Study finds healthcare professionals ‘less confident’ with LGBTQI+ patients

First of its kind research on LGBTQI+ people with cancer and their healthcare professionals suggests that found clinicians feel “less confident” in their knowledge of this patient population, according to those behind the study. Their findings were presented this week at the Adolescent and Young…

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Digoxin

 Drug Name

Generic Name : digoxin

Brand Name: Digitek, Lanoxicaps, Lanoxin

Classification: Cardiac glycoside, Cardiotonic

Pregnancy Category C

Dosage & Route

• Patient response is quite variable. Evaluate patient carefully to determine the appropriate dose.

ADULTS

• Loading dose, 0.75–1.25 mg PO or 0.125–0.25 mg IV. Maintenance dose, 0.125–0.25 mg/day PO.
• Lanoxicaps capsules
• Loading dose, 0.4–0.6 mg PO. Maintenance dose, 0.1 –0.3 mg/day PO.

PEDIATRIC PATIENTS

Loading dose:

Age	Oral (mcg/kg)	IV (mcg/kg)
Premature	20–30	15–25
Neonate	25–35	20–30
1–24 mo	35–60	30–50
2–5 yr	30–40	25–35
5–10 yr	20–35	15–30
> 10 yr	10–15	8–12

Maintenance dose, 20%–30% of loading dose in divided daily doses. Usually 0.125–0.5 mg/day PO; 20%–30% for premature babies.

GERIATRIC PATIENTS WITH IMPAIRED RENAL FUNCTION

Creatinine Clearance (mL/min)	Dose
10–25	0.125 mg/day
26–49	0.1875 mg/day
50–79	0.25 mg/day

Therapeutic actions

• Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity.

Indications

• CHF
• Atrial fibrillation

Adverse effects

• Extra beats, anorexia, nausea and vomiting. Diarrhoea in elderly, confusion, dizziness, drowsiness, restlessness, nervousness, agitation and amnesia, visual disturbances, gynaecomastia, local irritation (IM/SC inj), rapid IV admin may lead to vasocostriction and transient hypertension.
• Potentially Fatal: Cardiac arrhythmias in combination with heart block.

Contraindications

• Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive cardiomyopathy. Arrhythmias due to accessory pathways (e.g. Wolff-Parkinson-White syndrome).

Nursing considerations

Assessment

• History: Allergy to digitalis preparations, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency, decreased K+, decreased Mg2+ increased Ca2+, pregnancy, lactation
• Physical: Weight; orientation, affect, reflexes, vision; P, BP, baseline ECG, cardiac auscultation, peripheral pulses, peripheral perfusion, edema; R, adventitious sounds; abdominal percussion, bowel sounds, liver evaluation; urinary output; electrolyte levels, LFTs, renal function tests

Interventions

• WARNING: Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate.
• Take care to differentiate Lanoxicaps from Lanoxin; dosage is very different
• Check dosage and preparation carefully.
• Avoid IM injections, which may be very painful.
• Follow diluting instructions carefully, and use diluted solution promptly.
• Avoid giving with meals; this will delay absorption.
• Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor readily available in case toxicity develops.
• WARNING: Monitor for therapeutic drug levels: 0.5–2 ng/mL.

Teaching points

• Do not stop taking this drug without notifying your health care provider.
• Take pulse at the same time each day, and record it on a calendar (normal pulse for you is___; call your health care provider if your pulse rate falls below ____.)
• Weigh yourself every other day with the same clothing and at the same time. Record this on the calendar.
• Do not start taking any prescription or over-the-counter products without talking to your health care provider. Some combinations may increase the risk of digoxin toxicity and may put you at risk of adverse reactions.
• Wear or carry a medical alert tag stating that you are on this drug.
• Have regular medical checkups, which may include blood tests, to evaluate the effects and dosage of this drug.
• Report unusually slow pulse, irregular pulse, rapid weight gain, loss of appetite, nausea, diarrhea, vomiting, blurred or “yellow” vision, unusual tiredness and weakness, swelling of the ankles, legs or fingers, difficulty breathing.

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West Midlands trust recognised for efforts in tackling discrimination

A mental health trust in the West Midlands has been awarded a race equality accolade, as part of its ongoing efforts to tackle discrimination in the workplace and path to becoming an anti-racist organisation. The Black Country Healthcare NHS Foundation Trust has received the RACE…

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Trust hopes new ‘teaching hospitals’ status will boost recruitment

A Hertfordshire trust is celebrating reaching “teaching hospital” status and has said it reflects the hard work and efforts of those across the organisation who deliver training, learning and education across its workforce. Having achieved its new status, West Hertfordshire Hospitals NHS Trust will become…

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Daily tasks are ‘more problematic’ for women than men in old age

Women are more likely than men to struggle with both regular daily tasks and mobility activities as they age, according to researchers from France and the UK. They said that the study indicated that early intervention should be targeted during middle age to try and…

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Bullied and disciplined: How Black nurses are being failed

The Covid-19 pandemic has sparked an increase in racism experienced by nursing staff, according to the founder of an organisation set up last year to promote equality. “If they were experiencing racism before Covid, now it will have increased,” said Neomi Bennett, the Black British…

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RCN reveals results of consultation on action over pay in England and Wales

Royal College of Nursing members in England and Wales have signalled support for industrial action over pay in a consultation exercise, though the response level was well below that needed in an official ballot. The college has today published the results of its indicative ballot…

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MHRA approves Covid-19 treatment for patients at-risk of severe disease

The UK’s medicines regulator has approved a Covid-19 treatment that has been found to cut the risk of hospitalisation and death by 79% in high-risk adults with the infection. Scientists have also said that preclinical data suggests it should work well against the latest variant…

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Asthma control in children linked to risk of bullying, suggests study

Children with asthma that is relatively well controlled are less likely to be bullied or teased by their peers because of their condition, suggests a UK study. In contrast, it found that children who reported bullying or teasing because of their asthma were more likely…

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New social care white paper ‘fails to fix workforce shortages’

Ministers have revealed a workforce “strategy” for adult social care in England, with fresh details on how it intends to support staff professional development and wellbeing. But unions and other organisations representing health and socical care have raised concerned that it lacks a solution to…

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Omicron could set off Covid-19 wave ‘sufficient to overwhelm NHS’

Government advisors have warned they cannot rule out that the new Omicron variant of Covid-19 could initiate a new wave of the pandemic “sufficient to overwhelm NHS capacity”. In a briefing note published on Monday, scientists from the New and Emerging Respiratory Virus Threats Advisory…

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Warning patient backlogs could soar to 12 million by early 2025

Elective care waiting lists in the English NHS could reach anywhere between seven to 12 million by 2025, adding further concerns that nursing workforce numbers and bed capacity are not meeting growing demands. The National Audit Office (NAO) has today published a new report exploring…

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Northern Ireland to implement 3% pay increase for NHS staff

All health and social care in Northern Ireland on the Agenda for Change (AfC) contract will receive the 3% pay increase recommended by the NHS Pay Review Body, a move unions are “relieved” to hear  following months of waiting. The pay rise will be backdated…

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Health secretary starts next NHS pay round, but unions fear delays

Health unions are concerned that next year’s pay deal for NHS nurses and colleagues in England will be delayed again, following latest correspondence from the health and social care secretary. Sajid Javid has written to the NHS Pay Review Body to “formally commence” the 2022-23…

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Special investigation: The voice of nursing on mute

The post Special investigation: The voice of nursing on mute appeared first on Nursing Times.

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Social care CNO highlights IPC importance in next phase of Covid-19

Nurses and colleagues “going above and beyond” to ensure good infection prevention and control is what has helped the country through the pandemic so far and what will continue to “get us through” the next phase, according to the England’s chief nurse for adult social…

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Child Health Nursing Quiz Series - 20

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Boris Johnson sets ‘ambitious’ January target for booster roll out

Prime Minister Boris Johnson has set an “ambitious” end of January target for the booster roll out to those aged 18 and over in response to the new Omicron variant. In a press conference today, Mr Johnson said the booster jab will be rolled out…

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‘Lessons must be learnt’ from PPE shortages during pandemic

It is “essential” that the forthcoming public inquiry into the Covid-19 pandemic examines why there was not sufficient and adequate public protective equipment to go around initially, according to a new report. The circumstances and rationale behind the changing PPE advice in different settings across…

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New ‘NHS Reserves’ scheme calls on retired nurses to return to work

The government is calling on retired NHS nurses and colleagues to return to work, as part of a health service “reserves” scheme being launched across the country. The move comes against a backdrop of more than 39,800 nurse vacancies across the NHS in England and…

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