Patients Receiving Digoxin (Lanoxin) Potential Nursing ...

1 Nursing Process Focus: Patients Receiving Digoxin ( lanoxin ). Assessment Potential Nursing Diagnoses Prior to administration: Tissue perfusion, Ineffective related to Assess for shortness of breath, decreased cardiac contractility peripheral edema, pulmonary edema Fluid volume, Excess related to inadequate (initially and throughout therapy) drug therapy Obtain complete medical history Knowledge deficient, related to drug action including allergies, especially cardiac, and side effects hypertensive, liver, hematological, pulmonary diseases including blood studies: CBC with differential for blood dyscrasias, liver function tests, electrolytes, BUN, creatinine, arterial blood gases. Planning: Patient Goals and Expected Outcomes The patient will: Experience relief of symptoms related to fluid overload.

2 Demonstrate evidence of improved organ perfusion, including kidney, heart and brain. Demonstrate expected outcomes of drug therapy and list reportable side effects Implementation Interventions and (Rationales) Patient Education/Discharge Planning Observe for side effects such as nausea, Instruct patient to signs and symptoms of vomiting, diarrhea, anorexia, shortness of side effects and to report side effects to breath, vision changes, leg muscle cramps health care provider Monitor apical-radial pulse for a full Instruct patient to: minute prior to every administration of Count pulse for a full minute and record medication. Monitor ECG for rate and pulse with every doe. rhythm changes during initial digitalization Contact prescriber if pulse rate is less than therapy.

3 (Serious cardiac dysrthymias may 60 or greater than 100. occur during initial therapy.) Report changes in cardiac rhythm Monitor patient's cardiac rhythm. (If given Instruct patient to report pulse findings and for atrial fibrillation, report pulse below 60 rhythm irregularities to health care or above 110, skipped beats or change if provider. rhythm to health care provider.). Weigh patient daily. (Weight increase or Instruct patient to report weight gain of 2. decrease is an indicator of worsening or lb. per day. improvement of medical condition.). Monitor serum drug level to determine Instruct patient to report to laboratory as therapeutic concentration and toxicity. scheduled by health care provider as Report serum drug levels > to health directed and for ongoing drug level care provider.

4 Determinations. Monitor levels of potassium, magnesium Instruct patient to: and calcium, BUN, creatinine. (Impaired Report changes in urinary output renal function may contribute to drug Keep appointment for followup lab studies toxicity.). Monitor for signs and symptoms of Digoxin Instruct patient to immediately report toxicity. (There is a narrow margin of drug visual changes, mental depression, levels.) palpitations, weakness, and loss of appetite, vomiting and diarrhea. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that the patient goals and expected outcomes have been met (see Planning ). Nursing Process Focus: Patients Receiving Lisinopril (Prinivil, Zestoric). Assessment Potential Nursing Diagnoses Prior to administration: Fluid volume, Excess related to disease Assess for excessive sweating, s/s of process dehydration, edema of lower extremities, Fluid volume, deficit related to effects of diarrhea, vomiting (initially and drug therapy thoroughout therapy) Injury, Risk for related to hypotension Obtain complete medical history including Protection, Ineffective, related to allergies, especially renal, thyroid disease, agranulocytosis or neutropenia salt restricted diet, use of diuretic, severe Knowledge Deficient, related to drug salt/volume depletion, coronary action and side effects insufficiency, leukemia.

5 CBC with differential, BUN/creatinine, electrolytes, serum/urine protein, glucose Obtain patient's drug history to determine possible drug interactions and allergies. Planning: Patient Goals and Expected Outcomes The patient will: Demonstrate relief of dyspnea Demonstrate an increase in activity tolerance Maintain a decrease in peripheral edema Exhibit expected outcome of drug therapy and list reportable side effects Implementation Interventions and (Rationales) Patient Education/Discharge Planning Observe for side effects such as orthostatic Instruct patient to report: persistent, dry hypotension, persistent, dry irritating cough; indications of infections; swelling cough, swelling of face, eyes, lips, tongue, of face, mouth; difficulty breathing.

6 Arms or legs, difficulty breathing or headache, dizziness; nausea, vomiting, swallowing, syncope, fever, sore throat and diarrhea. hoarseness. Report immediately Use with caution in Patients with salt or Instruct patient to report changes in urinary volume deficit, or renal disease (may lead output. to increased drug levels). Use with caution in Patients taking Inform patient of importance to report all potassium supplements, potassium sparing medication including OTC and herbal diuretics or lithium. (May cause supplements hyperkalemia). Monitor serum levels of lithium if patient is Instruct patient that ACE inhibitor may Receiving lithium. increase serum level of lithium. Monitor for effectiveness of drug. (A Inform patient of signs and symptoms of decrease in dyspnea, edema or jugular positive therapeutic effect.)

7 Distention indicate improvement in medical condition.). Observe for dizziness during first few days Instruct patient to: of therapy. (May cause drop in blood Avoid driving or operating dangerous pressure, especially with diuretic therapy). machinery until effects of drug are known Change positions slowly to prevent injury Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ). Nursing Process Focus: Patients Receiving Isosorbide Dinitrite (Isordil, Sorbitrate, Dilatrate). Assessment Potential Nursing Diagnoses Prior to administration: Activity intolerance related to Assess for tachycardia, dyrhythmias, compromised oxygen transport system reduced exercise intolerance, dyspnea, Fatigue secondary to cardiac failure orthopnea, paroxysmal nocturnal dyspnea, Knowledge deficient of self- care program peripheral edema, and weight gain related to nonacceptance of lifestyle (initially and throughout therapy) modifications Obtain complete medical history including Pain related to headache allergies, especially coronary artery disease, rheumatic heart disease, pregnancy, impaired renal function, CVA.

8 Diseases including blood studies: CBC. with diff, ANA titers, electrolytes, renal functions, and urinalysis. Obtain patient's drug history to determine possible drug interactions and allergies Planning: Patient Goals and Expected Outcomes The patient will: Exhibit an increase in activity tolerance Demonstrate decrease in shortness of breath related to activity Maintain a normal blood pressure Demonstrate expected outcomes of drug therapy and list reportable side effects. Implementation Interventions and (Rationales) Patient Education/Discharge Planning Check other medications taken because Instruct patient to report all drugs taken. Isosorbide Dinitrite is contraindicated if patient is taking sildenafil. (If drug is taken serious and potentially fatal hypotension may result.)

9 Observe for side effects such as blurred Instruct patient to: vision, dryness of mouth, hypotension, Report side effects. lupus-like reaction (fever, facial rash, Avoid alcohol while taking this drug. muscle and joint aches, enlarged liver), Rise and change position slowly. anorexia, peripheral edema of hands and Record the pulse daily and notify health feet, bluish-color lips, fingernails, and/or care provider if pulse is 20 or > beats per palms of hands, headache, shortness of minute. breath, weak and slow heartbeat. Report Report any weight gain 2lbs or >. immediately. To decrease nausea, take unsalted crackers as needed. Use cautiously in head trauma or cerebral Instruct patient to report changes in hemorrhage. (May put patient at high risk sensorium, symptoms of stroke to the for reduced blood flow to vital organs.)

10 Health care provider. Inform patient that headache is a common Inform patient: side effect. Headache should subside with time. Health care provider may prescribe aspirin or acetaminophen for persistent headache. Provide guidelines for physical activity. Instruct patient to: (Exercise, hot weather or prolonged Use caution when exercising during standing may result in dizziness or extreme heat, fainting.) Avoid standing for long periods of time Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ). Nursing Process Focus: Patients Receiving Furosemide (Lasix). Assessment Potential Nursing Diagnoses Prior to administration: Fluid excess related to impaired cardiac Assess for sites and amount of edema, function and output blood pressure, pulse, and weight gain/loss Urinary elimination, impaired related to (initially and throughout therapy).