Question

Ms. L is being discharged form the acute care facility after admission for atrial fibrillation. While in the acute care facility, it was discovered that Ms. L also has essential hypertension. Ms. L has no prior history of medical problems. She is 45 years old, single, living on her own with two aging parents, who have multiple health problems. Ms. L is responsible for most of their care. She is to be discharged from the acute care facility and states, “I really need to know about this digoxin and verapamil I am required to take. I have to take care of myself so I can work and take care of my parents.” How should the nurse proceed with the teaching?

Answer 1

As a nurse we will give Ms.L health eductaion that it can be very helpful in the self care at the home , such as we advice her to take the medicine exactly as directed , and don't skip the doses .. and also teach them how to take their own pulse , and keep the record of her result . and also tell in which pulse rate mean that she need medical attention . On slowing the pulse is often the goal of treatment . also she can use automatic machine to check pulse at home sometimes these machine don't count thepulse correctly with aterial fibrilltaion . And very importantly on the diet related instruction such as she have to limit the intrake of coffee , tea , cola and other drinks with caffeine . Also advice her to not to take over the counter medicienes that have caffeine in them , also avoid medicines with pseudoephedrine . If she are taking blood thinner medicine , alcohol may interfere with them by increasing the effect so just to avoid to take alcohol. And never take stimulants such as amphetamines or cocaine . Thses drugs can speed up her heart rate and trigger aterial fibrillation.

Teaching the patient regarding taking digoxin

Instruct the Ms.L to take medication as directed , at same time each day . teach her also how to take accurately measure medication. Take a missed doses within 12 hrs of scheduled dose or omit . Do not double the doses  

Teach Ms, L to take Pulse and to contact health care professional before taking medication if pulse rate is below 60 or above 100 .

Teach Ms.L that changes in heartrate , especially bradycardia are among the first signs of digoxin toxicity  

Instruct to the Ms.L to keep digoxin tablets in their original container and not to mix in pill boxes with other medication , and may look similar to and may be mistaken for other medication.

emphasizes the importance of routine follow up exams to determin e effectiveness and to monitor for the toxicity .

Teaching regarding taking the verapamil

Ms. L have to take this medication in cautiously while taking alcohol as , verapamil may cause the effects of alcholol to be more severe and longer - lasting .

Take the missed dose as soon as you remember it .However , if it is almost time for the next dose , skip the missed dose and continue theregular dosing schedule .And do not take a double dose to make up for a missed one .

It is important to keep this medication inteh container it came in, tightly closed and Unneeded medication should be disposed of in special ways to ensure that pets , children and other people cannot consume them .  

However , Msl should not flush this medication down the toilet Instead thebest way to dispose of this medication is through a medicine take - back program