In the event of severe diarrhea and lethargy in a patient on digoxin, what should the nurse do first?

In the scenario where a patient is experiencing severe diarrhea and lethargy while on digoxin, it is crucial to prioritize the patient's safety due to the potential for serious complications such as bradycardia (low heart rate) and hypotension (low blood pressure). Digoxin has a narrow therapeutic range, and its levels can be affected by electrolyte imbalances, particularly those caused by diarrhea, which can lead to increased risk of digoxin toxicity.

Maintaining safety involves monitoring the patient for any signs of cardiac instability and ensuring that emergency measures are in place if the heart rate drops significantly or if blood pressure becomes dangerously low. By focusing on the patient's safety first, the nurse can help prevent potential adverse events that can arise from compromised cardiovascular function.

Administering digoxin before ensuring the patient is stable could exacerbate any existing issues, and providing intravenous fluids would typically follow an initial assessment of the patient's vital signs and overall condition. Conducting an abdominal assessment is also important but is secondary to ensuring the patient is stable, particularly given the immediate concerns related to lethargy and the implications of their medication therapy.