Question

Explain why a child with congestive heart failure should be placed on a regiment of oral digitalis and diuretics.

What is the expected response?

What side effects of oral digitalis and diuretics and/or monitoring should the RN consider with this treatment regimen?

Discuss the signs and symptoms of digital toxicity.

Answer 1

1. Congestive heart failure in children:

Congestive heart failure( CHF) is a syndrome marked by weakness , oedema and shortness of breath due to the inability of heart to circulate the blood adequately to the lungs and other tissues.

In adults it may be caused due to Coronary Artery Disease, increased blood pressure , heart valve disorders etc. But in children CHF occurs mainly due to Congenital heart abnormalities.

Oral Digitalis and Diuretics in children :

The main medical management of CHF in children are with the drugs Digitalis/ Digoxin and Diuretics. Digitalis is a purified Cardiac glycoside extracted from foxglove plant ( Digitalis Lanata), widely used in the treatment of heart conditions such as CHF and atrial fibrillation,  and Digoxin helps the child's heart to beat stronger with a regular rhythm.

Diuretics are the drugs that used to increase the urination and this drugs helps the child's kidney to remove excess fluid from the body.

2. Expected Response

Congestive heart failure in children is characterised by the swelling of angles, abdomen, eyelids and face, shortness of breath , fatigue, falling asleep when feeding , changes in temperature and colour of skin while playing. Digoxin helps to the heart beat to be stronger and regulating the heart beat by strengthening the heart muscles for contraction. Diuretics helps to relieve the swelling and pulmonary oedema, that causes breathing difficulty by helping the kidneys to remove excess fluid from the body.

3. Side effects and RN consideration:

Side effects of Digoxin in children are Diarrhoea, vomiting, loss of Appetite, swelling of ankles, slow or fast hear rate.

Diuretics treatment in children may cause headache, diarrhoea, blurred vision, stomach cramps etc.

Combined regimen of Digitalis and Diuretics may increase the risk of Digitalis toxicity.

RN has to monitor

*the apical pulse for 1 minute, hold the medication if it below 90 in infants. Chech again after 1 hr, if there is no improvement ,then report to the physician.

* Check the dosage of drug and preparation properly.

* Avoid the drug giving with the meals, as it may hinder the absorption.

* Monitor the ECG and electrolyte levels.

* Monitor the drug level in the blood ( 0.5 to 1.5 ng/mL is the therapeutic range.)

* Closely monitor the signs and symptoms of Digitalis toxicity.

4. Signs and symptoms of Digitalis toxicity:

Digitalis toxicity can occur due to the over dose of Digitalis product/ Digoxin or it may be due to drug interactions with other drugs such as Furosemide ( diuretics). Diuretics cause excess loss of water and other electrolytes from the body. Risk of Digitalis toxicity can be increased by loss of Potassium ions. Therapeutic range of Digoxin is 0.5 to 1.5 ng/mL. Above 2ng/m L can cause toxicity.

Sign and symptoms of Digitalis toxicity:

Irregular pulse

GI disturbances: nausea, vomiting, diarrhoea

Blurring of vision

Confusion, decreased consciousness

decreased urinary output

dyspnoea on lying down position.