question about heart failure

classicdame, MSN, EdD · Mar 27, 2013

of course this is the MD's decision. But the MD will consider the condition of the kidneys. If they are not functioning properly the pt will hold on to potassium which can lead to heart arrhythmias. So sometimes the MD wants more circulating in the body and sometimes less. Another consideration is the pancreas. A healthy pancreas secretes insulin which takes glucose AND POTASSIUM out of the blood. If too much K is being dumped in the system and the kidneys cannot handle it, then again the K elevates. You are right that lasix will encourage K excretion. There is too much to consider based on the little bit of info we have on this "patient"

rubato, ASN, RN · Mar 27, 2013

Depends. What's their potassium level? If their level is fine, Lasix should be fine, but you'll need to monitor their K+

guest042302019, BSN, RN · Mar 27, 2013

If a patient has heart failure, is on lasix, and has decreased bowel sounds and muscle weakness, would you give a potassium sparing diuretic or 20 meq/l potassium?
Could you guys help me understand why you would choose one or the other?
I would think that giving a potassium sparing diuretic is best, because the patient needs the diuretic (Excessive fluid volume), but needs to keep the potassium. If you just give the patient extra potassium they're still going to excrete it, because of the lasix correct?

Patient Condition: Heart Failure

S/S: decreased bowel sounds (hypoactive), muscle weakness

Meds: Lasix

Which med to give, lasix or 20meq/L potassium?

I can see why you would ask about lasix. However, I don't understand why you are asking about potassium? What is the level? Are you implying that the other S/S are caused by hypokalemia hence the potassium administration?

They may have hypoactive bowel sounds for a number of reasons. For instance, immobility, narcotics, bedridden, some GI issue, etc. Also, muscle weakness can be caused by being simply lethargic or a vast number of other conditions (i.e. Electrolyte, Hematological, Cardiac, etc.) or the heart failure.

Or, I imagine one could be on both medications: lasix for the HF and potassium replacement for the lasix, I believe this to be feasible. Patients are given medications all the time for the side effects. For example, stool softeners for narcotics, electrolytes for diuretics, antinausea for many medications.

Is lasix (a K sparing diuretic) best?

This idea struck my interest. I did a quick scan of a research paper comparing diuretics and generally when which diuretics are indicated.

It seems thiazides are first line to loop. And, kidney function is evaluated when using diuretics (like any other drug).

How about a what if?

What if your patient has hypokalemia but still is prescribed lasix? Or, if the patient is given extra potassium but is prescribed lasix?

I would imagine, if the patient has hypokalemia, and is prescribed lasix, we would hold the medication and call the MD for a potassium rider (if there isn't an order already).

Anyway, here's the paper I found if you're interested in reading it.

http://www.factsandcomparisons.com/common/PDF/20090201_Feb2009_peer1.pdf

Good luck!

-andrew

hodgieRN · Mar 28, 2013

It's 20 meqs of potassium. The question wants to know if you can pick out the issue. It's the muscle weakness and decreased bowel sounds. Marked hypokalemia causes muscle weakness, paralysis, decreased bowel sounds, respiratory depression. You have to fix the problem. If you give a potassium sparing diuretic, that isn't going to increase the K level. It will just help it from going lower.

Muscle weakness is from the low potassium level. You fix it by giving PO potassium.

I think people are reading too much into the question. Remember to read question in a way to answer the question. The fact that the pt is on lasix says the pt is at risk for hypoK. If they have muscle weakness and decreased bowel sounds, then hypoK is highly confirmed. I don't know why calling the doctor is being brought up or asking what the K level is. This is how NCLEX questions are based. They aren't going to give you all the info. You have to work with the info given to you and get the best answer. If they gave you the level, then there's not going to be any critical thinking involved.

The question isn't asking about treatment for heart failure and fluid volume deficit has nothing to do with it. Other reasons for decreased bowel sounds has nothing to do with it. The pt takes lasix and now has muscle weakness. That's it. What do you do? You have to give PO potassium to treat the hypokalemia.

nurseprnRN, BSN, RN · Mar 28, 2013

Furosemide (Lasix) is not a potassium-sparing diuretic.

YOU don't make any decision about which medications to give, absent a clear prn prescription. If this is an NCLEX-type question, the answer you would check would be something to the effect of "get more information," because you don't have enough. What you learn would give you data to ask the prescriber, who is the proper person to choose.

Esme12, ASN, BSN, RN · Mar 28, 2013

If a patient has heart failure, is on lasix, and has decreased bowel sounds and muscle weakness, would you give a potassium sparing diuretic or 20 meq/l potassium?
Could you guys help me understand why you would choose one or the other?
I would think that giving a potassium sparing diuretic is best, because the patient needs the diuretic (Excessive fluid volume), but needs to keep the potassium. If you just give the patient extra potassium they're still going to excrete it, because of the lasix correct?

The diuretic effect of lasix is different from the diuretic effect of HCTZ.

To have effective diuresis in the presence of heart failure a loop diuretic is the drug of choice. The general idea is to remove excess salt and water from the body--decreasing the volume of fluid inside the blood vessels creating the back flow. Simply put....Loop Diuretics work in the early proximal convoluted tubule (where over 40% of water is reabsorbed)...in addition to the areas that HCTZ works. So it is more effective in that way.

You choose the drug that offers the most effective treatment of the disease you are trying to treat then you deal with the side effects of those drugs.....like administering potassium as an adjunct therapy.\

What was the question exactly.

mlauren · Apr 4, 2013

The correct answer was the potassium sparing diuretic. The other option for 20 meq was a bolus dose. Sorry I left that part out. So that's why it wasn't correct. But I still don't understand why you would just give a potassium sparing diuretic to this patient, since they had symptoms of hypokaloemia. No, the question did not provide me with values, but I just assumed that's where they were headed with it. And the other two options were bogus. It seems like these NCLEX questions are aiming to confuse you as much as possible. It's very hard not to over think them. I mean, they give you options (apparently even the right answer) that aren't even what you would do in this situation. Shouldn't the point of the question be for you to know what you should do exactly? Like someone said above, if this patient has heart failure, they need the diuretic. And maybe a potassium sparing diuretic WOULD be ordered, I don't know (I don't have near enough experience to say). But if they're hypokalemic they need extra potassium as well. And I would think that giving PO would be the first thing before administering it IV, especially if they already have heart failure. Correct me if I'm wrong please. I'm just trying to understand this. I think I'll ask my instructor about it and see what she has to say. I'll be sure to share her thoughts.

MendedHeart · Apr 4, 2013

If the question did not say the K+ was low. .u cannot assume it is. Never add any assumptions or possibilities to what the stem is asking. Only go by exactly what it telks you about the patient. If we give a patient K+ as well as Aldactone or the such and dont know what the level is what could happen?

Esme12, ASN, BSN, RN · Apr 4, 2013

The correct answer was the potassium sparing diuretic. The other option for 20 meq was a bolus dose. Sorry I left that part out. So that's why it wasn't correct. But I still don't understand why you would just give a potassium sparing diuretic to this patient, since they had symptoms of hypokaloemia. No, the question did not provide me with values, but I just assumed that's where they were headed with it. And the other two options were bogus. It seems like these NCLEX questions are aiming to confuse you as much as possible. It's very hard not to over think them. I mean, they give you options (apparently even the right answer) that aren't even what you would do in this situation. Shouldn't the point of the question be for you to know what you should do exactly? Like someone said above, if this patient has heart failure, they need the diuretic. And maybe a potassium sparing diuretic WOULD be ordered, I don't know (I don't have near enough experience to say). But if they're hypokalemic they need extra potassium as well. And I would think that giving PO would be the first thing before administering it IV, especially if they already have heart failure. Correct me if I'm wrong please. I'm just trying to understand this. I think I'll ask my instructor about it and see what she has to say. I'll be sure to share her thoughts.

Leaving out part of the question or answers available to you doesn't give us what is necessary to answer the question for you properly.

IN this case it didn't really matter and I have to tell you in the real world that would make you wonder if the patient had a low K+ so you would call the MD, get an order for serum Lytes.....then if the K+ is low administer K+ p.o. or IV. Seldom, if ever would they change the diuretic to a non potassium sparing diuretic from lasix in the presence of heart failure.

Sometime I think these questions are......not effective questions. 2013SNGrad is right....do not assume.....read the question only .

mlauren · Apr 5, 2013

Yes, that is how the question should have been set up and graded, but it wasn't. I HAD to assume to get the question correct. I agree that this is not effective at all. I didn't learn anything from it if it's not even what should really be done in the real world. Like you said, electrolytes would be checked, doctor would order potassium if anything. And not switching the diuretic makes complete sense. At first I thought that would be ordered to help with potassium levels, but I see how it wouldn't be a good idea for the patient with heart failure. Even more reason why this question was so crazy.

nurseprnRN, BSN, RN · Apr 5, 2013

This reminds me of the classic scene in "The Princess Bride." "I don' think that word means wha' you think it means."

"Potassium-sparing" means potassium is not wasted by the kidney as a side effect of this diuretic, so that would be a good idea for someone with hypokalemia, right? Lasix (furosemide) makes you lose potassium, so it is not a potassium-sparing diuretic. But it's generally better to give furosemide to someone with acute fluid overload because it works fast, and it's trivially easy to replace IV potassium.

But I STILL think this is an NCLEX-style question, and despite some opinions, it is not a bad one at all. At least one of you have just fallen into one of the common traps in them-- it's not the nurse's decision, so if you say what med to give, you're wrong. (Also, some don't know what "potassium-sparing" means...another problem.) It's not a question about K+ or diuresis or heart failure, it's a question about whether you know your role as an RN. Word to the wise.