Reference no: EM133869300
Case Study
Mrs. Kidway is a 71-year-old woman who lives at home with her daughter's family. Her daily medications prior to admission include digoxin 0.125 mg once a day. Mrs. Kidway arrives in the emergency room with her daughter who explains, "She was fine this morning but then this afternoon she developed terrible abdominal pain and got short of breath." Mrs. Kidway is lethargic. Her physical examination is unremarkable except for facial grimacing when palpating her abdomen. She is afebrile with a blood pressure of 105/50, pulse 60, and respiratory rate 18. Blood work on admission reveals a digoxin level of 3.8 ng/mL.
Questions
1. How does digoxin work in the body?
2. Why is Mrs. Kidway taking digoxin?
3. Given Mrs. Kidway's digoxin level, briefly explain what electrolyte imbalance is of concern.
4. During a nursing assessment of Mrs. Kidway's current medications, the nurse asks if Mrs. Kidway takes any over-the-counter medications or herbal remedies. Mrs. Kidway's daughter says, "Is licorice considered an herbal remedy? My mother started taking licorice capsules about a month ago because we heard that licorice helps decrease heartburn." Does licorice interact with digoxin? If so, explain.
5. Discuss what the terms loading dose and steady state indicate.
6. What are the onset, peak, and duration times of digoxin when it is taken orally?
7. If Mrs. Kidway was having difficulty swallowing her digoxin capsule and her health care provider changed her prescription to the elixir form of digoxin, theoretically would she still receive 0.125 mg?
8. What is a medication's "half-life"? What is the half-life of digoxin? Theoretically, if Mrs. Kidway took her digoxin at 8:00 a.m. on a Monday, when will 75% of the digoxin be cleared from her body according to the half-life? Since the half-life of digoxin is prolonged in the elderly, use the high end of the range of digoxin's half-life.
9. What is the normal therapeutic range of serum digoxin for a client taking this medication?
10. What symptoms may be noted when digoxin levels are at toxic levels?
11. At what serum digoxin range do cardiac dysrhythmias appear and what is the critical value for adults?
12. Mrs. Kidway's heart rate drops to 50 beats per minute. Her potassium is 2.1 mEq/L. She is given four vials of intravenous digoxin immune fab (reconstituted with sterile water) and admitted to the intensive care unit for monitoring. Discuss how her digoxin toxicity will be treated.
13. What are the two highest priority nursing diagnoses appropriate for Mrs. Kidway's plan of care.