Nursing Students or Nurses?

I have a case study that I'm working on. Mrs. B is a diabetic with a history of chronic alcoholism and heart disease. Is admitted to the e.r. for dka and hypomagnesemia. Dr. orders digitalis prep for treatment of heart disease. What specific observation should be made regarding the administration of a digitalis prep (we have toxicity...anything else?) What nursing interventions must be initiated? and what diagnostic tests can be anticipated? Have come up with some...but this needs to be fairly comprehensive, so any help anyone can give would be terrific! Thanks so much.

Hi I am an Rn, and remeber those case studies well!! Ok, here you go. Classic s/s of dig toxcicity is yello green halos around visual images, arrhtymias, anorexia, nauses vomiting and diarrhea. I t can also casue fatigue, lehtagry, hallucinations, vetigo, and p aresthesis. If your going to give bt IV bolus, give slowly over a 5 minute time only after you have taken BP first.
Monitor potassium levels, as hypkalemia can predispose to dif toxcicity. Antacids like Myklanta casue decreased absorbtion becasue the calcium binds with the dig in the gut. Antibiotic increase the risk of dig toxcidity.Anticholenergis also increase the rish of risk of toxcity. Also check with you pateint about thier use of alternative herbal medicine, as manyu of them like Saint John's wort are not comapatabile. Dif is contrindicatd in patients whoa re elderly, those with acute MI, AV block, sinus bradycardia, PVC's, pericarditis, hypertropic cardiomyopathy,relan insufficiecny severe pulomary problems like COPD, or hypothyroidis. Drug induced arrthymia my increase the severuty of heart failure and hypotension. In childrem cardia arrthymia, sinus bradycardia are usally ealry sign og toxcicity. Before giving a loading dose IV, be sure to obtain basleine heart, rate and rhthym, blood pressure and electrolyes. Especialy ask the patient about current or past use of cardio glycocides winth the past two or three weeks. I forgot to mention that hypercalcemia and hypomagnesemia can predipose to dig toxcicity. An oral loading dose is usually divided in hald over the first 24 hours. Before gining the dose take the pulse for a whole minute, and be sure to notifu the doctor of changes in the pulse, pulse defecit, increase or decrese in pulse rate or any irreguar rhthyms. I these occur check blood pressure and do a baseline 12 lead EKG/ Thera[eutic dig blood leves range fro, 0.5-2ng/ml. Therfore it is especiaaly imopotant to remain you patient to be faithful in keeping his appoinments for blood work. There is a fine line between thereapeutic blood levels and toxic levles. Tell the patient to take his puse first thing before taking the drug, and to withohold it if the puse is below 60 or aove 110 beats. Aso tell the patient to eat potassium rich food as this will help to avoid hypokalemia. Also encourage the patient not to switch one kind of digitallis fotr another as dosing and interations between diffferent forms can occur when changing. Whne doing patient teaching about dig., I also try to have a family member or some other siginificant other avilanle so thea they too know about the benefits and h azard of thaking this drug. Whena asked speciefiaaly what this drug does, I tell them that it helps the drug beat more regularly. I know this has been llong winded, but I gave you everthing I know abouty dig, and what i usally tell my patients. Best wishes in school and and on your case study...Fred. p>S> Hang in there..you'll make it!!!!!

Please see the web pages for more details on Digitalis.