Page 1774 - Saunders Comprehensive Review For NCLEX-RN

blockers and calcium channel blockers
are used more often).
g. These medications are contraindicated
in those with ventricular dysrhythmias
and second- or third-degree heart
block. They should be used with
caution in clients with renal disease,
hypothyroidism, and hypokalemia.

2. Side and adverse effects

a. Anorexia, nausea, vomiting, diarrhea
b. Bradycardia
c. Visual disturbances: Diplopia, blurred
vision, yellow vision, photophobia
d. Headache
e. Fatigue, weakness
f. Drowsiness

Early signs of digoxin toxicity present as

gastrointestinal manifestations (anorexia, nausea,
vomiting, diarrhea); then, heart rate abnormalities
and visual disturbances appear.

3. Interventions

a. Monitor for toxicity as evidenced by
anorexia, nausea, vomiting, visual
disturbances (blurred or yellow
vision), and dysrhythmias.
b. Monitor serum digoxin level,
electrolyte levels, and renal function
test results.
c. The optimal therapeutic range for
digoxin is 0.5 to 2.0 ng/dL (0.63 to
2.56 nmol/L). However, a level on the
low end of normal may be preferred to
avoid toxicity.
d. An increased risk of toxicity exists in
clients with hypercalcemia,
hypokalemia, hypomagnesemia, or
hypothyroidism.
e. Monitor the potassium level; if
hypokalemia occurs (potassium lower
than 3.5 mEq/L [3.5 mmol/L]), notify
the PHCP.
f. Instruct the client to avoid over-the-
counter medications.

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