Digoxin has a razor-thin therapeutic window, and the four things that decide whether it helps or harms are all nursing assessments — the apical pulse, the serum level, the potassium, and what the patient tells you. Set the findings and see what the nurse does.
Bedside check
Apical pulse—60–100 · full 60 sec
Digoxin level—0.5–2.0 ng/mL
Potassium—3.5–5.0 mEq/L
Complaints—GI · visual · CNS
The pre-dose checkmove a slider to begin
Try a report from the night nurse
Apical pulse—
3560100120 bpm
Serum digoxin (trough)—
0.20.52.04.0 ng/mL
Serum potassium—
2.23.55.06.5 mEq/L
What this patient needs to hear
Digoxin is renally cleared with a 36–48 hour half-life — a rising creatinine, a new loop diuretic, or added amiodarone, verapamil, or quinidine will push the level up days later.