Monitoring apical pulse for one full minute before administration is critical for digoxin due to its effects on cardiac conduction. Hold digoxin if pulse <60 bpm in adults (or per protocol) and notify provider. Digoxin has narrow therapeutic index with toxicity risk increased by: hypokalemia; renal impairment; hypothyroidism; and drug interactions. Therapeutic level: 0.5-2.0 ng/mL (lower range preferred). Toxicity signs: gastrointestinal (nausea, vomiting, anorexia); cardiac (arrhythmias - especially bradycardia, heart block, PVCs); neurological (visual disturbances - yellow/green halos, confusion); and fatigue. Nurses also monitor: potassium levels; renal function; ECG; and signs of heart failure improvement. Patient education: take pulse daily; report symptoms; maintain consistent potassium intake; and avoid OTC medications affecting digoxin (antacids, some herbs). Digoxin immune Fab is antidote for severe toxicity. Careful monitoring balances benefits (increased contractility, rate control in atrial fibrillation) with toxicity risks.

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Zambia

• Joseph Soko – 101 pts

• Visual Pathway Lesions
• Positive and Negative Symptoms
• Hallucinations and Delusions
• Antipsychotic Medications
• Emergency: Environmental Emergencies