Nursing considerations about diuretics
Nursing considerations about diuretics
In this article, you will learn aboutNursing implications of digoxin and patient education. Likewise, its dosage, indication, side effects, interactions andsigns and symptoms of digoxin toxicity.
Digoxin belongs to the group of digitalis glycoside medicines. These are some of the oldest drugs used in medicine dating back to 1200AD.
Digitalis inhibits the sodium-potassium pump, leading to an increase in intracellular sodium. This increase causes an influx of calcium, which causes cardiac muscle fibers to contract more efficiently. The main actions of digitalis in the myocardium are:
(1) positive inotropic effect (increases the stroke volume of myocardial contraction),
(2) negative chronotropic effect (decreases heart rate) and
(3) negative dromotropic effect (decreases cardiac cell conduction).
Brand names:Toloxin (CAN), Digitek, Lanoxin, Pediatric Lanoxin.
Class and category of digoxin
Pharmacological class:cardiac glycoside
Therapeutic class:Antiarrhythmic, ionotropic
Pregnancy category: C
Intravenous (IV) loading dose and maintenance
- Adults and children over 10 years old: 8 – 12 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.Maintenance dose:2.4-3.6 mcg/kg dia OD.
- Children aged 5 to 10 years: 15 – 30 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.Maintenance dose:2,3 – 4,5 mcg/kg BD.
- Children from 2 to 5 years old: 25 – 35 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.Maintenance dose:3,8 – 5,3 mcg/kg BD.
- Babies from 1 to 24 months: 30 – 50 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.Maintenance dose:4,5 – 7,5 mcg/kg BD.
- Full-term newborns: 20 – 30 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.maintenance dose: 3 – 4,5 mcg/kg BD.
- premature newborns: 15 – 25 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart. Administer a slow IV over 5 minutes.Maintenance dose:1,9 – 3,1 mcg/kg BD.
Oral loading and maintenance dose
- Adults and children over 10 years old: 10 – 15 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart.Maintenance dose:3.4-5.1 mcg/kg dia OD.
- Children aged 5 to 10 years: 20 – 45 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the subsequent two doses, each 25% of the initial loading dose, given every 6 to 8 hours.Maintenance dose:3,2 – 6,4 mcg/kg BD.
- Children from 2 to 5 years old: 30 – 45 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart.Maintenance dose:7.5 – 10 mcg/kg twice daily.
- Babies from 1 to 24 months: 35 – 60 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the subsequent two doses, each 25% of the initial loading dose, should be given 6 to 8 hours apart.Maintenance dose:10 – 15 mcg/kg BD.
- Full-term newborns: 25 – 35mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart.maintenance dose: 6 – 10 mcg/kg BD.
- premature newborns: 20 – 30 mcg/kg in three divided doses. The first dose should equal 50% of the total dose and the two subsequent doses, each 25% of the initial loading dose, given 6 to 8 hours apart.Maintenance dose:5 – 7,5 mcg/kg BD.
Digoxin pharmacokinetics and pharmacodynamics
|4||0.5 – 2 hours||6 – 8 hours||3 – 4 dias|
|AFTER||5 – 30 minutes||15 hours||3 – 4 dias|
Absorption:Digoxin is effectively absorbed from the gastrointestinal tract when taken orally.
Distribution:Protein binding 30%
Half life:36 – 48 hours
Excretion:Most kidneys eliminate inactive substances through the urine.
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Mechanism of Action of Digoxin
- It inhibits the sodium-potassium ATPase pump, which causes calcium influx and thus promotes cardiac contractility.
- It increases the strength and speed of cardiac contraction, leading to positive inotropic effects.
- Digoxin acts as an antiarrhythmic agent, slowing conduction and prolonging the effective refractory period of the AV node.
What are the indications for digoxin?
Indications for digoxin include:
- Heart failure (HF)/CHF
- flutter atrial
- atrial fibrillation (atrial fibrillation)
- It is also used off-label for the treatment/prophylaxis of paroxysmal supraventricular tachycardia (PSVT).
What are the contraindications of digoxin?
Digoxin contraindications are:
- ventricular arrhythmias
- Second or third grade AV block
Careful:AMI, kidney disease, hypothyroidism, hyperthyroidism, liver dysfunction, bradycardia, hypokalemia, hypertension, cor pulmonale, Wolff-Parkinson-White syndrome.
- Increases serum digoxin level with quinidine, flecainide, verapamil
- Decreases absorption of digoxin with antacids, colestipol
- The risk of digoxin toxicity is increased when taken with thiazide diuretics, loop diuretics, amiodarone, corticosteroids.
- Licorice can amplify negative effects.
- High fiber and pectin content can reduce absorption.
- Flaxseed and psyllium can decrease the effect of digoxin.
- Foxglove, goldenseal, hawthorn and rue can increase the cardiac effect.
What are the side effects of digoxin?
Digoxin side effects/adverse reactions include:
- Dor abdominal
- Blurred vision
- Life-threatening adverse reactions:Atrioventricular block, cardiac arrhythmias
Nursing Diagnosis Digoxin
- Decreased cardiac output related to decreased myocardial contractility.
- Ineffective peripheral tissue perfusion associated with decreased myocardial contractility.
- Anxiety related to hospitalization; serious heart health condition.
Click here to view AFIB Nursing Care Plan
Click here to view nursing care plan for congestive heart failure (CHF)
Nursing implications of digoxin [Nursing considerations]
Nursing implications of digoxinThey are divided into assessment, interventions and nursing assessment.
- Take a complete medical, medication, and herbal history. Determine prior hypersensitivity to digoxin and related ingredients and possible food interactions.
- Obtain baseline vital signs for future comparison, including apical pulse.
- Assess the apical pulse for a full 1 minute before administering each dose. If the apical pulse is less than 60 bpm in an adult or less than 90 bpm in a child, reassess after 1 hour. Notify the physician if the patient still has bradycardia.
- Watch closely for signs and symptoms of digoxin toxicity. Anorexia, nausea, vomiting, bradycardia, cardiac arrhythmias, altered mental status, and visual disturbances are common symptoms. Report symptoms immediately to your doctor.
- Check the apical pulse rate before administering digoxin. If your pulse is less than 60 bpm DO NOT administer.
- Monitor the ECG trace to detect cardiac arrhythmias.
- Determine the presence of HF by observing signs of peripheral and pulmonary edema.
- Keep the input and output (I&O) chart.
- Monitor serum digoxin level (normal therapeutic range: 0.8 to 2 ng/mL; digoxin toxicity level: greater than 2 ng/mL).
- Monitor serum potassium levels (normal range: 3.5 to 5.3 mEq/L) and report hypokalemia (less than 3.5 mEq/L). Patients with hypokalemia are more likely to develop digitalis toxicity and severe arrhythmias.
- Digoxin is not recommended in patients with acute cor pulmonale with heart failure related to amyloid heart disease, constrictive pericarditis, heart failure with preserved ejection fraction (EPHF) or restrictive cardiomyopathy due to increased vulnerability to digoxin toxicity. Digoxin is also not indicated for patients with idiopathic hypertrophic subaortic stenosis because its inotropic effects may aggravate outflow obstruction.
- Digoxin therapy may be ineffective if the underlying thiamine deficiency is not treated in patients with beriberi heart disease.
IV management considerations
- Administer IV digoxin undiluted or diluted 1:4 or more with sterile water for injection, NS, or D5W.
- Administer immediately after dilution.
- Administer slowly over 5 minutes.
- Evaluate ECG tracings for cardiac arrhythmias.
- Discard the injection if it is discolored or contains precipitates.
To assess the effectiveness of digoxin treatment: improvements in symptoms, such as a decrease in heart rate and a decrease in rales; no signs of digoxin side effects or toxicity; obtained therapeutic serum levels of digoxin, stabilization of atrial fibrillation.
Pregnancy/breastfeeding considerations for digoxin
- Digoxin crosses the placenta and is present in breast milk.
- Evaluate the newborn for signs and symptoms of digoxin toxicity, such as arrhythmias and vomiting.
- Instruct nursing mother to consult before taking digoxin.
- The dose of digoxin may need to be increased during pregnancy and decreased postpartum. Closely monitor serum digoxin levels.
What is patient education for digoxin?
- Teach the patient and caregiver to measure the pulse accurately.
- Advise the patient to take the pulse before each dose and notify the healthcare professional if the pulse is less than 60 beats per minute or if the pulse rate suddenly increases.
- Instruct the patient to take the medication exactly as prescribed and not to stop abruptly.
- Teach the patient to avoid over-the-counter medications when taking digoxin.
- Teach the patient about food-herb interactions.
- Instruct the patient that they should always carry an identity card that includes information about digoxin therapy and diagnosis.
- Teach the patient about the signs and symptoms of digoxin toxicity and report immediately if such symptoms appear. Signs and symptoms of digoxin toxicity include, but are not limited to, nausea, vomiting, diarrhea, visual changes, confusion, and malaise.
- If the missed dose is within 12 hours of the scheduled dose, instruct the patient to take it as soon as he remembers. If not, it is advisable to notify the prescriber as soon as possible.
- Educate patients to consume potassium-rich foods such as fresh and dried fruits, fruit juices, vegetables, and potatoes.
Digoxin (Digitalis) toxicity
Cardiotoxicity is a significant side effect of digoxin that causes ventricular arrhythmias. Digoxin-induced ventricular arrhythmias can be caused by three impaired cardiac functions:
(1) suppression of AV conduction,
(2) improved automaticity, and
(3) shortened refractory period in ventricular muscle.
Signs and symptoms of digoxin (Digitalis) toxicity
- Bradycardia (pulse less than 60 beats/min)
- premature ventricular contractions
- Blurred vision
- Visual illusions (white, green, and yellow halos around objects)
- ventricular arrhythmias
What is the antidote for digoxin?
The antidote for digoxin or digitalis toxicity isDigoxin immune fab (sheep, Digibind). This drug binds to digoxin to produce complex molecules that can be excreted in the urine, preventing digoxin from binding to the cell's site of action.
Treatment for digoxin overdose (digital toxicity)
- stop medication
- monitor electrocardiogram
- Administer potassium as prescribed.
- Administer an adrenergic blocking agent as prescribed.
- To manageFAB immune to digoxinas prescribed.
- Ventricular arrhythmias induced by digoxin can be effectively treated with the antiarrhythmics phenytoin and lidocaine. Lidocaine should not be used as a long-term treatment.
AFIB Nursing Care Plan
Nursing Care Plan for Congestive Heart Failure (CHF)
you learned aboutNursing Implications of Digoxin (aka Nursing Considerations)ypatient teachingin this article. In addition, you learned about the mechanism of action, pharmacokinetics, dosage, indications, contraindications, side effects and digoxin.signs and symptoms of digoxin toxicity.
Recommended reading and reference
Kee, J., Hayes, E. e McCuistion, L. (2015).PHARMACOLOGY A patient-centered approach to the nursing process(8ª ed.). Elsevier Inc/Saunders.
Kizior, R. y Hodgson, K. (2021).SAUNDERS 2021 NURSING MEDICINES MANUAL. Elsevier Inc.
Learning from Jones and Bartlett. (2021).Medication Handbook for Nurses(20th ed.). Learning from Jones & Bartlett, LLC.
Skidmore-Roth, L. (2021).MOSBY'S NURSING DRUGS REFERENCE 2021(34th edition). Elsevier Inc.
What is most important for the nurse to teach the patient in taking digoxin? ›
Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100. Pedi: Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children.What can you teach a patient about 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 are the nursing implications for digoxin? ›
Nursing Considerations Across the Lifespan
Serum digoxin levels should be monitored, with a normal therapeutic range from 0.8 to 2 ng/mL. Serum potassium levels should also be closely monitored for patients on digoxin because hypokalemia increases the effect of digoxin and can result in digoxin toxicity.
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 should the nurse monitor with digoxin? ›
Serum digoxin levels should be monitored, with a normal therapeutic range from 0.8 to 2 ng/mL. Serum potassium levels should also be closely monitored for patients on digoxin because hypokalemia increases the effect of digoxin and can result in digoxin toxicity.What considerations and precautions should be addressed with a patient taking digoxin? ›
Follow your doctor's directions carefully. The amount of this medicine needed to help most people is very close to the amount that could cause serious problems from overdose. Some early warning signs of overdose are confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems.What side effects are important to note with patients taking digoxin? ›
- Feeling confused, dizzy or generally unwell. ...
- Feeling or being sick (nausea or vomiting) and loss of appetite. ...
- Diarrhoea. ...
- Changes in your vision (including blurred vision and not being able to look at bright light) ...
- Skin rashes.
Digoxin is a type of drug called a cardiac glycoside. Their function is to slow your heart rate down and improve the filling of your ventricles (two of the chambers of the heart) with blood.How do you monitor a patient with digoxin? ›
- When monitoring digoxin, blood levels should be drawn no sooner than 6 hours after the most recent dose. - Digoxin levels should be interpreted and acted on based on clinical signs and symptoms. - Therapeutic digoxin levels should fall between 0.6 – 1.2 nmol/L despite reference ranges of up to 2.6 nmol/L.What is the nursing intervention for digoxin toxicity? ›
An additional nursing intervention to guard against digoxin toxicity is to assess the apical pulse for one full minute before administering digoxin. Hold the next dose and contact the physician if the apical pulse is less than 60 or more than 120 beats per minute.
What are nursing implications and considerations? ›
Nursing implications are the nursing-related consequences of something (a disease, a medication, a procedure). ie. not the medical side effects, but the things which may occur which are up to the nurse to resolve. To work out what they are, you need to understand about the disease, medication or procedure.What are the nursing responsibilities related to administering medications? ›
Nurses' responsibility for medication administration includes ensuring that the right medication is properly drawn up in the correct dose, and administered at the right time through the right route to the right patient. To limit or reduce the risk of administration errors, many hospitals employ a single-dose system.Does digoxin affect blood pressure? ›
Conclusions: Digoxin significantly decreases diastolic blood pressure during overnight sleep in patients with congestive heart failure. This effect is likely to be caused by reduction of sympathetic activity or increase of parasympathetic activity.What should you avoid when taking digoxin? ›
- Erythromycin and tetracycline (antibiotics)
- Antiarrhythmic drugs (amiodarone)
- Calcium channel blockers.
- Over-the-counter antacids.
- Hawthorn (an herbal remedy)
- Black licorice. ...
- Large amounts of oatmeal, milk and high-fibre cereals.
A normal Digoxin level should be 0.5 – 2 ng/mL. Any levels greater than 2 ng/mL is considered toxic.What should you check before administering digoxin? ›
Check your pulse before you take your digoxin. If your pulse is under 60 beats per minute (or the rate that your healthcare provider advises for you), wait 5 minutes. Then check your pulse again.What should you watch for with digoxin? ›
Some early warning signs of overdose are confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems. Other signs of overdose are changes in the rate or rhythm of the heartbeat (becoming irregular or slow), palpitations (feeling of pounding in the chest), or fainting.What is important to know about digoxin? ›
You can take digoxin with or without food, but it's best to take it at the same time each day. Most people take it in the morning after breakfast. You'll usually take it once a day. Swallow the tablets whole with a drink of water.What are the most important reported drug interactions with digoxin? ›
Drugs which reduce digoxin absorption include the antacids aluminium hydroxide, magnesium hydroxide and magnesium trisilicate, the antidiarrhoeals kaolin and pectin, the hypocholesterolaemic agent cholestyramine and the chemotoxins cyclophosphamide, vincristine and bleomycin.