the administration of a digitalis preparation to a person with a heart disorder to increase the force of myocardial contractions; produce a slower, more regular apical rate; and slow the transmission of impulses through the conduction system. It may be used in treating many cardiac disorders, including atrial fibrillation, atrial septal defect, coarctation of the aorta, congenital heart block, congestive heart failure, endocardial fibroelastosis, great vessel transposition, malformation of the tricuspid valve, myocarditis, paroxysmal atrial tachycardia, and patent ductus arteriosus.
method Complete prescriptions include the name of the digitalis preparation, the dosage in milligrams, the route and intervals of administration, and the pulse rate under which the drug is to be withheld. It is administered before feeding and is never mixed with the formula or food. Before each administration the person's resting apical pulse is checked for rate and rhythm for a full minute. If the rate is slower than desired; if it is irregular or shows a rapid rise or fall; if there are any signs of toxicity, such as anorexia, nausea, or vomiting; or if there are visual disturbances, the drug is withheld and the problem is reported.
interventions The nurse participates in calculating the dosage volume ordered, administers the drug, and observes for and reports any undesirable effects. Once the dosage is stabilized and before discharge, the nurse or pharmacist ensures that the patient understands the proper method, time, and purpose of administering the drug, as well as the need and the time to give the complete dose, when to withhold medication, and how to recognize and report signs of toxicity to the drug.
outcome criteria In addition to promoting more forceful myocardial contractions and a slower, more regular apical beat, digitalis therapy can reduce venous pressure, improve pulmonary and systemic circulation, increase urinary output, reduce edema, and stop paroxysmal atrial tachycardia and atrial fibrillation.