Final answer:
The nurse should hold digoxin if heart rate parameters are abnormal and consider withholding digoxin and furosemide in the event of significant weight gain or hypokalemia, with the latter potentially increasing digoxin toxicity risk.
Step-by-step explanation:
The appropriate actions for a nurse to perform when administering digoxin (Lanoxin) and furosemide (Lasix) to a newborn with congestive heart failure are contingent upon certain clinical parameters. For example:
- Hold digoxin if the apical heart rate is lower than the standard range for infants, which is commonly considered to be 90 to 160 beats per minute in a rested state. However, an apical heart rate of 170 bpm is high, so the decision to withhold medication would rely on the clinical judgement of the healthcare provider and the specific circumstances of the patient.
- Hold digoxin for a digoxin level of 1 ng/mL is not usually indicated, as this is within the normal therapeutic range of 0.5 to 2.0 ng/mL for heart conditions.
- Hold both the digoxin and furosemide for a weight increase would depend on the amount and rapidity of the weight gain, as well as other clinical indicators of worsening heart failure.
- Hold both the digoxin and the furosemide for a potassium level of 3.2 mEq/L, which is indicative of hypokalemia (low potassium levels), could be appropriate since hypokalemia can increase the risk of digoxin toxicity.
The nurse should also monitor the fluid intake and output meticulously because the neonatal kidneys are immature and inefficient at concentrating urine, making newborns at higher risk for electrolyte imbalances.