Patient Data

Exhibits

Which of the following findings should the nurse recognize as manifestations of digoxin toxicity? (Select all that apply.)

A. Tell the client that the medication's side effects will most likely dissipate over time: While side effects may lessen with continued use, this response does not address the client’s intent to stop the medication safely.

B. Inform the client that gradual tapering must be used to discontinue the medication: Abrupt discontinuation of antidepressants can lead to withdrawal symptoms and risk of relapse. Educating the client about the need for a gradual taper ensures safe discontinuation and continuity of care.

C. Remind the client that feeling better is the therapeutic effect of the medication: Acknowledging the therapeutic benefit is important but does not provide guidance on safely stopping the medication or addressing the client’s concerns.

D. Tell the client to discuss the medication side effects with the healthcare provider (HCP): Encouraging communication with the HCP is appropriate, but the immediate priority is to inform the client that discontinuation must be gradual to prevent adverse effects.

Rationale for correct choices:

• Infection: The client presents with redness, warmth, swelling, and pain in the left lower leg, accompanied by a small cut and a history of type 2 diabetes. These findings, along with elevated temperature and glucose, indicate a bacterial skin infection requiring prompt treatment with antibiotics to prevent progression.

• Sepsis: Older adults with diabetes and chronic comorbidities are at high risk for systemic infection. The client’s generalized muscle aches, fever, and elevated glucose may indicate early systemic involvement. Interventions to prevent sepsis, such as timely IV antibiotics, monitoring vital signs, and laboratory markers (e.g., WBC, lactate), are crucial to reduce life-threatening complications.

Rationale for incorrect choices:

• Congestive heart failure: While the client has a history of heart failure, the acute presentation of erythema, warmth, and localized swelling suggests infection rather than fluid overload as the priority concern. CHF management is important but secondary in this scenario.

• Kidney disease: Stage 3a chronic kidney disease is a chronic condition and does not explain the acute signs of infection. Monitoring kidney function is important for medication dosing, but it is not the immediate priority.

• Hyperglycemia: The client’s blood glucose is elevated at 252 mg/dL, likely worsened by stress and infection. Hyperglycemia requires monitoring and management, but the underlying infection poses a more immediate threat to health.

• Deep vein thrombosis: DVT can cause leg swelling and pain, but the presence of erythema, warmth, and a break in the skin indicates cellulitis rather than thrombus formation. DVT prevention may be part of ongoing care but is not the priority in this acute presentation.

• Peripheral neuropathy: The client has baseline neuropathy contributing to bilateral leg discomfort, but it does not explain the acute swelling, redness, and warmth. Pain management may be necessary, but infection treatment is urgent.

• Edema: Edema is a symptom present in several chronic conditions, including CHF and PVD, but in this case, localized edema is part of the infection process. Addressing the infection takes priority over general edema management.