Page 1773 - Saunders Comprehensive Review For NCLEX-RN

2. Monitor the apical pulse and BP.
3. Monitor for hypersensitivity.
4. Assess lung sounds for wheezing and crackles.
5. Monitor for edema.
6. Monitor for relief of heart failure as noted by
reduction in edema and lessening of dyspnea,
orthopnea, and fatigue.
7. Monitor electrolyte and liver enzyme levels, platelet
count, and renal function studies; the medications
may decrease potassium and increase liver enzyme
levels; continuous electrocardiographic monitoring is
done during administration.

V. Cardiac Glycosides

A. Digoxin
1. Description
a. Cardiac glycosides inhibit the sodium-
potassium pump, thus increasing
intracellular calcium, which causes the
heart muscle fibers to contract more
efficiently.
b. Cardiac glycosides produce a positive
inotropic action, which increases the
force of myocardial contractions.
c. Cardiac glycosides produce a negative
chronotropic action, which slows the
heart rate.
d. Cardiac glycosides produce a negative
dromotropic action that slows
conduction velocity through the
atrioventricular (AV) node.
e. The increase in myocardial contractility
increases cardiac, peripheral, and
kidney function by increasing cardiac
output, decreasing preload, improving
blood flow to the periphery and
kidneys, decreasing edema, and
increasing fluid excretion; as a result,
fluid retention in the lungs and
extremities is decreased.
f. Cardiac glycosides are used second-line
for heart failure (medications affecting
the renin-angiotensin-aldosterone
system are used more often) and
cardiogenic shock, atrial tachycardia,
atrial fibrillation, and atrial flutter;
they are used less frequently for rate
control in atrial dysrhythmias (beta

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