رضيع عمره ٦ أشهر عنده عيب قلبي خلقي وفشل قلب، يأخذ ديجوكسين مرتين يومياً. اليوم رضاعته أقل وتقيأ مرة. قبل الجرعة عدّ الممرض النبض القمي دقيقة كاملة فكان ٨٤، والتنفس ٤٤. ما التصرف الصحيح؟

A 6-month-old with congenital heart disease and heart failure takes digoxin twice daily. Today he fed less and vomited once. Before the dose the nurse counts the apical pulse for a full minute at 84, RR 44. What is the correct action?

1. Hold the dose and notify the prescriber
2. Give half the dose and recount in an hour
3. Give the dose because the rate is above 60
4. Give the dose with milk to reduce nausea

Answer: A) Hold the dose and notify the prescriber. Digoxin hold limits in infants are usually below 90–110 depending on age and policy, below 70 in older children and below 60 in adults. A rate of 84 is low for an infant, so the dose is held and reported.