A mother calls the nurse to report that at 0900 she administered an oral dose of digoxin to her 4-month-old infant, but at 0920 the baby vomited the medicine. Which instruction should the nurse provide to this mother?
A.
Administer a half dose now.
B.
Give another dose.
C.
Mix the next dose with food.
D.
Withhold this dose.
The Correct Answer and Explanation is:
The correct answer is D. Withhold this dose.
Explanation:
Digoxin is a medication commonly used to treat heart conditions, including heart failure and certain types of arrhythmias. It has a narrow therapeutic range, meaning that the difference between an effective dose and a toxic dose is small. Therefore, precise dosing and careful monitoring are crucial.
In this scenario, the mother administered an oral dose of digoxin at 0900, but the infant vomited the medication at 0920. When a dose of digoxin is vomited, it is generally advised to withhold the dose rather than re-administer it. Here’s why:
- Risk of Overdosing: Since digoxin has a narrow therapeutic index, there’s a risk of overdose if the dose is repeated. If the vomited dose was partially absorbed, adding another full dose could result in toxic levels of the medication.
- Absorption Considerations: Vomiting shortly after administering medication often means that the medication did not have adequate time to be absorbed into the bloodstream. Since the vomiting occurred within 20 minutes of administration, it is likely that most of the medication was not absorbed.
- General Practice: The standard practice for oral medications when vomiting occurs is to withhold the dose rather than administer another. This helps to prevent the risk of giving an excessive amount of the medication.
- Professional Guidance: In cases like this, it’s important for the nurse to provide guidance based on the specific medication and the patient’s condition. For digoxin, re-administering the medication or adjusting the dose without professional advice can be dangerous.
The nurse should instruct the mother to contact the healthcare provider for further guidance on whether to administer the next dose at the scheduled time or to adjust the dosing schedule. This helps to ensure that the infant receives the appropriate amount of medication without the risk of toxicity.
In summary, withholding the dose and seeking professional guidance is the safest approach when an oral dose of digoxin is vomited shortly after administration.