Pediatric Nursing Q 194

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Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure?

  

     A. Headache

     B. Respiratory distress

     C. Extreme bradycardia

     D. Constipation

    

    

Correct Answer: C. Extreme bradycardia

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Extreme bradycardia is a cardinal sign of digoxin toxicity. Increased intracellular calcium from the poisoning of the Na-K transporter and AV nodal blockade from increased vagal tone are the primary causes of digoxin toxicity. The former leads to increased automaticity and inotropy; the latter leads to decreased dromotropy.

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Option A: Elderly patients frequently will present with vague symptoms, such as dizziness and fatigue. The most important historical detail in evaluating a random digoxin level is the time of the last dose.

Option B: Patients also may report visual symptoms, which classically present as a yellow-green discoloration, and cardiovascular symptoms, such as palpitations, dyspnea, and syncope. Digoxin may improve the quality of life in CHF patients, but it does not confer a mortality benefit, and its narrow therapeutic index limits its utility.

Option D: Gastrointestinal upset is the most common symptom of digoxin toxicity. Derived from the foxglove plant (Digitalis spp.), digoxin is a cardiac glycoside that historically was used for “dropsy” (edema) and is currently used as an inotrope to improve systolic dysfunction in patients with congestive heart failure (CHF) and as an atrioventricular nodal blocking agent for managing atrial tachydysrhythmias.

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