Question

The physician orders digoxin (Lanoxin) \(0.25\) mg p.o. every day. The nurse has digoxin \(0.125 \mathrm{mg}\) scored tablets. The client's serum digoxin level is \(1.4\) and his potassium level is \(4.2\). What should the nurse plan to do? a. Administer \(1 / 2\) tablet. b. Administer 2 tablets c. Do not administer the digoxin because the client's digoxin level is too high. d. Do not administer the digoxin because the client's potassium is too low.

Short answer

Administer 2 tablets.

Step-by-step solution

Identify the physician's order

The physician has ordered digoxin (Lanoxin) at a dosage of 0.25 mg to be given orally every day.

Identify the available medication

Each available digoxin tablet contains 0.125 mg, and the tablets are scored, meaning they can be split in half if needed.

Calculate the required number of tablets

To find out how many 0.125 mg tablets are needed to make up the 0.25 mg prescribed, divide the prescribed dose by the dose per tablet: \[ \frac{0.25 \text{ mg}}{0.125 \text{ mg/tablet}} = 2 \text{ tablets} \] Therefore, 2 tablets of 0.125 mg each must be administered to provide the desired dose of 0.25 mg.

Review the client's serum digoxin and potassium levels

The client's serum digoxin level is 1.4 and potassium level is 4.2. Both levels are within the normal range: \( \text{Normal serum digoxin level: 0.8-2.0 ng/mL} \) \( \text{Normal potassium level: 3.5-5.0 mEq/L} \)

Determine the appropriate action

The client's serum digoxin and potassium levels are within the normal range, which means there is no contraindication based on these values. Since the client’s serum digoxin level (1.4) is not too high and the potassium level (4.2) is not too low, the appropriate action is to administer 2 tablets of digoxin (0.125 mg each): \( 2 \times 0.125 \text{ mg} = 0.25 \text{ mg} \)

Key concepts

Digoxin Administration

Understanding how to administer digoxin correctly is crucial for ensuring patient safety. Digoxin is prescribed to manage heart conditions like atrial fibrillation and heart failure. When administering digoxin, it’s important to note the physician’s order. In this case, the order is for 0.25 mg to be taken orally every day. The available tablets are 0.125 mg each and are scored, meaning they can be split in half if needed. Based on this, the nurse must calculate the required dose by dividing 0.25 mg by the dose per tablet (0.125 mg/tablet), resulting in the administration of 2 tablets.

Serum Drug Levels

Serum drug levels are essential for monitoring the efficacy and safety of medication therapy. For digoxin, the therapeutic range is between 0.8-2.0 ng/mL. It’s vital to keep serum levels within this range to avoid toxicity or subtherapeutic effects. The client's serum digoxin level is 1.4 ng/mL, indicating that the drug is within the therapeutic range and is effective but not toxic. Regular monitoring ensures that the medication is working properly and that any adjustments to the dosage can be made promptly. Always verify serum drug levels before administering medications like digoxin.

Potassium Levels

Potassium levels play a significant role in heart function and can influence the effects of medications like digoxin. The normal potassium level range is 3.5-5.0 mEq/L. In this scenario, the client’s potassium level is 4.2 mEq/L, which is within the normal range. Maintaining a balanced potassium level is crucial because both hypokalemia (low potassium) and hyperkalemia (high potassium) can lead to dangerous heart rhythms, especially when the patient is on digoxin. Monitoring potassium levels helps ensure that the heart’s electrical activity remains stable, preventing potential drug interactions or side effects.

Clinical Decision Making

Clinical decision making involves integrating clinical information, patient data, and evidence-based practices to determine the best course of action. In the discussed exercise, clinical decision making requires evaluating the physician’s order, the medication’s availability, and the patient’s serum digoxin and potassium levels. Since both the serum digoxin level (1.4 ng/mL) and potassium level (4.2 mEq/L) are within normal ranges, the appropriate clinical decision is to administer the prescribed dose of 0.25 mg, which means giving 2 tablets of 0.125 mg each. Careful consideration and analysis of all these factors ensure safe and effective patient care.