Question

Case Study—The Client With Cardiovascular Disease

Grace Markham is a 63-year-old widow who lives alone. She has a history of rheumatic heart disease manifested by moderate mitral valve stenosis with slight mitral insufficiency. She has been maintained on digoxin, 0.25 mg PO daily, for several years, with few adverse effects. Compliance with therapy has generally been excellent. She understands the drug therapy and her 3-g sodium diet.

She was admitted to the hospital complaining of dyspnea on exertion, ankle edema, mild chest pain on exertion, and fatigue. The ECG showed no signs of infarction but showed atrial fibrillation, with a ventricular response of 124 beats/min. Her serum digoxin level was 0.9 ng/mL. A repeat cardiac catheterization showed no changes in the mitral valve but did indicate some early coronary artery narrowing. While she was in the hospital, the following medications were ordered for Ms. Markham:

digoxin, 0.25 mg PO daily

Lasix, 20 mg PO twice daily

K-Dur, 20 mEq PO daily

verapamil SR, 240 mg PO daily

Isordil, 10 mg PO three times daily

1. Describe the relationship among digoxin, Lasix, and K-Dur in the management of Mrs. Markham's symptoms.

2. What additional data should be included in the assessment of the client related to the use of these three medications?

3. What is the significance of a serum digoxin level of 0.9 ng/mL?

4. How will the use of digoxin affect Mrs. Markham's atrial fibrillation?

Several weeks later, Mrs. Markham comes to the clinic complaining of nausea, vomiting, and diarrhea. She reports having had these symptoms for several days. She has continued to take her medications except for the K-Dur, which she found increased her nausea.

5. What additional assessment data (subjective, objective, laboratory) should you gather related to these new symptoms?

6. The serum digoxin level for Mrs. Markham was 2.5 ng/mL. Explain the significance of this change in relationship to the symptoms she was having.

Answer 1

1. Describe the relationship among digoxin, Lasix, and K-Dur in the management of Mrs. Markham's symptoms.

Digoxin is used for the treatment for atrial fibrillation.

Lasix is given to reduce ankle edema.

K Dur is given to treat hypokalemia.

Since the patient is taking digoxin for atrial fibrillation, lasix is given to remove excess fluid from body. When there is fluid loss, there are chances of potassium loss which causes hypokalemia.In order to maintain potassium level,K Dur is given.Also,low level of potassium can cause digitalis toxicity.

2. What additional data should be included in the assessment of the client related to the use of these three medications?

Signs of digitalis toxicity includes confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhoea,vision changes, decreased urine output, decrease breathing pattern when lying down.

3. What is the significance of a serum digoxin level of 0.9 ng/mL?

Normal serum digoxin level 0.5 - 2ng/ml. It is normal level.