Question

Fill in the blank: Prior to administering digoxin, the nurse listens to the apical heart rate for 1 minute. If the apical heart rate is less than 60 , what action should the nurse take?

Short answer

In case of an apical heart rate of less than 60, the nurse should withhold the administration of digoxin and consult with the physician.

Step-by-step solution

Understanding digoxin

Digoxin is a medication used to treat heart conditions such as atrial fibrillation, atrial flutter and heart failure that cannot be controlled by other medication. However, it's important to note that digoxin can slow down the heart rate.

Heart Rate Interpretation

A normal adult resting heart rate ranges from 60-100 beats per minute. In this case, if the apical heart rate is less than 60, this implies that the patient's heart rate is slower than the normal rate. Considering that digoxin can further slow down the heart rate, it's critical to re-evaluate its administration for a patient with a heart rate less than 60.

Appropriate Nursing Intervention

Nurses share the responsibility to administer medications in a safe manner. In this context, when the apical heart rate is less than 60, the appropriate action for the nurse would be to withhold the medication, digoxin, and immediately consult with the patient's physician for further directions about its administration. This action is guided by the standard protocol or guideline in the administration of digoxin.

Key concepts

Nursing Medication Safety

When nurses administer medications, patient safety is of utmost importance. Nursing medication safety practices protect patients from potential medication errors and the adverse effects these errors can have.

Medications like digoxin require close monitoring due to their narrow therapeutic range and potential side effects. Before giving any medication, a nurse must verify the correct medication, dosage, patient, route, and timing, often referred to as the 'Five Rights' of medication administration. With digoxin, there's an added precaution: confirming the apical heart rate. If it is below the set threshold, as in the exercise, withholding the dose and consulting with a physician are critical steps that should be seamlessly integrated into nursing protocols.

Furthermore, complete and accurate documentation of all medications given, along with any actions taken when an abnormality is identified, is essential. Continuous education on medication management and staying updated with policies ensure that the nurse remains a frontline defender against medication errors.

Apical Heart Rate Assessment

The apical heart rate is a pivotal part of evaluating a patient's cardiovascular status, especially when administering cardiac medications like digoxin. To accurately assess the apical heart rate, a nurse should place the stethoscope at the apex of the heart and count the number of beats in one full minute.

A heart rate below 60 can indicate bradycardia, which is especially concerning when a patient is on digoxin, as the medication can further decrease the heart rate. Nurses need to be adept at auscultating and discerning a clear heart rate to recognize these scenarios promptly. Regular practice and knowledge on the use of stethoscopes reinforce a nurse's ability to perform accurate apical heart rate assessments.

Additionally, understanding the impact of digoxin and other medications on heart rate helps nurses anticipate potential changes and make informed decisions about medication administration.

Pharmacology Nursing Education

Effective pharmacology nursing education serves as the foundation for medication safety and therapeutic management in nursing practice. It emphasizes not only the knowledge of drugs and their effects but also equips nurses with the critical thinking skills needed to apply this knowledge in clinical settings.

When dealing with medications such as digoxin, nurses must understand its mechanism of action, indications for use, and potential side effects, including how it affects heart rate. By mastering these details, nurses can anticipate the need to assess the apical heart rate and make judicious decisions concerning drug administration.

Continuing education, including scenarios and simulations, reinforces correct drug administration practices and refreshes the nurses' knowledge on updated guidelines and protocols. Through education, nurses uphold the highest standards of patient care and medication administration, ensuring the well-being and safety of the individuals they serve.