Digoxin
- Description – (cardiac glycosides)
- Mode of action – inhibits enzyme sodium-potassium ATPase -» promotes ca accumulation -» causes the heart muscle fibers to contract efficiently.
- Therapeutic effects – increases force of contractions, slows the HR, slows conduction -» increases CO, decreases edema, and increases fluid excretion.
- Therapeutic range – 0.5 to 2ng/mL ( > 2ng/mL is toxic)
- Antidote – Digoxin immune Fab (Digibind) -» used in extreme toxicity
- Indications – CHF, cardiogenic shock, atrial dysrhythmias
- Contraindications – ventricular dysrhythmias and 2nd/3rdº heart block
- Side effects/toxicity – anorexia, n/v, diarrhea, HA, visual disturbances (yellow-green halos), bradycardia
- Early s/s present as GI manifestations (anorexia, n/v, diarrhea); then HR abnormalities, and visual disturbances.
- Interventions
- Monitor for toxicity
- Monitor serum digoxin levels
- Potassium levels
- Monitor the client taking a potassium-losing diuretic or corticosteroid closely for hypokalemia -» hypokalemia can cause digoxin toxicity
- Note that older clients are more sensitive to digoxin toxicity
- Monitor apical pulse for 1 full minute -» hold med and notify MD if HR < 60 bpm
- Teach pt. s/s of toxicity, to avoid OTC meds
- Advise pt. to eat foods high in potassium (dried/fresh fruits, fruit juices, vegetables, and potatoes)
How to Fake Confidence
1. Hold your head high, and look others in the eye
2. Smile
3. Stop apologizing
4. Relax and be quick to laugh at yourself (but not at others!)
5. Dress in a way that indicates you have self worth
6. Use good manners (like saying please and thank you) as this is actually a mark of self respect
7. Expect other people to believe in you, and to see and appreciate your good qualities.
8. Before you know it, its no longer fake
wheRE WAS THIS ALL MY LIFE
(via thenursingjourney)
It’s getting to the time when I start preceptorships. I’m honestly worried that I might not do a good job, and I feel that I don’t know enough. Someone give me advice? What was your preceptorship experience like? Anything that would help?
