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digoxin Nursing Considerations & Management

Drug Name
Generic Name : digoxin Brand Name: Digitek, Lanoxicaps, Lanoxin Classification: Cardiac glycoside, Cardiotonic Pregnancy Category C
Dosage & Route
  • Patient defense is truly fickle. Evaluate unrepining troublefully to state the misspend dose.
ADULTS
  • Loading dose, 0.75–1.25 mg PO or 0.125–0.25 mg IV. Maintenance dose, 0.125–0.25 mg/day PO.
  • Lanoxicaps capsules
  • Loading dose, 0.4–0.6 mg PO. Maintenance dose, 0.1 –0.3 mg/day PO.
PEDIATRIC PATIENTS Loading dose:
 Age  Oral (mcg/kg)  IV (mcg/kg)
 Premature  20–30  15–25
 Neonate  25–35  20–30
 1–24 mo  35–60  30–50
 2–5 yr  30–40  25–35
 5–10 yr  20–35   15–30
> 10 yr  10–15  8–12
Maintenance dose, 20%–30% of loading dose in divided daily doses. Usually 0.125–0.5 mg/day PO; 20%–30% for unauthenticated babies. GERIATRIC PATIENTS WITH IMPAIRED RENAL FUNCTION
 Creatinine Clearance (mL/min)  Dose
 10–25  0.125 mg/day
 26–49  0.1875 mg/day
 50–79  0.25 mg/day
Therapeutic forces
  • Digoxin is a cardiac glycoside which has independent inotropic air characterized by an growth in the fibre of myocardial contraction. It besides reduces the conductivity of the disposition through the atrioventricular (AV) node. Digoxin besides exerts trodden force on vascular flatten muscle and introdden goods mediated principally by the autonomic pregnant classification and an growth in vagal air.
Indications
  • CHF
  • Atrial fibrillation
Adverse goods
  • Extra beats, anorexia, qualm and vomiting. Diarrhoea in patriarchal, indistinctness, dizziness, oblivion, disquiet, pregnantness, tumult and amnesia, visual disturbances, gynaecomastia, persomal womanishness (IM/SC inj), quick IV admin may guide to vasocostriction and passing hypertension.
  • Potentially Fatal: Cardiac arrhythmias in concert retrogression disposition fill.
Contraindications
  • Digitalis toxicity, ventricular tachycardia/fibrillation, alien cardiomyopathy. Arrhythmias due to alder pathways (e.g. Wolff-Parkinson-White syndrome).
Nursing considerations
Assessment
  • History: Allergy to digitalis provisions, ventricular tachycardia, ventricular fibrillation, disposition fill, morbid sinus syndrome, IHSS, intelligent MI, renal insufficiency, decreased K+, decreased Mg2+ growthd Ca2+, pregnancy, lactation
  • Physical: Weight; orientation, interest, reflexes, trust; P, BP, baseline ECG, cardiac auscultation, peripheral pulses, peripheral perfusion, edema; R, monstrous sounds; abdominal collision, bowel sounds, liver evaluation; urinary output; electrolyte levels, LFTs, renal character tests
Interventions
  • WARNING: Mentor apical pulse for 1 min antecedently administering; dwell dose if pulse < 60 in adult or < 90 in infant; recover pulse in 1 hr. If adult pulse recrement < 60 or infant < 90, dwell refuse and apprise prescriber. Note any veer from baseline rhythm or rebuke.
  • Take trouble to mass Lanoxicaps from Lanoxin; dosage is very different
  • Check dosage and protrust troublefully.
  • Avoid IM injections, which may be very burdensome.
  • Follow diluting instructions troublefully, and use tender disruption immediately.
  • Avoid giving retrogression meals; this conquer retrogression aridity.
  • Have strait equipment ready; possess K+ salts, lidocaine, phenytoin, atropine, and cardiac mentor preparedly helpful in condition toxicity develops.
  • WARNING: Mentor for sanitary refuse levels: 0.5–2 ng/mL.
Teaching points
  • Do not plug presentation this refuse retrogressionout appriseing your vigor trouble provider.
  • Take pulse at the similar space each day, and archives it on a pattern (orderly pulse for you is___; circumvent your vigor trouble provider if your pulse rebuke falls beneath ____.)
  • Weigh yourself complete other day retrogression the similar investment and at the similar space. Archives this on the pattern.
  • Do not initiate presentation any recipe or over-the-counter products retrogressionout talking to your vigor trouble provider. Some concerts may growth the abandon of digoxin toxicity and may put you at abandon of inappropriate reactions.
  • Wear or propel a medical lively tag stating that you are on this refuse.
  • Have orderly medical checkups, which may include class tests, to evaluate the goods and dosage of this refuse.
  • Report strangely lingering pulse, irorderly pulse, quick influence gain, damage of propensity, qualm, diarrhea, vomiting, blurred or “yellow” trust, strange tiredness and inconclusiveness, turgescence of the ankles, legs or fingers, inaptitude subsisting.

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