A patient with congestive heart failure is given digitalis. Which of the following indicates the earliest manifestation of digitalis toxicity?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

Gastrointestinal (GI) symptoms, particularly anorexia, nausea, and vomiting, are the most common and earliest signs of digitalis toxicity.
These symptoms are caused by both direct GI irritation and stimulation of the chemoreceptor trigger zone in the brain.
The appearance of GI disturbances often precedes the onset of more dangerous cardiac arrhythmias, making them a crucial early warning sign.

Option A: Hypokalemia (low potassium) is a condition that increases a patient's sensitivity to digitalis, making toxicity more likely. It is a cause or risk factor, not a symptom or manifestation of toxicity.
Option B: While digitalis toxicity can cause a variety of arrhythmias, bradycardia (a slow heart rate) is a more classic sign than tachycardia (a fast heart rate). Furthermore, GI symptoms typically manifest earlier than cardiac signs.
Option D: Gynecomastia (enlargement of male breast tissue) is a rare, endocrine-related side effect associated with long-term (chronic) use of digitalis. It is not a sign of acute toxicity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Early identification of digitalis (digoxin) toxicity to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role is to monitor for early signs of toxicity. Always assess for anorexia, nausea, or vomiting before administering a dose of digitalis.
It is critical to monitor the patient's serum potassium levels, as hypokalemia (a level below 3.5 mEq/L) significantly increases the risk of toxicity.
Before administration, the nurse must check the apical pulse for one full minute. If the rate is below 60 beats/min (in an adult), the dose should be withheld, and the physician notified.

How to Approach the Question

First, identify the key terms in the question: "digitalis" and "earliest manifestation of toxicity."
The question asks for the first sign to appear. This requires you to know the typical progression of symptoms.
Differentiate between symptoms (manifestations), predisposing factors (causes), and long-term side effects.
Evaluate each option based on this differentiation. Hypokalemia is a predisposing factor, not a symptom.
Consider the commonality and timing of the remaining options. GI symptoms like nausea are known to be the most frequent and earliest indicators.
Gynecomastia is a chronic, rare side effect. Tachycardia is a possible cardiac sign, but bradycardia is more classic, and GI signs usually appear first. This leaves nausea and vomiting as the best answer.

Concept Tested & Keywords

Concept Tested: Early identification of digitalis (digoxin) toxicity.
Stem keywords: congestive heart failure, digitalis, digitalis toxicity, earliest manifestation
Lead-in keywords: earliest manifestation

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