Digoxin is an essential medication every nurse needs to know about in a clinical setting and every nursing student needs to understand for the Next Generation NCLEX.
This is why, in this week’s episode of NCLEX Ready, I will be sharing with you everything you need to know about this important medication.
Together, you and I will be learning about Digoxin’s mechanism of action, its therapeutic use, its administration, the side effects it can cause, its toxicity, nursing monitoring, patient education, interactions with other substances, and more.
Plus, we’ll also be doing a quick Q&A together at the end of the episode, so make sure to listen till the last minute if you want to check your skills.
Are you ready for the challenge?
Let’s dive in!
Everything You Need to Know About Digoxin
Digoxin is a cardiac glycoside. It’s a medication that increases the output force of the heart –it helps the heart muscle have stronger contractions and pump more effectively.
If someone has a heart rate that is too high or stroke volume that’s too low, then digoxin we give them digoxin to decrease the heart rate or improve the stroke volume.
Indication
We give digoxin for mild heart failure and arrhythmias such as atrial fibrillation and atrial flutter. Digoxin helps with lowering the heart rate and maintaining a healthy heart rhythm.
Contraindication
Do not use digoxin in patients with ventricular fibrillation or acute myocardial infarction. The contraction of the heart and blood flow can be affected, leading to death.
Therapeutic Range
The therapeutic levels of serum digoxin range from 0.8ng/mL to 2.0 ng/mL. This may vary from clinic to clinic, but this is the most common number we see on the NCLEX.
Digoxin Toxicity
Nausea, vomiting, bradycardia, confusion, fatigue, dizziness, or vision changes are all signs and symptoms of digoxin toxicity, which occurs when there is too much digoxin in the bloodstream.
IMPORTANT: Hold the medication if the heart rate is less than 60 beats per minute in an adult, less than 70 beats per minute in a child, and less than 90 beats per minute in an infant.
Hypokalemia, which is a decrease in potassium level, is a risk of digoxin administration, so you must closely monitor the patient if they are taking digoxin and a diuretic.
Injured kidneys and being an elderly patient can also place the patient at risk for digoxin toxicity. If the kidneys are injured, then the digoxin won’t be excreted out properly and it will stay in the bloodstream, resulting in digoxin toxicity. An elderly patient has a decrease in GFR, which also affects how the kidneys excrete digoxin from the body.
Nursing Consideration
The nurse must listen to the apical pulse for a full minute to make sure the heart rate is stable and in the right range.
The nurse must also know the signs and symptoms of toxicity, know the therapeutic range of serum digoxin level, and notify the healthcare provider for any abnormal findings.
Fluid status monitoring is essential as well. We should watch the amount of fluids that’s entering and exiting the body. Daily weighings help with this.
Patient Education
- Educate the patient on taking the medication consistently and not to switch brands.
- Educate the patient on the signs of digoxin toxicity. If the patient is experiencing any of the side effects, they must report to the healthcare staff immediately.
- Encourage your patient to maintain a high-potassium diet to lower the risk of hypokalemia.
Digoxin True or False Statements
Statement #1: Digoxin is used for patients with heart failure.
This statement is true.
Statement #2: Digoxin is used for patients with atrial fibrillation.
This statement is true.
Statement #3: Digoxin is also known as Lanoxin.
This statement is true. You may also hear the medication’s nickname, which is “Dig”.
Statement #4: The therapeutic levels of serum digoxin range from 0.8 to 2.8 ng/mL.
This statement is false. The therapeutic levels of serum digoxin range from 0.8 to 2.0 ng/mL.
Statement #5: Assess the apical pulse for 1 full minute before administering digoxin.
This statement is true.
Statement #6: You can use digoxin for patients with ventricular fibrillation.
This statement is false. Do not give digoxin to a patient with ventricular fibrillation.
Digoxin Practice Questions and Answers
Question #1: The nurse is providing care for a 40-year-old patient who is on digoxin therapy. Which of the following laboratory values should you monitor closely?
- Serum potassium
- Blood urea nitrogen (BUN)
- Complete blood count (CBC)
- Blood glucose levels
Answer: Serum potassium.
Rationale: While all of these laboratory values should be monitored, serum potassium should be CLOSELY monitored. Digoxin toxicity is worsened by hypokalemia. On the other hand, too much potassium actually reduces the effectiveness of digoxin.
Question #2: The nurse is providing care for a 53-year-old patient, who is scheduled for digoxin administration. Which of the following actions should the nurse perform?
- Administer digoxin
- Assess the blood pressure
- Assess the apical pulse for one full minute
- Assess the apical pulse for two full minutes
Answer: Assess the apical pulse for one full minute.
Rationale: Taking vital signs is important, but assessing the apical pulse for one full minute is essential prior to administering digoxin. Digoxin should not be given if the pulse is less than 60 beats per minute. The nurse must withhold the dose and notify the healthcare provider. Assessing the apical pulse for two full minutes is not necessary.
Question #3: The nurse is providing education with digoxin administration to a patient with heart failure. Which of the following dietary recommendations is most appropriate for a patient taking digoxin?
- Increase sodium intake
- Restrict fluid intake
- Decreased potassium diet
- Increased potassium diet
Answer: Increased potassium diet.
Rationale: Digoxin has the potential to cause hypokalemia. Increasing foods high in potassium can help maintain potassium levels. Encourage potassium-rich foods, such as bananas, avocados, leafy greens, and oranges.
Question #4: A nurse is providing care for a patient and is preparing to administer digoxin. Which of the following statements from the patient requires further action prior to administration?
- “I feel nauseous and everything appears yellow.”
- “I like to go for walks after my medication.”
- “I like to take naps in the morning.”
- “I feel a little dizzy after I wake up.”
Answer: “I feel nauseous and everything appears yellow.”
Rationale: Reports of nausea and yellowish vision can indicate digoxin toxicity. Further evaluation must be done immediately. Digoxin must be withheld and the healthcare provider must be notified as soon as possible. The other statements do not warrant an emergency.
Question #5: The nurse is reviewing the digoxin level of a 49 year-old-patient with atrial fibrillation. Which of the following digoxin levels should be reported to the healthcare provider immediately?
- 1.0 ng/mL
- 1.5 ng/mL
- 2.0 ng/mL
- 2.5 ng/mL
Answer: D. 2.5 ng/mL.
Rationale: The therapeutic levels of serum digoxin range from 0.8 to 2.0 ng/mL. While 2.0 ng/mL is too close to comfort, 2.5 ng/mL is way out of range and indicates digoxin toxicity.
