vSim M Richards Clinical Packet Latest Update 2023

vSim M Richards Clinical Packet Latest Update 2023 CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Overview ▪ Intoxication with digoxin from use in long-term therapy, accidental or intentional overdose, or ingestion of naturally occurring compounds containing cardiac glycosides (such as foxglove, oleander, and lily of the valley) ▪ Life-threatening condition ▪ May be acute or chronic Pathophysiology ▪ Digoxin inhibits the sodium-potassium pump in myocytes, which results in an increase in intracellular sodium and a decrease in the transmembrane sodium gradient. ▪ The loss of the sodium gradient decreases the drive of the Na+-Ca2+ transporter, leading to increased intracellular calcium and increased muscle contractions. ▪ Automaticity increases and conduction decreases. Causes ▪ Long-term digoxin therapy ▪ Intentional overdose (suicide) ▪ Accidental overdose (children) ▪ Prescription or administration error ▪ Electrolyte disturbances such as potassium depletion ▪ Kidney disease or any condition that decreases drug clearance ▪ Poisoning with plants containing cardiac glycosides (such as foxglove, oleander, and lily of the valley) ▪ Low tolerance to digoxin DIAGNOSTICS TESTS (Reason for Test and Results) ▪ A serum digoxin level (therapeutic range, 0.8 ng/mL to 2.0 ng/mL for rate control in atrial fibrillation) above 2.5 ng/mL is considered toxic. ▪ Potassium level (serum) is commonly increased and life-threatening in acute toxicity; chronic toxicity can cause a decreased potassium level. ▪ Magnesium level test results may be decreased with chronic toxicity. Diagnostic Procedures ▪ An electrocardiography (ECG) tracing shows a characteristic digitalis effect, which can occur at therapeutic levels and includes: o prolonged PR segment o T-wave changes o prolonged T-wave intervals o scooping of the ST segment. WARNING! ▪ Other ECG changes that are relatively specific to digoxin toxicDitiygionxcilnudlee:vel may be falsely high if o accelerated junctional rhythm o bidirectional ventricular tachycardia o new-onset Mobitz type I atrioventricular (AV) block o non- paroxysmal atrial tachycardia with AV block. ▪ Other associated ECG rhythms include: o ventricular ectopy o premature ventricular contractions o high-degree heart block o sinus bradycardia o sinus bradycardia with junctional tachycardia o ventricular fibrillation or tachycardia o atrial flutter. PATIENT INFORMATION measured less than 6 hours after an acute ingestion. Toxicity may develop even when digoxin levels are within the normal therapeutic range. Non digoxin cardiac glycosides (such as foxglove, oleander, and lily of the Mary Richards, 82-year-old African American female. Brought into ED for confusion and complaints of trouble with vision. Also complains of nausea, dizziness, and weakness. History of hypertension, diagnosed 40 years ago, and heart failure, diagnosed 30 years ago. Her current medications include furosemide, amlodipine, and digoxin.