DIGOXIN

(di-jox’in)
Lanoxicaps, Lanoxin
Classifications: cardiovascular agent; cardiac glycoside; antiarrhythmic
Pregnancy Category: A

NURSING IMPLICATIONS

Assessment & Drug Effects

• Be familiar with patient’s baseline data (e.g., quality of peripheral pulses, blood pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a foundation for making assessments.
• Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Notify physician of abnormal values. Draw blood samples for determining plasma digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dose. Therapeutic range of serum digoxin is 0.8–2 ng/mL; toxic levels are >2 ng/mL.
• Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If changes are noted, withhold digoxin, take rhythm strip if patient is on ECG monitor, notify physician promptly.
• Withhold medication and notify physician if apical pulse falls below ordered parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children).
• Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.
• Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate chest for rales.
• Monitor serum digoxin levels closely during concurrent antibiotic–digoxin therapy, which can precipitate toxicity because of altered intestinal flora.
• Observe patients closely when being transferred from one preparation (tablet, elixir, or parenteral) to another; when tablet is replaced by elixir potential for toxicity increases since 30% of drug is absorbed.

Patient & Family Education

• Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation.
• Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances.
• Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.
• Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day.
• Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician.
• Continue with brand originally prescribed unless otherwise directed by physician.
• Do not breast feed while taking this drug without consulting physician.