin due to its positive inotropic action (it increases contractility, stroke volume, and, thus, cardiac output), negative chronotropic action (it decreases heart rate), and negative dromotropic action (it decreases electrical conduction ...
What advice can be given for a patient taking digoxin?Do not increase or decrease the dosage without his or her advice. Your doctor may advise you to record your heart rate and blood pressure daily while taking digoxin. Some doctors may initiate digoxin dosing with a loading dose (a higher than normal dose) followed by a smaller, regular maintenance dose.
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