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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is caring for a 78-year-old client who is prescribed daily oral digoxin and furosemide for the management of heart failure. During the morning assessment, the PN notes the client has become acutely restless and reports seeing "yellow halos" around the room lights. The client's morning laboratory results reveal a serum potassium level of 3.1 mEq/L (3.1 mmol/L), and the current apical pulse is 56 beats/minute. Which of the following is the priority action for the PN to take?

  1. Withhold both the digoxin and furosemide and immediately notify the supervising registered nurse of the findings.Answer
  2. B
    Document the visual disturbances and restlessness as expected age-related changes and administer the medications as prescribed.
  3. C
    Prepare to administer a dose of intravenous potassium to rapidly correct the electrolyte imbalance before giving the oral digoxin.
  4. D
    Withhold the furosemide due to the low potassium result, administer the digoxin, and leave a non-urgent message for the healthcare provider.

Answer

The priority action is to withhold both medications and immediately notify the supervising registered nurse.
The correct action is to withhold both the digoxin and furosemide and immediately notify the RN. The client is displaying classic, life-threatening signs of digoxin toxicity (bradycardia, visual halos, and restlessness). Furthermore, the potassium level of 3.1 mEq/L indicates hypokalemia. Because potassium and digoxin bind to the same receptors in the heart, low potassium increases digoxin binding, causing toxicity even at normal doses. Furosemide is a potassium-wasting diuretic that would further deplete the client's potassium. Immediate escalation is critical and directly within the practical nurse's scope of practice.

Step-by-Step Solution

1
Analyze the client's vital signs and clinical presentation.
The client has an apical pulse of 56 beats/minute, acute restlessness, and reports visual yellow halos.
These findings represent classic cardiovascular, neurological, and visual signs of digoxin toxicity.
2
Evaluate the morning laboratory results.
The serum potassium level is 3.1 mEq/L, which indicates hypokalemia (normal is typically 3.5 to 5.0 mEq/L).
Hypokalemia increases the sensitivity of the myocardium to digoxin, making it a primary precipitating factor for digoxin toxicity.
3
Determine the appropriate intervention within the practical nurse scope of practice.
The nurse must withhold the scheduled digoxin and furosemide and immediately escalate the critical findings to the RN or provider.
Administering digoxin would worsen the toxicity, and administering furosemide (a potassium-wasting diuretic) would further lower the potassium level. Rapid escalation is required for life-threatening toxicity.

Key Concept

Digoxin Toxicity and Hypokalemia Management
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Topics

Pharmacological Therapies

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