Can anyone explain to me the rationale behind this order? - page 2

by MyUserName,RN 4,999 Views | 23 Comments

Just some background on the patient-elderly man, severe abdominal pain, dehydrated. He was NPO, had NG tube to constant suction with a large amount of drainage coming out. CT of abd was negative. He hadn't had a bm in a few days... Read More


  1. 0
    Aaaaaaaaaaaand then there's the renal NH3 production which is heightened in hypokalemia which can cause acidosis...
  2. 1
    An enema will NOT fix a bowel obstruction. Unless it was a very low partial obstruction.
    The K is usless given PO as it is not absorbed. That is the rationale for the NG. What goes in must come out if the usual exit route is blocked it will reverse up the entrance. So no matter how long you clamp the NG it will still be there.
    Because the GIT has lost the absorption function electrolytes are not being absorbed causing K+ derangement.
    I don't understand the,rationale in the choice of fluid resus.
    From a colorectal nurse who has just spent a night shift explaining this very thing to a grad.
    MyUserName,RN likes this.
  3. 1
    Quote from grntea


    and you did pull the ng before you gave him po kcl, right? else you could have just put it directly into the suction cannister, :d .
    didn't have to pull the ng before giving. the ng tube was clamped during and for about an hour after med administration. the patient was able to swallow pills with the ng tube in place. i didn't give kcl iv because there was not an order for iv, only po. yes i could have obtained an order, but since the patient was already taking po meds while the ng tube was clamped, i didn't see the need to do so.
    Last edit by MyUserName,RN on Jul 20, '12
    #1ME likes this.
  4. 0
    Quote from ~*Stargazer*~
    I can only think that maybe it had something to do with the patient's acid/base balance, and wanting to keep him from tipping into the acidotic side with the NS. Did you have a pH on him?
    No, ABG's were not drawn.
  5. 3
    Quote from #1ME
    Doesn't matter if it was placed in his NG or he swallowed it. If the NGT is at continous suction the KCL is just going to be sucked back up into the cannister. You would need to clamp the NG tube.
    ^^
    That is a given to me.
    It's a given to me too. I'm kind of offended at the assumptions that I don't know basic nursing or have a lick of common sense!
    gummi bear, #1ME, and sapphire18 like this.
  6. 0
    Quote from K+MgSO4
    An enema will NOT fix a bowel obstruction. Unless it was a very low partial obstruction.
    The K is usless given PO as it is not absorbed. That is the rationale for the NG. What goes in must come out if the usual exit route is blocked it will reverse up the entrance. So no matter how long you clamp the NG it will still be there.
    Because the GIT has lost the absorption function electrolytes are not being absorbed causing K+ derangement.
    I don't understand the,rationale in the choice of fluid resus.
    From a colorectal nurse who has just spent a night shift explaining this very thing to a grad.
    This does make sense. So why would the doctors have us continue giving all of his PO meds and clamping the ng tube if they were all not going to be absorbed anyways?

    I don't understand why we would give both LR and NS at the same time. Since both NS and LR are volume expanders and do basically the same thing aside from the LR containing some electrolytes. In that case, I understand giving the LR because it contains electrolytes, which he needed, so why not just give D5LR at a higher rate instead of running two different solutions?
    Last edit by MyUserName,RN on Jul 20, '12
  7. 2
    I am guessing there is no rationale for that order and that the resident misunderstood the directions of his supervisor. Usually when no one can come up with a reason for doing something (nurses, MDs, pharmacists) it is usually because it is wrong.
    corky1272RN and MyUserName,RN like this.
  8. 2
    Well, I'm just guessing here, but: D5NS because he is NPO and doesnt have a PEG, so he needs something for energy. LR has 4 mEq of potassium in it, for the K of 3.3.
    corky1272RN and MyUserName,RN like this.
  9. 3
    I don't know. But I would like to give kudos to the resident for admitting he didn't know and going off to research it, instead of getting all defensive and saying "Because I and Dr X and Dr Y say so!"
  10. 0
    aaaand they moved a post of mine again....I forgot why I was so annoyed with allnurses. There's so many different forums on this website I'm sure every single post in the general forum has a "spot"...that nobody would know or care to go to.


Top