Low potassium level, post CABG patient

[lindsmith88]

We had a post CABG patient when I was on a tele floor (I'm a student) and his potassium was 3.2. He had potassium chloride running and the nurse told me we were just going to continue monitoring him because the level wasn't in the danger zone. If I came across this situation again, is there anything I could do differently? I have to write a reflective journal and need to come up with 3 things I could do differently in a similar situation. I really am not sure what I could do.

Thanks guys.

[tcvnurse, BSN, RN]

Post op CABG patients are aggressively diuresed on my unit. We pretty much have to give them PO KCL a couple times a day and at night also. With K that low he was probably due for some IV bolus or else a few potassium tablets. I would keep an eye on the tele strip for him to make sure he is not having incr arrthymias.

[CyclicalEvents]

I work in a cardiac ICU. All of our post-op CABGs have to maintain K's above 4.0. Our cardiothoracic surgeons find this to be most therapeutic. I don't have any sources to cite though.

[Esme12, ASN, BSN, RN]

We had a post CABG patient when I was on a tile floor (I'm a student) and his potassium was 3.2. He had potassium chloride running and the nurse told me we were just going to continue monitoring him because the level wasn't in the danger zone. If I came across this situation again, is there anything I could do differently? I have to write a reflective journal and need to come up with 3 things I could do differently in a similar situation. I really am not sure what I could do.

Thanks guys.

That depends on the patient. The facility. The surgeons/cardiology. The monitor. Generally speaking...cardiac patients will have their K levels on the higher side of normal......IF their renal function is normal.

You have a heart that has been stopped, started, man-handled, cut, sewed upon, frozen ....which makes it pretty IRRITABLE. The hearts tolerance for everyday annoyances is pretty low so..... A low potassium can cause myocardial irritability. In this setting the heart is pretty irritable already so any disturbance can cause arrhythmias.

When you are the primary nurse......check the patients chart for past labs. Check if there are any standing orders for K. Is this pt prone for arrhythmias? What is the renal status? are the getting diuretics routinely? How fast is the IVF infusing? Are they any oral supplements being given? What are the trending lytes showing? Depending on these factors I would either call the MD or wait to let him know on rounds.

[DolceVita, ADN, BSN, RN]

As a student the first thing you could have done differently is speak with your instructor. An extremely important step for you, your patient and your instructor. If you are remaining on that unit get a copy of their K+ replacement protocols. Know where to find that and other similar information quickly within their system.

As a student you won't know the experience level of the nurse you are speaking with. Nor will you know if they are the nurse who is diligent with protocols or slightly less so. They may be newer to the unit.

You could still discuss this with your instructor and ask him or her the same question you are asking us. They may remember the patient details too.

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