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1. Assess the patient's response to the digoxin by evaluating relief of symptoms such as dyspnea, orthopnea, crackles, hepatomegaly, and peripheral edema.

2. Monitor the patient for factors that increase the risk of toxicity:

a. Decreased potassium level

b. Use of meds that enhance the effects of digoxin such as oral antibiotics and cardiac drugs that slow AV conduction and slow heart rate

c. Impaired renal function especially in patients 65 years and older

3. Before administering the drug, assess the patient's apical heart rate. If it below 60, the drug should be held. More importantly assess the PR interval for AV conduction blockage.

4. Monitor for GI side effects

5. Monitor for neurologic side effects.

A classic symptom of digoxin toxicity is a yellow halo effect seen by the patient.

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