Digoxin Lifecycle: Therapeutic Use → Toxicity Recognition → Toxicity Management
Digoxin has one of the narrowest therapeutic windows you'll encounter — the margin between "working" and "killing" is razor-thin. The NCLEX expects you to trace the full arc: appropriate administration, the moment you hold the dose, the moment you recognize toxicity, and the moment you escalate to Digibind. Miss any transition point and you've picked the wrong answer.
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Therapeutic Use
What's happening- ↑ contractility, ↓ heart rate (HF, AFib)
Key findings- Therapeutic level 0.5–2.0 ng/mL
- Apical pulse 60–100
- Improved HF symptoms
Nursing focus- ★Hold & assess if apical pulse < 60
- Check K⁺ — low K⁺ precipitates toxicity
Toxicity Recognition
What's happening- Level exceeds narrow therapeutic range
Key findings- Anorexia, N/V: earliest signs
- ★Yellow-green halos / blurred vision
- Bradycardia, dysrhythmias
- Level > 2.0 ng/mL
Nursing focus- Hold dose, notify provider
- Stat digoxin level and K⁺
Escalate when- Rising level or new dysrhythmia
Toxicity Management
What's happening- Reverse toxicity, stabilize rhythm & K⁺
Key findings- Hyperkalemia in acute overdose
- Dialysis does not remove digoxin
Nursing focus- ★Digoxin immune Fab (DigiFab) antidote
- Correct potassium
- Continuous ECG monitoring
Escalate when- Lethal dysrhythmia or K⁺ > 5: give Fab
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Hold at HR < 60, suspect at halos and nausea, Digibind at dysrhythmias — that's the whole spectrum.
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