Grace Markham is a 63-year-old widow who lives alone. She has a history of rheumatic heart...

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

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.

Expert Solution

4,Digoxin can cause all sorts of arrhythmias and conduction disturbnces including AF, mostly this is prescribed for heart failure and after a while AF and other arrhythmias develop this nmay result from absolute or ralative digoxin overdosage.

5,Ask the patient about the lack of appetite nausea vumiting,head ache ,confusion,hallucination,depression,blurred vision, and assess the subjective data, we should watch for signs and symptoms of toxicity, acees the serum examination of medications especially digoxin.

6,The normal level of digoxin is between 0.5-.9 nanograms of medications per millilitr of blood. If treated for heart arrythmia the normal level os the drug is between 0.5-2.0 ng/ml. her digoxin 2.5 ng/ml.

The signs and symptoms and the lab value of blood digoxin is 2.5 n/g of Mrs Markam it significe that the patient is having digoxin toxicity.

The digoxin toxiicity is life thretening condition, The most common symptoms are gastrointestinal and include nausea,vomiting,abdominal pain and diarrhea, the cardiac manifestations are most common and can ba fatal.

plz give a thums up

Nightingale answered 2 years ago

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