[Brownms46]

jenac I don't understand why there would be concern about giving the K+ d/t cardiac concerns. That is a reason for replacing it, not for getting a ECG first??? If there is an irregularity, what would you do different??? Would you not give the K+???, if the pt. K+ were low????

[Todd SPN]

Originally posted by Brownms46
First when hydrating a pt., renal function always comes into the situation. Yes rehydration is done in gastroenteritis, d/t diarrhea, especially per IV when vomiting. But that doesn't mean you don't have to assess whether or not kidneys are normal, and GI fld losses can lead to acute renal failure.

Second I thnk you meant to write hypokalemia, and yes both can cause ECG changes, but this is not a priority in accessing this pt. prior to giving K+ , but renal function is IMO.

I don't argue the fact about renal function coming into the equation, I'm just thinking that might be reading into the question. I did mean hyperkalemia as I was thinking there is a chance of toxicity from the K+ infusion and that would show on a ECG.

By looking strictly at the question, I see no mention or hint of renal problems, so I assume the focus should be on the actions/reactions and side effects of the K+ that could affect the pt. Anyway, I understand what you are saying. It's a tough question.

[Brownms46]

Yes it is ToddSPN, as there is a lot of information left out of the question. But again, it does say before giving the K+...which would mean this pt is hypokalemic. Which would be common with GI fld loss. And with dehydration comes the possibility of impaired renal function. If you give the K+ and the renals aren't functioning, then the kidney can't get rid of any excess, then this would lead to hyperkalemia, and ECG changes.

If the question stated as one of the opitons was to check the latest lab results, then I would worry about what they were. But that isn't an option. So I must conclude that the recent labs showed low K+ level.

Then concerning the EKG, well if the K+ is low, there might be some changes noted, but this still wouldn't be a concern before giving the K+. But renal functioning would, as when giving K+ you would need to know how well they're functioning. And since it is more usuall for a pt. to be in ARF with dehydration, this is the reason many times, MD will order to give such and such flds for the first 8, check output, and then order K+ to be given.

But I wish wiseRN would come back and give the answer to the question..

[EastCoast]

I'm still sticking with checking EKG but i can see more reasoning than i did previously into checking ability to void. However, again, i a kid can't mechanically void then that is a whole other can of worms and it sounds to me like ability to void here is a mechanical issue (which can be remedied) versus a physiological process. So my question also is why don't we check every adults ability to void before administering K+ ?

The question is a poorly worded question and without doubt probably had a 10 point weight on a final exam somewhere.

[Love-A-Nurse]

"jenac I don't understand why there would be concern about giving the K+ d/t cardiac concerns."


I know you are talking to Jnette, but I want to try and answer and looking forward to the correct answer from original poster.

This patient has diarrhea and in a state of hypokalemia because of it, therefore, to correct the imbalance, KCL is ordered.

The concern with cardiac problems as a complication is KCL in excess causes, V Fib, cardiac arrest, and if the patient is not urinating prior to giving, the KCL does not have a way of being excrected since it does it by way of the kidneys.

Where is the answer?

[Brownms46]

Love A Nurse , that was me talking to jenac, and I'm with you on the answer being C.

[EastCoast]

http://www.emedicine.com/ped/topic1121.htm


this has a fairly good article on repletion of Potassium in children. While it does reference overall that one should not give Potassium in the face of renal failure (duh) it does continuously reference the need to obtain serial if not continuous EKG during replacement due to the risk of short term morbidity.

Given this I would argue with any instructor that cardiac monitoring would be the best answer.

Also note that the article lists all the GI complications involved with hypo/hyper kalemia.

So what is the answer and where did this question come from??

thanks.

[jenac]

Thank you Love-A-Nurse. My sediments exactly. My concerns here was that potassium might CAUSE an arryhtmia or other cardiac problem. If there is already an irregularity, I would be very careful admisinstering it-and atleast know to monitor it.

[jnette]

Originally posted by Brownms46
Yes it is ToddSPN, as there is a lot of information left out of the question. But again, it does say before giving the K+...which would mean this pt is hypokalemic. Which would be common with GI fld loss. And with dehydration comes the possibility of impaired renal function. If you give the K+ and the renals aren't functioning, then the kidney can't get rid of any excess, then this would lead to hyperkalemia, and ECG changes.

If the question stated as one of the opitons was to check the latest lab results, then I would worry about what they were. But that isn't an option. So I must conclude that the recent labs showed low K+ level.

Then concerning the EKG, well if the K+ is low, there might be some changes noted, but this still wouldn't be a concern before giving the K+. But renal functioning would, as when giving K+ you would need to know how well they're functioning. And since it is more usuall for a pt. to be in ARF with dehydration, this is the reason many times, MD will order to give such and such flds for the first 8, check output, and then order K+ to be given.

But I wish wiseRN would come back and give the answer to the question..

Gotta agree 100% with Brownie on this one ! Her reasoning follows along the same lines as mine. That's why I chose and stuck with my initial answer.."C".

Also, in all my nursing courses, still so fresh in my mind as a "new" nurse, everytime a question of this nature was brought up on any quizz or exam, this was the answer desired. It was pounded heavliy into my brain, over and over and over. Renal function is always the first concern before giving K+. I even had a similar question on NCLEX.

Of course, working in dialysis only helps add to my understanding of the importance the ability to rid the body of K+.

I think the question was pretty basic, but a lot of folks here were just trying to read more into it than there really was.

[Love-A-Nurse]

Originally posted by Brownms46
Love A Nurse , that was me talking to jenac, and I'm with you on the answer being C.

Brownie, thanks for the clarification.