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

[Love-A-Nurse]

"jenac i don't understand why there would be concern about giving the k+ d/t cardiac concerns."

i know you are talking to jnette, but i want to try and answer and looking forward to the correct answer from original poster.

this patient has diarrhea and in a state of hypokalemia because of it, therefore, to correct the imbalance, kcl is ordered.

the concern with cardiac problems as a complication is kcl in excess causes, v fib, cardiac arrest, and if the patient is not urinating prior to giving, the kcl does not have a way of being excrected since it does it by way of the kidneys.

where is the answer?

[Brownms46]

Love A Nurse :chuckle, that was me talking to jenac, and I'm with you on the answer being C.

[EastCoast]

http://www.emedicine.com/ped/topic1121.htm

this has a fairly good article on repletion of Potassium in children. While it does reference overall that one should not give Potassium in the face of renal failure (duh) it does continuously reference the need to obtain serial if not continuous EKG during replacement due to the risk of short term morbidity.

Given this I would argue with any instructor that cardiac monitoring would be the best answer.

Also note that the article lists all the GI complications involved with hypo/hyper kalemia.

So what is the answer and where did this question come from??

thanks.

[jenac]

Thank you Love-A-Nurse. My sediments exactly. My concerns here was that potassium might CAUSE an arryhtmia or other cardiac problem. If there is already an irregularity, I would be very careful admisinstering it-and atleast know to monitor it.

[jnette, ASN, EMT-I]

Originally posted by Brownms46

Yes it is ToddSPN, as there is a lot of information left out of the question. But again, it does say before giving the K+...which would mean this pt is hypokalemic. Which would be common with GI fld loss. And with dehydration comes the possibility of impaired renal function. If you give the K+ and the renals aren't functioning, then the kidney can't get rid of any excess, then this would lead to hyperkalemia, and ECG changes.

If the question stated as one of the opitons was to check the latest lab results, then I would worry about what they were. But that isn't an option. So I must conclude that the recent labs showed low K+ level.

Then concerning the EKG, well if the K+ is low, there might be some changes noted, but this still wouldn't be a concern before giving the K+. But renal functioning would, as when giving K+ you would need to know how well they're functioning. And since it is more usuall for a pt. to be in ARF with dehydration, this is the reason many times, MD will order to give such and such flds for the first 8, check output, and then order K+ to be given.

But I wish wiseRN would come back and give the answer to the question.:).

Gotta agree 100% with Brownie on this one ! Her reasoning follows along the same lines as mine. That's why I chose and stuck with my initial answer.."C".

Also, in all my nursing courses, still so fresh in my mind as a "new" nurse, everytime a question of this nature was brought up on any quizz or exam, this was the answer desired. It was pounded heavliy into my brain, over and over and over. Renal function is always the first concern before giving K+. I even had a similar question on NCLEX.

Of course, working in dialysis only helps add to my understanding of the importance the ability to rid the body of K+.

I think the question was pretty basic, but a lot of folks here were just trying to read more into it than there really was.

[Love-A-Nurse]

originally posted by brownms46

love a nurse :chuckle, that was me talking to jenac, and i'm with you on the answer being c.

brownie, thanks for the clarification.

[Love-A-Nurse]

Originally posted by jenac

Thank you Love-A-Nurse. My sediments exactly. My concerns here was that potassium might CAUSE an arryhtmia or other cardiac problem. If there is already an irregularity, I would be very careful admisinstering it-and atleast know to monitor it.

[EastCoast]

The ability to void independently is not a solitary indication that the kidneys are working. If the child pees 8 cc by himself of brown sludgey urine I would be worried. If he has a bladder full of urine and for whatever reason can't find the gusto to pee I would not hesitate to give the K. There are a lot of peolple with creatnines that are elevated who void independently. The fact of the matter is is that if the K is low you need to replete it. Sitting around trying to lower a creatnine while you patient develops more severe electrolyte disturbance is sillly. It is much easier to put someone on dialysis or give some Kayexylate and insulin that it is to defibrillate them because they are severely hypokalemic and acidiotic.

[Brownms46]

I think there is some confusion here with monitoring a pt. receiving K+ and getting a baseline ECG. Yes I would monitor a child getting K+, but I wouldn't get a baseline ECG before adding the K+ to an IV. I mean what is the baseline ECG going to show you, except that the K+ is low, which you would have already been confirmed prior to an order of K+?

[Brownms46]

originally posted by love-a-nurse

brownie, thanks for the clarification.

you're welcome love-a-nurse:).

[cannoli]

Okay, so where is the person that posted this question and what is the correct answer?

Probably it was a question on a test and the original poster didn't know the answer (and probably still doesn't).

[EastCoast]

from

http://www.emedicine.com/ped/topic1121.htm

The ECG in hypokalemia may appear normal or may have only subtle findings immediately before clinically significant dysrhytmias.

Ventricular dysrhythmia

Prolongation of QT interval

ST-segment depression

T-wave flattening

Appearance of U waves

During therapy, monitor for changes associated with overcorrection and hyperkalemia, including a prolonged QRS, peaked T waves, bradyarrhythmia, sinus node dysfunction, and asystole.

Cardiovascular examination findings may also be within normal limits. Occasionally, tachycardia with irregular beats may be heard. Severe hypokalemia may manifest as bradycardia with cardiovascular collapse.

I guess what the article is stating is having a baseline gives you the ability to compare if the patient develops complications from over correction. That's my interpretation. I understand about assessing the ability to void as i said but i think that is different from assessing renal status.

If it was my kid i think i would like a baseline EKG after reading this article.

Wise RN where are you.??