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Zorluk: OrtaPharmacological and Parenteral Therapies

An older adult client with a history of heart failure is prescribed daily oral digoxin and furosemide. During the morning rounds, the client reports a new onset of loss of appetite, mild nausea, and seeing a 'yellowish haze' around the lights in the room. Which of the following actions should the nurse take first?

  1. Withhold the scheduled dose of digoxin and obtain a prescription for serum digoxin and potassium levels.Cevap
  2. B
    Administer a prescribed as-needed antiemetic to relieve the nausea before giving the digoxin.
  3. C
    Reassure the client that declining vision and a yellowish haze are normal changes associated with the aging process.
  4. D
    Delegate the task of measuring the client's vital signs and apical pulse to the unlicensed assistive personnel (UAP).

Cevap

The nurse should immediately withhold the scheduled dose of digoxin and prepare to check the client's serum digoxin and potassium levels.
The client's symptoms of anorexia, nausea, and yellow visual halos are hallmark signs of digoxin toxicity. Because the client is also taking furosemide, which causes potassium loss, they are at an exceptionally high risk for this toxicity (as hypokalemia potentiates digoxin). The immediate priority to ensure client safety is to withhold the medication to prevent further harm and to check serum levels to confirm the diagnosis.

Adım Adım Çözüm

1
Analyze the client's reported clinical symptoms.
The combination of anorexia, nausea, and visual disturbances (yellowish haze or halos) is identified as the classic presentation of digoxin toxicity.
Recognizing the adverse effects and toxicity signs of specific pharmacological therapies is essential for patient safety.
2
Correlate the client's current medication regimen with the presenting symptoms.
The client is taking furosemide, a loop diuretic known to cause potassium depletion.
Hypokalemia increases the myocardium's sensitivity to digoxin, significantly elevating the risk of toxicity even if the serum digoxin level is within the normal therapeutic range.
3
Determine the highest priority nursing action based on the assessment.
The nurse must withhold the next dose of digoxin to prevent further absorption and notify the provider to evaluate laboratory values.
Administering the medication would exacerbate the toxicity and could lead to life-threatening cardiac dysrhythmias.

Anahtar Kavram

Digoxin toxicity recognition and the effect of hypokalemia
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Konular

Pharmacological and Parenteral Therapies

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