Clinical Pearls of Wisdom for Floor Nurses

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Specializes in Utilization Management.

I'm a pretty good nurse, but I sure don't know everything.

Won't you share your clinical pearls of wisdom with us? Please keep it brief; some of us are at work. ;)

Here's something I didn't know. Must've been absent that day.

If your patient has a low potassium level and a low magnesium level, you have to fix the Mag level first. Otherwise, the K+ level can't be corrected.

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I remember learning about how to do a corrected calcium according to albumin levels, but until my last assignment I never knew there was a calculation for figuring phenytoin levels in the presence of hypoalbuminemia too.

]Calculating phenytoin level correction in hypoalbuminemia:

]Corrected level= Measured phenytoin level /[(albumin x 0.2) + 0.1]

]In renal failure: CrCL

]Corrected level= Measured phenytoin level /[(albumin x 0.1) + 0.1]

http://www.ascp.com/publications/tcp/1996/feb/subacute.html

Not a pearl of wisdom necessarily, but interesting :)

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Specializes in Cardiology, Oncology, Medsurge.

K+, potassium's quickest route is oral. I still run across nurses that believe all meds fall under the category of IV = fastest route. Not true when it comes to potassium... I've even heard MDs verbally correct nurses regarding this issue. And please try tasting some before giving. Salty yes but far from unpleasant. Some patients make it appear so gruesome to swallow, grimacing, complaining, and nauseating...however a swig of apple juice to follow as a "chaser" is kind to do. Who wants to live with a salty mouth? As we all know, potassium PIV is so painful, why not save a person from the pain and give orally.

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K+, potassium's quickest route is oral. I still run across nurses that believe all meds fall under the category of IV = fastest route. Not true when it comes to potassium... I've even heard MDs verbally correct nurses regarding this issue. And please try tasting some before giving. Salty yes but far from unpleasant. Some patients make it appear so gruesome to swallow, grimacing, complaining, and nauseating...however a swig of apple juice to follow as a "chaser" is kind to do. Who wants to live with a salty mouth?

the tabs are horse pills.

the caps are also huge.

the ec don't have a taste.

and the sol is just sheer disgusting...nothing salty, just gag-inducing.

leslie

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K+, potassium's quickest route is oral. I still run across nurses that believe all meds fall under the category of IV = fastest route. Not true when it comes to potassium... I've even heard MDs verbally correct nurses regarding this issue. And please try tasting some before giving. Salty yes but far from unpleasant. Some patients make it appear so gruesome to swallow, grimacing, complaining, and nauseating...however a swig of apple juice to follow as a "chaser" is kind to do. Who wants to live with a salty mouth? As we all know, potassium PIV is so painful, why not save a person from the pain and give orally.

How can PO K+ be absorbed faster than IV? Just curious--I thought all drug absorption from fastest to slowest was something like this:

IV

Inhalation

eyes

PR

SC/IM

PO

Ok, I think I'm making most of that up. BUT, the point being--PO down at the bottom, and IV at the top :)

I would love to know more about this. Esp. K+ since I give it so much.

BTW, that Mag before K+ is invaluable advise. Thanks

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Specializes in Cardiology, Oncology, Medsurge.

Actually let's look at this potassium by mouth (liquid potassium) with some common sense. If you want to give 10 mEqs of K+ IV it will take 1 hour for infusion start to finish. But let's just say you need to give the patient IV 40 mEqs, that would mean an IV infusion lasting 4 hours total. Do you honestly think it would take your body more than 4 hours to absorb liquid K+ of 30mLs ? ? ? I am thinking that most PO meds require conservatively 30 minutes to be absorbed by the digestive tract. So, if we consider this, it is by far the faster route.

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Specializes in ob/gyn med /surg.
Actually let's look at this potassium by mouth (liquid potassium) with some common sense. If you want to give 10 mEqs of K+ IV it will take 1 hour for infusion start to finish. But let's just say you need to give the patient IV 40 mEqs, that would mean an IV infusion lasting 4 hours total. Do you honestly think it would take your body more than 4 hours to absorb liquid K+ of 30mLs ? ? ? I am thinking that most PO meds require conservatively 30 minutes to be absorbed by the digestive tract. So, if we consider this, it is by far the faster route.

yes this is true and i tried to expalin this to one of my instructors ( a dr told me this) and she told me no way this just couldn't be so.. but it is true. i didn't want to get her made at me so i didn't push the idea... i passed boards and now i can declare it to the world PO is faster than iv , because i heard it from a DR and from teleRNer..alot of dr's order it PO now. and i love it.. because i hate giving it IV ..

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Ok, I know this is not a thread on Kcl boluses but since it has been brought up I have a question.

When a patient is NPO for surgery and they have a low K+ level the surgeons always bolus them IV preop and the infusions are NEVER finished by the time the surgery starts. Could the PO potassium be given with a sip of water or is it likely to cause vomiting?(Not the water but the K!)

Thanks

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Specializes in Jack of all trades, and still learning.
Ok, I know this is not a thread on Kcl boluses but since it has been brought up I have a question.

When a patient is NPO for surgery and they have a low K+ level the surgeons always bolus them IV preop and the infusions are NEVER finished by the time the surgery starts. Could the PO potassium be given with a sip of water or is it likely to cause vomiting?(Not the water but the K!)

Thanks

Our policy is usually to give essential meds preop with sips of water. And then document on the nursing preop checklist that this has been done. Obviously diabetic related medications, and anticoagulants are withheld, and you have to use your judgement based on the patient's physical condition. Also, you'd query things like opiates as well. But we do give potassium orally if it has been ordered. I've been pulled up for not doing it.

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Specializes in Telemetry, Oncology, Progressive Care.

Don't forget K IV burns. Whenever I get an order for that I ask the doc if pharmacy can add some lidocaine to the bag if it is going through a peripheral line. The patients tolerate it much better and I do run the infusion in a little slower but can get it up to the desired rate in about 30 minutes.

Kelly

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Obviously diabetic related medications, ,,, are withheld,

Why diabetes meds?

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Specializes in Med/Surg.
Why diabetes meds?

If the pt has been NPO, and will remain NPO after surgery, you can bottom out their blood sugar by giving them their "diabetes meds."

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