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16Unless you are taking a potassium-sparing diuretic, integrate foods rich in potassium into your diet Limit sodium use.POSITIVE INOTROPIC AGENTSoDigitalis Glycosides, Digoxin (Lanoxin)oDigitalis improves myocardial contractility by interfering with ATPase in the myocardial cell membrane and increasing the amount of calcium available for contraction. The increased force of contraction causes the heartto empty more completely, increasing stroke volume and cardiac output. Improved cardiac output improves renal perfusion, decreasing renin secretion. This decreases preload and afterload, reducing cardiac work. Digitalis also has electrophysiologic effects, slowing conduction through the AV node. This decreases the heart rate and reduces oxygen consumption.oNursing ResponsibilitiesAssess apical pulse before administering. Withhold digitalis and notify the physician if heart rate is below 60 bpm and/or manifestations of decreased cardiac output are noted. Record apical rate on medication record.Evaluate EKG for scooped (spoon-shaped) ST segment, AV block, bradycardia, and other dysrhythmias (especially PVCs and atrial tachycardias).Report manifestations of digitalis toxicity: anorexia, nausea, vomiting, abdominal pain, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos seen around objects), and new-onset dysrhythmias.Assess potassium, magnesium, calcium, and serum digoxin levels before giving digitalis. Hypokalemia can precipitate toxicity even when the serum digitalis level is in the “normal” range.Monitor clients with renal insufficiency or renal failure and older adults carefully for digitalis toxicity.Prepare to administer digoxin immune fab (Digibind) for digoxin toxicity.oHealth Education for the Client and FamilyTake your pulse daily before taking your digoxin. Do not take the digoxin if your pulse is below 60 bpm or if you are weak, fatigued, light-headed, dizzy, short of breath, or having chest pain. Notify your physician immediately.Contact your doctor if you develop manifestations of digitalis toxicity: palpitations, weakness, loss of appetite, nausea, vomiting, abdominal pain, blurred or colored vision, double vision.Avoid using antacids and laxatives; they decrease digoxin absorption.Notify your physician immediately if you develop manifestations of potassium deficiency: weakness, lethargy, thirst, depression, muscle cramps, or vomiting.Incorporate foods high in potassium into your diet: fresh orange or tomato juice, bananas, raisins, dates, figs, prunes, apricots, spinach, cauliflower, and potatoes.Sympathomimetic AgentsoDopamine (Inotropin), Dobutamine (Dobutrex)oSympathomimetic agents stimulate the heart, improving the force of contraction. Dobutamine is preferred in managing heart failure because it does not increase the heart rate as much as dopamine, and it has a mild vasodilatory effect. These drugs are given by intravenous infusion and may be titrated to obtain their optimal effects.Phosphodiesterase Inhibitorso