A patient is being treated with tab Digoxin. What signs and symptoms are indicative of digoxin toxicity?

IGIMS Staff Nurse - 2018

Pharmacology

Easy

Appeared in: IGIMS Staff Nurse - 2018

Explanation

Yellow vision, medically termed xanthopsia, is a hallmark and specific visual disturbance associated with digoxin toxicity.
Digoxin toxicity affects the central nervous system and the retina, leading to characteristic changes in color perception, such as seeing yellow or green halos around objects.
While other symptoms like nausea and bradycardia are common, the appearance of yellow vision is a strong and classic clue pointing specifically to digoxin toxicity.

Option A: Convulsions are not a common or early sign of digoxin toxicity. They are considered a rare CNS effect, typically occurring only in cases of massive overdose.
Option C: Vertigo (dizziness) is a non-specific symptom. While it can be associated with digoxin toxicity, it can also be caused by numerous other conditions and lacks the specificity of the visual disturbances.
Option D: Muscle cramping is a classic sign of hypokalemia (low potassium). Hypokalemia is a major risk factor that potentiates digoxin toxicity, but the cramping itself is a symptom of the electrolyte imbalance, not a direct effect of the drug toxicity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Recognition of signs and symptoms of Digoxin toxicity to guide bedside assessment, documentation, and the next nursing action.
A critical nursing responsibility before administering digoxin is to measure the apical pulse for one full minute. The medication should be held and the prescriber notified if the pulse is less than 60 beats/min in an adult.
Nurses must monitor serum potassium levels closely, as hypokalemia (low potassium) significantly increases the risk of digoxin toxicity. Educate patients on potassium-rich foods if they are also taking potassium-losing diuretics.
What if? If the patient develops renal impairment, the risk of digoxin toxicity increases dramatically because the drug is primarily excreted by the kidneys. In this case, the dose would need to be reduced, and serum digoxin levels monitored more frequently.

How to Approach the Question

First, identify the core of the question: it asks for a specific sign of 'digoxin toxicity'.
This is a factual recall question that tests your knowledge of pharmacology and adverse drug reactions.
Scan the options: Convulsion, Yellow vision, Vertigo, Muscle cramping.
Recall the classic, hallmark signs of digoxin toxicity. The most unique and frequently tested signs are the visual disturbances (yellow/green halos, xanthopsia) and GI issues (anorexia, nausea).
Evaluate each distractor. 'Muscle cramping' is strongly linked to hypokalemia, a risk factor for toxicity, not a direct sign. 'Convulsion' is rare. 'Vertigo' is non-specific.
Select 'Yellow vision' as it is the most specific and characteristic sign of digoxin toxicity among the choices.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 pp. 73-75, 76-78