Order: Zosyn 1.3g in 100mL. D5W IVPB q8h to infuse over 30 min. Drop factor: 60 gtt/mL. Determine rate in gtt/min.

Given:

Volume of fluid: 50 mL (DSW)

Infusion time: 30 minutes

Drop factor: 10 gtt/mL

Formula:

Flow rate (gtt/min) = (Volume (mL) / Time (min)) x Drop factor (gtt/mL)

Step 1: Calculate the infusion rate in mL/min:

Infusion rate (mL/min) = Volume (mL) / Time (min)

Infusion rate (mL/min) = 50 mL / 30 min

Infusion rate (mL/min) = 1.67 mL/min

Step 2: Calculate the flow rate in gtt/min:

Flow rate (gtt/min) = Infusion rate (mL/min) x Drop factor (gtt/mL)

Flow rate (gtt/min) = 1.67 mL/min x 10 gtt/mL

Flow rate (gtt/min) = 16.7 gtt/min

Step 3: Round to the nearest whole number:

Flow rate (gtt/min) ≈ 17 gtt/min

A) Check the weight of the patient:
While weight monitoring is important in managing heart failure and tracking fluid retention, it is not the most critical action before administering digoxin. Digoxin primarily affects heart rate and rhythm, so the priority assessment is related to the cardiovascular system.

B) Check the skin for bruising:
Checking for bruising is not a necessary step before administering digoxin. Bruising could be an indication of an underlying bleeding disorder or anticoagulant therapy, but it is not directly related to the administration of digoxin. The primary concern with digoxin is its effect on the heart, particularly heart rate and rhythm.

C) Check the apical pulse:
It is crucial to check the apical pulse before administering digoxin, as one of the major effects of the drug is to slow the heart rate (negative chronotropy). If the heart rate is below 60 beats per minute (bpm), the nurse should hold the medication and consult the healthcare provider, as digoxin can further decrease the heart rate and lead to bradycardia or other complications.

D) Check the temperature of the patient:
Although monitoring vital signs, including temperature, is important in overall patient care, temperature does not specifically impact the administration of digoxin. A normal or abnormal temperature would not typically influence the decision to give digoxin unless the patient had a fever due to an underlying infection that could complicate the clinical picture. The priority is assessing the pulse to ensure safe administration of the medication.