Question

José is a 78-year-old male patient who is experiencing HF after abdominal surgery. He has received digoxin for the past 4 days and has been progressing favorably. José is usually very alert and entertaining. He is a sports fanatic, and he especially loves football. When the nurse enters the room, the patient is watching a football game on television. The patient asks, “Why are those guys hitting each other and falling on the ground?” The patient is also confused as to the date and his location.

1. What does the nurse suspect is the cause of the sudden onset of confusion?

Answer:

Rationale:

2. What laboratory tests does the nurse expect to be ordered? What outcome does the nurse expect?

Answer:

Rationale:

3. What treatment option does the nurse expect to administer?

Answer:

Rationale:

Answer 1

Answer :

Introduction : here HF means Heart failure.

* it means failure of the heart function properly.it may happen sometimes after surgery or post operatively.

Q. No 1. Answer :

The patient is using digoxin, the side effects of dioxin includs dizziness, confusion, nausea, vomitings, changes in mood like anxiety and depression, mental alert ness, etc.

* so the nurse can suspect digoxin side effect, or due to toxicity of digoxin, sudden onset of confusion may occur in client.

Rationale: digoxin mainly inhibit the sodium, potassium and adenosin tried posphotase on the myocardium. Through these over dosage leads to severe electrolyte imbalance.

* the sodium is very important to the brain function.

* so decreased sodium levels ( hyponatremia) leads to altered brain function.

* leads to confusion.

So the nurse can suspect confusion is digoxin side effect.

Q. No. 2 Answer :

Digoxin toxicity blood test can be done to know the digoxin levels.

* the sample should be collect 6- 8 hrs after administration of drugs. Before these time if we will take blood sample may get false result.

* the out come can expected by nurse is the digoxin toxin levels in the blood more than 4 nano grams per dl it indicates life threatening.

Rationale: the nurse can suspect digoxin toxicity, and it is only one of the cause for confusion, and to know that compulsory she must have send blood sample for test to know the toxins levels. Then only she can know or evaluate another cause.

* if it comes normal then she can go another neurological test like CT scan and MRI brain ect.

* before these and all nurse must have to check or use glossgow coma scale to find out orientation level of client.

Q. No. 3 answer :

First nurse can administer the drug digoxin immune fab for toxicity.

* it is primary treatment.

* about 40 mg vial is available, the dosage should be calculated by depending on total body stores.

* then supportive treatment is potasium chloride administration, because hypokalemia also there, and sodium bicarbonate, for hypo natremia, and magnesium also.

* atropine can use during in bradycardia or dysarrythmias.

* administer IV fluids Nacl.

Rationale :

The digoxin immune fab accumulates with excess digoxin in the blood and excreats through urine.

* so that we can reduces the exes level of digoxin in blood.

* the mental status of client can improve.

* and through supportive treatment also can useful to early recovery of clients health.