An older adult taking digoxin reports nausea, poor appetite, and yellow-green halos. The apical pulse is 52/min. Which action should the nurse take?
1Give the digoxin with food, document the symptoms as transient effects, and reassess after the dose.
2Hold the dose, notify the provider, and anticipate a digoxin level plus electrolyte and renal-function tests.✓ Correct answer
3Give an over-the-counter potassium supplement, then administer the digoxin and recheck the pulse.
4Administer the scheduled dose and arrange a routine eye examination for age-related vision changes.
Explanation
Nausea, anorexia, visual disturbances, and bradycardia are compatible with digoxin toxicity. The nurse should hold the dose, notify the provider, and anticipate evaluation of the digoxin concentration, electrolytes, and renal function. Renal impairment and electrolyte abnormalities can increase toxicity risk. Giving the dose or independently administering potassium is unsafe, and the visual symptoms should not be dismissed as an expected effect of aging.
Clinical reasoning Digoxin toxicity can present with gastrointestinal symptoms, visual disturbances, and bradyarrhythmias. Hold the scheduled dose and escalate for rhythm, serum digoxin, electrolyte, and renal assessment.
Decision rule Do not treat a suspected electrolyte problem empirically before laboratory evaluation; potassium management depends on the clinical context and measured value.
Clinical scenarioThe client is at the cardiology outpatient clinic for a routine follow-up appointment. The presenting complaint of "the lights have weird halos around them" was volunteered to the medical assistant during intake.
Digoxin toxicity — A toxic digoxin effect that can produce nausea, anorexia, visual disturbances, bradycardia, and other arrhythmias.
Renal and electrolyte risk — Reduced renal clearance and electrolyte abnormalities can increase susceptibility to digoxin toxicity and should be assessed with the serum concentration and ECG.
Digoxin immune Fab (Digibind) indications — Severe toxicity: serum level >10 ng/mL in chronic toxicity, life-threatening arrhythmia (Vfib, sustained Vtach, complete heart block, severe bradycardia unresponsive to atropine), hyperkalemia >5 in acute overdose, ingestion >10 mg adult or >4 mg pediatric.