Question

The client is ordered to receive a cardiac glycoside. Which of the following vital signs would make the nurse question administering this medication? a. Apical pulse 55 beats per minute c. Blood pressure 118/66 b. Respirations 12 breaths per minute d. Temperature 99.4°F A 73-year-old man with long-term congestive heart failure has presented for an office visit. He reports that he has been depressed and recently began taking St. John's wort. The nurse knows that this herbal supplement may: a. increase digoxin toxicity reduce the therapeutic benefits of digoxin. enhance digoxin effectiveness without producing toxicity c. alter the patient's potassium electrolyte balance. d. b.

Answer 1

The client is ordered to receive a cardiac glycoside.which of the vital signs would make the nurse question administering this medication?

Answer: a. Apical pulse 55 beats per minute.

• Cardiac glycosides are a class of organic compounds that increase the output force of the heart and decrease its rate of contractions by acting on the cellular sodium-potassium ATPase pump. Cardiac glycosides have long served as the main medical treatment to congestive heart failure and cardiac arrhythmia, due to their effects of increasing the force of muscle contraction while reducing heart rate.
• A nurse has to monitor apical pulse for 1 full min before administering cardiac glycoside. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Also notify health care professional promptly of any significant changes in rate, rhythm, or quality of pulse.

A 73 year old man with long term congestive heart failure has presented for an office visit. He reports that he has been depressed and recently began taking st. John's wort. The nurse knows that this herbal supplement may:

Answer: c. reduce the therapeutic benefits of digoxin.

• St. John's wort may reduce the effectiveness of several drugs by speeding up activity in a key pathway responsible for their breakdown. The end result is that blood levels of these drugs decrease because the body breaks them down faster making the drugs less effective. St. John's wort especially affects indinavir, a protease inhibitor used to treat HIV infection. It may also affect cyclosporine, a drug used to help prevent organ transplant rejection, and other drugs that work through this same pathway in the body, such as birth control pills and medications for heart disease and depression.
• St John's Wort may reduce the efficacy of the following medicines: warfarin, digoxin, theophylline, other HIV protease inhibitors (saquinavir, ritonavir, nelfinavir), HIV non-nucleoside reverse transcriptase inhibitors (efavirenz, nevirapine, delavirdine), anticonvulsants (phenytoin, carbamazepine, phenobarbitone)