Question

A nurse is caring for a client who presents to a clinic for a 1-week follow-up visit after hospitalization for heart failure. Based on the information in the client's chart, which of the following findings should the nurse report to the provider?

Prescriptions​
Digoxin 0.25 mg PO dailyFurosemide 40 mg PO dailyPotassium chloride 20 mEq/L PO dail

History and Physical
Discharge: Weight 66.7 kg (147 lb)SaO2 94%2+ pedal edemaHeart rate 74/min
Current: Weight 67.1 kg (148 lb)SaO2 92%1+ pedal edemaHeart rate 55/min

Laboratory ResultsDischarge:Sodium 137 mEq/LPotassium 4.2 mEq/LDigoxin 1.2 ng/dLCurrent:Sodium 135 mEq/LPotassium 4.1 mEq/LDigoxin 1.8 ng/dL

Answer 1

The nurse should report the increased digoxin level from 1.2 to 1.8 ng/dL and the decrease in heart rate from 74/min to 55/min, as these may indicate a risk for digoxin toxicity and require further evaluation by the provider.

Step-by-step explanation:

The nurse should report the increase in the client's digoxin level from 1.2 ng/dL at discharge to 1.8 ng/dL at the 1-week follow-up. This increased level approaching 2.0 ng/dL, which is at the higher end of the therapeutic range, could indicate an increased risk for digoxin toxicity. Additionally, the decrease in heart rate from 74/min to 55/min is notable and may be related to the increased digoxin level or other factors. While the weight gain is minimal and there is a reduction in pedal edema from 2+ to 1+, these findings suggest that the heart failure may be under control. However, the decrease in SaO2 (oxygen saturation) from 94% to 92%, though slight, could indicate worsening heart failure or other respiratory issues and should also be reported.