Question

A 73-year-old female presents to the emergency department with nausea and confusion. The client normally takes digoxin, furosemide, and enalapril.

A. What will the nurse assess when caring for this patient? Include physical assessment and laboratory monitoring.

B. The patient's digoxin level of 2.2 ng/mL. What does the nurse do with this information?

Answer 1

A. All patients receiving LASIX therapy should be observed for these signs or symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia or hypocalcemia): dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, ...Monitor BP periodically in patients receiving IVdigoxin. Monitor ECG during IV administration and 6 hr after each dose. Notify health care professional if bradycardia or new arrhythmias occur. Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing.Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril. Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.

comprehensive history and physical examination can often reveal the cause of nausea and vomiting, making further evaluation unnecessary. Acute symptoms generally are the result of infectious, inflammatory, or iatrogenic causes. Most infections are self-limiting and require minimal intervention; iatrogenic causes can be resolved by removing the offending agent. Chronic symptoms are usually a pathologic response to any of a variety of conditions. Gastrointestinal etiologies include obstruction, functional disorders, and organic diseases. Central nervous system etiologies are primarily related to conditions that increase intracranial pressure, and typically cause other neurologic signs. Pregnancy is the most common endocrinologic cause of nausea and must be considered in any woman of childbearing age. Numerous metabolic abnormalities and psychiatric diagnoses also may cause nausea and vomiting. Evaluation should first focus on detecting any emergencies or complications that require hospitalization. Attention should then turn to identifying the underlying cause and providing specific therapies. When the cause cannot be determined, empiric therapy with an antiemetic is appropriate. Initial diagnostic testing should generally be limited to basic laboratory tests and plain radiography. Further testing, such as upper endoscopy or computed tomography of the abdomen, should be determined by clinical suspicion based on a complete history and physical examination.In cases of confusion, a physical examination helps in localizing the lesion if the cause is from the brain. It also gives clues to the underlying cause of the disease. A complete neurological examination may not be done due to a limitation of the patient'scondition.

1. Complete blood count to look for signs of anemia and infections.
2. Electrolyte and kidney function panel to look for electrolyte abnormalities and liver issues.
3. Albumin tests to assess your nutritional status.

4. Complete blood cell count with differential - Helpful to diagnose infection and anemia

5. Electrolytes - To diagnose low or high levels

6. Glucose - To diagnose hypoglycemia, diabetic ketoacidosis, and hyperosmolar nonketotic states

7. Renal and liver function tests - To diagnose liver and renal failure

8. Thyroid function studies - To diagnose hypothyroidism

9. Urine analysis - Used to diagnose urinary tract infection

10. Urine and blood drug screen - Used to diagnose toxicological causes

11. Thiamine and vitamin B-12 levels - Used to detect deficiency states of these vitamins

12. Tests for bacteriological and viral etiologies including syphilis

13. Sedimentation rate

14. Drug screen including alcohol level

15. HIV tests

16. Tests for other infectious causes if necessary or clinically indicated (These tests are not performed routinely, even though 30-40% of hospitalized patients with HIV infection develop delirium during hospitalization. ^[32] )

17. Serum marker for delirium: The calcium-binding protein S-100 B could be a serum marker of delirium. Higher levels are seen in patients with delirium when compared to patients without delirium. B. Therapeutic levels of digoxin are 0.8-2.0 ng/mL. The toxic level is >2.4 ng/ mL.Monitor BP periodically in patients receiving IVdigoxin. Monitor ECG during IV administration and 6 hr after each dose. Notify health care professional if bradycardia or new arrhythmias occur. Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing.If you have atrial fibrillation, or certain heart problems such as arrhythmia, you may notice improvements after a few weeks. If you have atrial fibrillation, the following symptoms may mean that digoxin is not working as well as it could be: a fast pulse.