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.

Solutions

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 1 year ago

Next > < Previous

Related Solutions

Case Study—The Client With Cardiovascular Disease Grace Markham is a 63-year-old widow who lives alone. She...

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,...

A 23-year-old woman presents with a history of recent seizures. She lives alone and has several...

A 23-year-old woman presents with a history of recent seizures. She lives alone and has several cats in her apartment. An MRI scan of her brain shows a 3-cm mass lesion in the left temporal lobe and several smaller lesions in her cerebellum and right frontal cortex. What infectious disease is the most likely cause of this patient's intracerebral mass lesions? A. Cryptococcosis B. Actinomycosis C. Toxoplasmosis D. Coccidioidomycosis E. Histoplasmosis

A 35 year-old man with a clinical history of rheumatic fever has recently developed a heart...

A 35 year-old man with a clinical history of rheumatic fever has recently developed a heart murmur. This is most likely cause by? Presence of rheumatoid factor Molecular mimicry of the streptococcal antigen and cardiac myosin Common variable immune deficiency A birth defect

Mrs. Smith is an 88- year-old female who lives alone in her home. She walks with...

Mrs. Smith is an 88- year-old female who lives alone in her home. She walks with a walker. Last night Mrs. Smith needed to go to the bathroom. She got out of her bed and walked to the bathroom without using her walker. In the morning her daughter came to the house to check up on her. She found her mom on the bathroom floor. She called the ambulance and her mom was taken to the emergency room. In the...

(1.2pts) Question 1 - Bonnie is a 70-year-old woman who lives alone. One evening she felt...

(1.2pts) Question 1 - Bonnie is a 70-year-old woman who lives alone. One evening she felt lightheaded and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point, she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time...

Mr. Cooper is a 73-year-old man with no significant past medical history. He lives alone and...

Mr. Cooper is a 73-year-old man with no significant past medical history. He lives alone and is very independent in function and spirit. He was seen in the emergency department six weeks ago for complaints of “arthritis in his right knee.” He was examined, given a prescription for ibuprofen, provided with a cane, and instructed to follow up with his health care provider. When Mr. Cooper sees his health care provider for his follow-up visit, the health care provider notices...

Case: Miss Diasy is an 85-year-old economically disadvantaged woman who lives alone, has no car and...

Case: Miss Diasy is an 85-year-old economically disadvantaged woman who lives alone, has no car and cannot take public transportation because she cannot stand or walk without her walker or a store scooter. She lives only on what she collects from Social Security and has no family to care for her. She has a few well-intentioned neighbors and does have access to a senior center that can transport her to the grocery store, but lately she has no desire to...

Mrs. Smith is a 75 year old widow who is very active and healthy. She was...

Mrs. Smith is a 75 year old widow who is very active and healthy. She was brought in to the ED after collapsing at the grocery store. Mrs. Smith explains to the nurse practitioner she doesn't know what happened but she has been feeling exhausted and no energy for the last month. She tells the nurse practitioner, " I must be getting old, I am slowing down." The nurse practitioner is suspecting there is more going on than just age....

Lorraine Terrance, an 83-year-old widow who has lived alone since her husband died 6 months ago,...

Lorraine Terrance, an 83-year-old widow who has lived alone since her husband died 6 months ago, is in the early stages of Alzheimer’s disease. She has a history of cardiovascular disease and hypertension and has been admitted to the local hospital for observation after complaints of chest pain. At present, she is very anxious and agitated. The admitting nurse received a telephone call from Mrs. Terrence’s daughter, who lives out of town. The daughter states that her mother has experienced...

A 63-year-old woman reports for her annual physical examination. She has no major previous medical history...

A 63-year-old woman reports for her annual physical examination. She has no major previous medical history but does have a recent history of a broken wrist she sustained after a mild fall. Three years ago her height was recorded at 5’3” and is now recorded at 5’1”. She complains that she can’t be quite as active as she used to be and that her back is beginning to bother her. This leads her to be outside less frequently. Her physician...

Subjects