Pediatric Nursing Q 181
A nurse is providing instructions to a mother who has a child with congestive heart failure regarding Digoxin (Lanoxin). Which statement made by the mother indicates further teaching?A. “I will administer the medication 1 hour before or 2 hours after meal”.
A. "I will administer the medication 1 hour before or 2 hours after meal".
B. "I will use a special dose-measuring spoon or cup, not a regular table spoon for the liquid preparation".
C. "If my child vomits after administration, I will repeat the dose".
D. "If more than one dose is missed, I will inform the physician".
Correct Answer: C. “If my child vomits after administration, I will repeat the dose”.
Digoxin is a cardiac glycoside. The mother needs to be instructed not to repeat the dose once the child vomits it. Digoxin has a very narrow therapeutic index, and its administration is subject to drug-drug interactions and comorbidities. In the case of overdose, digoxin immune fab is the reversal agent.
Option A: Digoxin has an oral bioavailability of approximately 75%, although intake efficacy might diminish when taking digoxin with high fiber foods. Some patients possess gut flora that metabolizes digoxin to dihydrodigoxin, thereby decreasing the drug’s absorption.
Option B: The dosage of digoxin must be given accurately. The rate of toxicity increases as serum digoxin concentration reaches over 2.0 ng/ml. However, toxicity can also occur at lower levels, especially in the setting of other risk factors such as low body weight, advanced age, decreased renal function, and hypokalemia.
Option D: Digoxin has a narrow therapeutic index. The recommended serum levels stand between 0.8 to 2 ng/mL. Inform the physician first if a dose was missed. The prescriber needs to check levels with any recent change in medication. The kidneys excrete approximately 70% of digoxin in direct proportion to the patient’s glomerular filtration rate.