Digoxin

MECHANISM OF ACTION- Digoxin is a cardiac glycoside which has positive

inotropic activity characterized by an increase in the force of myocardial
contraction. It also reduces the conductivity of the heart through the
atrioventricular (AV) node. Digoxin also exerts direct action on vascular
smooth muscle and indirect effects mediated primarily by the autonomic
nervous system and an increase in vagal activity.
INDICATION- CHF and Atrial fibrillation
CONTRAINDICATION

Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive

cardiomyopathy.
Arrhythmias due to accessory pathways (e.g. Wolff-Parkinson-White
syndrome).
SIDE EFFECTS:
ANOREXIA
1. Eat small frequent meals and healthy snacks that are
high in protein and calories.
2. Eat during periods of greatest appetite, rather than
at set mealtimes. Be flexible. Eat whenever you feel
hungry.
3. Rest before eating.
4. Indulge in your favorite foods.
5. Make plans to eat with family and friends.
6. Dont drink large quantities of fluids with meals,
since this will make you feel fuller sooner.
7. Exercise as tolerated. A moderate exercise routine
helps stimulate appetite.
8. Make mealtime as pleasant as possible
9. Avoid foods that cause bloating and gas, such as
cabbage, broccoli, and beans; or indigestion, such as
spicy foods.
10.

Avoid empty calorie liquids

 NAUSEA AND VOMITING

1. Drinking gradually larger amounts of clear liquids.
2. Avoiding solid food until the vomiting episode has passed.
3. Temporarily discontinuing all oral medications (which can
irritate the stomach and make vomiting worse). But, do not
discontinue any medication before checking with your doctor
first.
4.
Eat small meals throughout the day instead of three large
meals.
5.
Rest after eating with your head elevated about 12 inches
above your feet.
6.
Drink liquids between meals instead of during meals and
drink at least six to eight 8-ounce glasses of water a day to
prevent dehydration (unless fluid restricted for another medical
condition).
7. Eat foods that are cool or room temperature, as hot foods
emit a stronger odor that may increase your nausea.
8. Avoid caffeine and smoking
9. Require appropriate dietary advice and advice on fluid intake.
10. watch for hydration status
CONFUSION
1.

Establish/maintain normal elimination patterns.

2.

Establish/maintain normal oxygenation (if clients experience low oxygen saturation treat
with supplemental oxygen).

3.

Establish/maintain normal blood glucose levels.

4.

Establish/maintain normal blood pressure.

5.

Minimize fatigue by planning care that allows for separate rest and activity periods.

6.

Increase activity and limit immobility.

7.

Provide exercise to combat the effects of immobility and to "burn off" excess energy.

8.

Decrease caffeine intake to help reduce agitation and restlessness.

9.

Manage client's discomfort/pain.

10. Promptly identify and treat infections.

RESTLESSNESS

1. Turning off or turning down television sets

2. Close her door

3. Minimize the use of loud appliances (vacuums, dishwashers, clothes

washers, etc.)
4. Limit the number of visitors and enforce strict visitation hours
5. Keep conversations quiet and never discuss distressing things where
she can hear you
6. If she has an oxygen concentrator, use extended length tubing and
move the concentrator to another room or put in a closet with the door
closed.
7. try gently reminding her where she is. Tell her the date, including the
year, and the time.
8. Familiar scents can also help an otherwise sensory deprived person
relax.
9. Provide divertional activities to divert the attention of the patient.
10.Provide relaxation techniques such as back rubs if tolerated.
AGITATION
1.

Offer food or fluids

2.

Treat pain or discomfort

3.

Maintain bowel and bladder continence

4.

Prompted voiding- ask patient to void at regular intervals

5.

Offer extra clothing; remove extra clothing

6.

Support sensory ability: assess hearing aids, assistive devices, and evaluate
vision needs

7.

Decrease use of physical restraints

8.

Explore the unique characteristics of each individual, e.g., work, hobbies, sense of
identity that my be used to reduce agitation

9.

Modify environment (physical or social)

10. Remove physical restraints