Medication question

[wiseRN]

nurse caring for an eight year old with gastroenteritis she is to add kcl to the iv. which of the following signs would be critical for the nurse to assess prior to adding kcl. a. independant bowel movements b. a baseline ekg c.ability to void d. active bowel sounds.

i have moved the thread from nursing issues to here as not a lot of pediatric nurses have responded on the thread yet and i thought it would be valuable if we had more input from that specialty

[wiseRN]

I guess not many venture to answer this one Stumped EH!

[becca.utns]

B. A Baseline Ekg ?

[bellehill, RN]

Wise RN, I am going to guess that the reason for a low k+ would be diarrhea therefore the bowel sounds and movement are not an issue. I would hope she would check the K+ lab level and obtain a baseline EKG if the K+ is low and warrants one. I don't see where voiding would affect the K+level or be required. Is this a test question or an actual clinical question?

[Todd SPN]

Hmmm, I'll take *B* especially since we are talking IV as the route.

[EastCoast]

B. would be best for the obvious reasons of contactility and cardiac issues.

a: they are already having independent bowel movements (whatever that means)

c: Ability to void is important in the face of renal disease. I would suspect with gastro the pt. is dehydrated a bit and so it's not an issue of the kids ability to pee rather the fluid balance

d: has nothing to do with KCL in the IV.

IMO The BEST answers which of course are not listed is:

make sure the IV is patent,

make sure they are hypokalemic

check their magnesium and renal function labs too

assure the dose is appropriate for age/size of patient

[jnette, ASN, EMT-I]

C. Ability to void !

Otherwise you are not able to rid the body of K+ and it would build up to dangerous levels !

[EastCoast]

I wouldn't go with ability to void as my first guess. My thinking is a sound nurse will notice if he in fact is not voiding and scan him and cath him if needed. As well a child with gastro without question should automatically be on I/O so this would have been assessed. He might not be able to void as he might be quite dry, bladder empty and he would need hydration. Then once hydrated he could pee. Also, if he is dry he may be hypotensive and not truly perfusing the kidneys which would be worrisome. My reasoning.

[purplemania, BSN, RN]

Ability to void is my guess, because as pedi nurse our policy was never start the KCL until the kid could pee on his own. Even being cathed in ER did not count.

[Todd SPN]

Originally posted by purplemania

Ability to void is my guess, because as pedi nurse our policy was never start the KCL until the kid could pee on his own. Even being cathed in ER did not count.

So you rehydrate before tackling the electrolyte imbalance? Why couldn't you do both at the same time?

[TMEEKEE]

I WOULD SAY B. BECAUSE POTASSIUM CAN AFFECT CARDIAC RYTHUMS.

[EastCoast]

Originally posted by purplemania

Ability to void is my guess, because as pedi nurse our policy was never start the KCL until the kid could pee on his own. Even being cathed in ER did not count.

As ToddSPN points out why would you hydrate and then replete electrolytes afterwards?? Do both at the same time.

Hydrating agressively without repleting other electrolytes puts you in the position of causing a dilutional hyponatremia or water intoxication and you are further up the river. why in the world would you wait till the kid can pee when he is hypokalemic. You could be hours and and he could die. Put a foley in him and give him the K. Tomorrow when he is hydrated and repleted pull the foley and see if he can pee.