The nurse is preparing to administer medications for an eight-month-old infant with heart failure. The infant has a blood pressure of 114/66 mm Hg, apical pulse of 88 beats/minute, and respirations of 30 breaths/minute.
Which medication should the nurse withhold until the healthcare provider is notified?
A.
Digoxin.
B.
Furosemide.
C.
Hydralazine.
D.
Enalapril.
The correct answer and Explanation is :
The correct answer is A. Digoxin.
Explanation:
In infants, especially those with heart failure, the careful administration of medications like digoxin is crucial due to the potential for toxicity and the narrow therapeutic window. Digoxin is a cardiac glycoside used to improve cardiac output and control heart rate. However, it is essential to assess the infant’s heart rate before administering this medication.
The guidelines for administering digoxin in infants typically include withholding the medication if the apical pulse is less than 90 beats per minute. In this case, the infant has an apical pulse of 88 beats per minute, which falls below the threshold. Administering digoxin under these conditions could lead to serious complications, including bradycardia, and increases the risk of digoxin toxicity. Therefore, it is critical to notify the healthcare provider for further assessment and instructions before proceeding with the medication.
On the other hand, the other medications listed—furosemide, hydralazine, and enalapril—do not have the same immediate concerns regarding heart rate. Furosemide is a diuretic used to reduce fluid overload in heart failure, while hydralazine is a vasodilator that can help reduce systemic vascular resistance. Enalapril is an ACE inhibitor that can improve heart function and reduce blood pressure. These medications should still be administered with caution and under the guidance of a healthcare provider, but they do not require the same immediate withholding based on heart rate.
In summary, due to the risk of bradycardia and potential toxicity associated with digoxin, the nurse should withhold this medication and notify the healthcare provider for further guidance.