Which assessment finding will indicate to the nurse that the client is experiencing digoxin toxicity?

Visual disturbances of yellow, green, or purple halos
-Weight gain of 5 pounds in 2 days
-Heart rate greater than 120beats per minute
-Shortness of breath and worsening ankle edema
Digoxin has a narrow therapeutic window and the client needs to be aware of signs of toxicity: anorexia, vomiting, nausea, diarrhea, bradycardia, lethargy, and yellow, green, or purple halo vision.The client should weigh themselves daily and record it in a notebook. Weight gain of 5 pounds or more in 2 days should be reported the the healthcare provider.While bradycardia is a common sign of toxicity with digoxin, tachycardia can also be a sign of digoxin toxicity. It can also be a sign that the dose is not controlling the symptoms of heart failure. Tachycardia should be reported to the healthcare provider so the etiology of the increased heart rate can be identified.If you watched the video on heart failure, you are aware that fluid retention is a big part of the disease process. If the client is experiencing shortness of breath and ankle edema, these are signs of worsening heart failure and should be reported.While the blood pressure is a little lower than normal, a failing heart will struggle meeting the demands of the body. A blood pressure of 100/50 is life sustaining and may be the best that a patient with heart failure can produce.

-Smoking cessation will help with disease management.
-Take your pulse every day before taking your morning medications and notify your healthcare provider if heart rate is less than 60 beats per minute
-Increase foods high in potassium because furosemide increases potassium loss
-Rise slowly, in stages, because metoprolol and isosorbide dinitrate can cause low blood pressure upon standing.
-Store the nitroglycerin in original container, keeping it away from heat and moisture.
Report yellow, green, or purple halos around lights as this could be a sign of digoxin toxicity
-Based on the discharge medications, the nurse must educate the client on potential adverse effects and when/what to report to the healthcare provider.With angina and heart failure, smoking cessation is part of disease management. Taking the pulse daily and reporting heart rate less than 60 is important since it can be a sign of digoxin toxicity, and metoprolol can also lower the heart rate. Since the cllient will be on furosemide and digoxin, the client should increase foods high in potassium to help prevent hypokalemia and the potential for digoxin toxicity related to hypokalemia. Since the client is on a beta blocker and a nitrate, the client is at risk for orthostatic hypotension and should be taught to rise slowly, in stages. Storage of nitroglycerine includes keeping it in the original container, or a specially made
dark, moisture resistant container, keeping the medication at room temperature and away from moisture. SL nitroglycerin should be taken 5 minutes apart, with a maximum of 3 doses. The client should call 9-1-1 after the second dose if chest pain persists (also book has another location that says after first dose).The client should weigh themselves daily and report a weight gain of 5 pounds or more in 2 days.The client needs to be taught about signs of digoxin toxicity and to report them to their HCP.

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