Question

Please use atleast 2 citations while answering the questions below. Must be atleast a page long.

1. A 73-year-old female presents to the emergency department with nausea and confusion. The client normally takes digoxin, furosemide, and enalapril.
   A. What will the nurse assess when caring for this patient? Include physical assessment and laboratory monitoring.
   B. The patient's digoxin level of 2.2 ng/mL. What does the nurse do with this information?

Answer 1

A. Physical assessment and laboratory monitoring.

1.Physical assessment

The patient is an older adult who came with nausea and confusion who takes digoxin, fusemide and enalapril. Usually digoxin is given with a diuretic during cardiac conditions like heart failure. so the physical assessment include the following,

• Monitor vital signs; palpate for apical pulse for the  rate, regularity and amplitude. Auscultate the heart sound to check rhythm and rate.
• Check tissue perfusion by checking skin color and capillary refill time to get a baseline date about cardiac output.
• Assess and monitor mental status as the patient have confusion.
• Get an Electrocardiogram done to know about cardiac dysrhythmias.
• Assess urine output , body weight
• Check for signs of dehydration
• Collect history regarding last dose of medication intake.

Laboratory monitoring

• Serum electrolyte levels for potassium, magnesium and calcium because patient is on diuretics and Hypokalemia, Hypercalcemia, Hypomagnesemia can lead to digoxin toxicity.
• Serun digoxin level to know about potential toxicity.
• Kidney function test and liver function test because digoxin is mainly excreted thorugh kidneys and liver. impaired function cause accumulation of digoxin in the body and toxicity.

B. The therapeutic levels of digoxin are 0.8-2.0 ng/mL. Here the patient has digoxin level of 2.2 ng/m associated with nausea and confusion which are the signs of digoxin toxicity. Thus the nurse should inform the physician immediately and need to do cardiac monitoring of the patient.If cardiac manifestations present, arrange for higher level admission like cardiac care unit for close monitoring. Prepare antidote for digoxin toxicity if ordered.