Question

What nursing measures should be implemented when working with older adults using cardiac glycosides? What are the signs and symptoms of digoxin toxicity and why are older adults at a higher risk?

Answer 1

What nursing measures should be implemented when working with older adults using cardiac glycosides?

• Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician 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
• Pediatric: Heart rate varies in children depending on age, ask physician to specify at what heart rates digoxin should be withheld
• Monitor blood pressure periodically in patients receiving IV digoxin
• Monitor ECG throughout IV administration and 6 hours after each dose. Notify health care professional if bradycardia or new arrhythmias occur
• Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing
• Monitor intake and output ratios and daily weights. Assess for peripheral edema, and auscultate lungs for rales/crackles throughout therapy
• Before administering initial loading dose, determine whether patient has taken any digitalis preparations in the preceding 2–3 wk
• Evaluate serum electrolyte levels (especially potassium, magnesium, and calcium) and renal and hepatic functions periodically during therapy. Notify health care professional before giving dose if patient is hypokalemic.
• Hypokalemia, hypomagnesemia, or hypercalcemia may make the patient more susceptible to digitalis toxicity.
• Neonates may have falsely elevated serum digoxin concentrations due to a naturally occurring substance chemically similar to digoxin.

What are the signs and symptoms of digoxin toxicity and why are older adults at a higher risk?

• In adults and older children, the first signs of toxicity usually include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias.
• In infants and small children, the first symptoms of overdose are usually cardiac arrhythmias.

If these appear, withhold drug and notify physician or health care professional immediately

Older adults are at increased risk for toxic effects of digoxin due to age-related decreased renal clearance, which can exist even when serum creatinine levels are normal.