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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is preparing to administer scheduled oral digoxin to a 4-month-old infant diagnosed with a ventricular septal defect. Prior to administration, the PN assesses the sleeping infant's vital signs and notes an apical pulse of 84 beats/minute and a respiratory rate of 32 breaths/minute. Which action should the PN take first?

  1. A
    Administer a proportionally reduced dose of digoxin to account for the infant's decreased heart rate.
  2. B
    Administer the scheduled dose, as a heart rate of 84 beats/minute is an expected finding for a sleeping infant.
  3. Withhold the dose of digoxin and immediately notify the registered nurse (RN).Answer
  4. D
    Awaken the infant to assess for the presence of the Moro reflex before administering the medication.

Answer

Withhold the dose of digoxin and immediately notify the registered nurse (RN).
For an infant (1 to 12 months of age), the typical threshold to withhold digoxin is an apical pulse of less than 90 to 110 beats/minute, depending on specific facility policy. An apical pulse of 84 beats/minute is definitively bradycardic for a 4-month-old. Because digoxin slows the heart rate, administering the medication could lead to severe bradycardia and decreased cardiac output. The practical nurse must withhold the dose and immediately notify the registered nurse or healthcare provider.

Step-by-Step Solution

1
Assess the infant's vital signs and compare them to expected physiological norms.
The apical pulse is 84 beats/minute, which indicates bradycardia for a 4-month-old infant.
Normal infant heart rates range from 100 to 160 beats/minute. A rate of 84 is dangerously low and requires immediate clinical attention.
2
Evaluate the specific safety parameters for administering digoxin to a pediatric client.
The standard protocol requires withholding digoxin in infants if the apical pulse is less than 90 to 110 beats/minute.
Digoxin has a negative chronotropic effect, meaning it slows electrical conduction through the heart. Administering it to an already bradycardic infant could precipitate a life-threatening arrhythmia or cardiac arrest.
3
Determine the appropriate action within the practical nurse (PN) scope of practice.
The PN withholds the medication and immediately notifies the registered nurse (RN).
The PN is responsible for executing safe medication administration, recognizing critical deviations, and promptly escalating abnormal findings to the RN or provider for medical management.

Key Concept

Safe administration of digoxin in pediatric clients involves rigorous pre-administration pulse checks, with strict withholding parameters for bradycardia (typically less than 90 beats/minute for infants).
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Topics

Pharmacological Therapies

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