Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, chronic renal insufficiency, and...

Julia Cook is a 74-year-old retired secretary. Her medical history includes hypothyroidism, chronic renal insufficiency, and hypertension. She suffered a myocardial infarction due to coronary artery disease 5 years ago. She was diagnosed with heart failure 1 year ago and has been managed with a diuretic and an ACE inhibitor. Six months ago, she developed an arrhythmia and was placed on quinidine. Over the past 2 months, her heart failure symptoms have been increasing in severity, with dyspnea and ankle edema occurring at rest or with minimal exertion. Digoxin is now being added to her heart failure treatment regimen.

a. The nurse is teaching Ms. Cook about the digoxin. What should the nurse teach Ms. Cook regarding digoxin toxicity?
b. Describe the factors that increase Ms. Cook’s risk for digoxin toxicity.
c. Ms. Cook’s symptoms continue to increase over the next month, and she is hospitalized for treatment of acute heart failure. She is given IV nesiritide along with an IV loop diuretic and digoxin. Discuss some of the nursing considerations related to the administration of the nesiritide.

Solutions

Expert Solution

Digoxin toxicity may be due to unintentional or accidental overdose, suicidal, homicidal or any interaction due to drug or ingestion of plant.This affects cardiac rate and rhythm and produce various dysthymias.

Symptoms can be seen related to Central nervous system, visual, gastrointestinal system, cardiac system with common symptoms like nausea, vomiting and drowsiness.

Central Nervous system

Lethargy
Neuralgia
Head ache
Hallucinations
Seizures
Confusion etc

Visual effects includes

Visual aberration
Yellow - green distortion
Snowy vision
Photophobia
Decreased visual acuity
Yellow halos

GI symptoms are

Anorexia
Weight loss
Abdominal pain
Diarrhea

Cardiac symptoms like

Palpitations
Shortness of breath or dyspnea
Syncope
Swelling of lower extremities
Bradycardia
Hypotension

Ms Cook has risk for developing digoxin toxicity as she is on diuretic and quinidine.

Both these drugs have interaction with digoxin and may increase serum digoxin level, and later toxicity.

Nesiritide is used to treat heart failure.

Continuously monitor patients heart rate, blood pressure and ECG while administering Nesiritide.
If Hypotension develops immediately stop or reduce the dose.
Serum creatine level may increase, so check before after and during administration of nesiritide.
Nesiritide cause severe hypersensitivity.

Nightingale answered 1 year ago

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