護理師檢視 Digoxin 0.25 mg PO QD 的醫囑。哪項發現應讓護理師暫緩給藥？
The nurse is reviewing a new prescription for digoxin 0.25 mg PO daily. Which finding would cause the nurse to hold the medication?
- AApical heart rate of 52 beats/min✓ 正解心尖脈搏為 52 次/分
- BRespiratory rate of 16 breaths/min呼吸頻率為 16 次/分
- CBlood pressure 110/70 mmHg血壓 110/70 mmHg
- DSerum potassium level of 4.2 mEq/L血清鉀離子濃度為 4.2 mEq/L
Digoxin（地高辛）是一種強心苷類藥物，主要用於治療心臟衰竭和某些心律不整（如心房顫動）。其主要作用是增加心肌收縮力（正性變力作用）和減慢心率（負性變頻作用），同時也會減慢房室結傳導。由於Digoxin的治療窗（therapeutic window）較窄，即治療劑量與中毒劑量非常接近，護理師在給藥前必須仔細評估病人的生命徵象和實驗室數據，以確保用藥安全，避免嚴重心臟毒性。 本題強調了給藥前對心率的評估，這是Digoxin安全使用的關鍵環節之一。
Digoxin is a cardiac glycoside used primarily to treat heart failure and certain arrhythmias (such as atrial fibrillation). Its main actions are to increase myocardial contractility (positive inotropic effect) and to slow heart rate (negative chronotropic effect), while also slowing AV nodal conduction. Because digoxin has a narrow therapeutic window, with therapeutic and toxic doses very close, the nurse must carefully evaluate vital signs and laboratory data before administration to ensure safety and avoid severe cardiotoxicity. This item emphasizes the heart rate assessment before administration, which is one of the key elements of safe digoxin use.
在美國和台灣，護理師在給予Digoxin前，測量心尖脈搏並確保心率不低於安全閾值（通常是60次/分，但具體數值可能依醫囑或院內政策而異）是標準且一致的護理常規。對Digoxin藥物毒性（如心律不整、噁心嘔吐、視力模糊）和影響因素（如低血鉀）的監測也是全球通用的臨床指引。