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
This was a peds question, but if it's no "P" no "K" (love it), then it must pertain to all patients, n'ces pas?
There are a lot of differences in Paediatric and adult care and this just highlihgts one of those differences. There is an old saying - children are not just tiny adults.
Todd one of the reasons why 12 lead ECG's are not done as frequently on children as adults is 1) physical limitation = smaller chests - more difficulty 2) kids are often "moving targets" so more difficult to get a good reading and 3) less likely to BE a change pre-administration. At least nothing that you could not get off of cardiac monitoring.
If the question had stated "cardiac monitoring I would be inclined to agree but it stated ECG.
gwenith, so are you saying that if it is an adult patient, they don't have to be able to void before giving KCL, are you saying it applies only to peds patients?
I'm going to say observations are done 4 hourly (or more often if needed) e.g TPR, B.P (if needed) and fluid balance charts, where bowel movements, urine output, vomits and what they have eaten or drank are recorded on my ward for every child.so by doing these surely you will be able to monitor all the necessary vital signs needed. Am i not right?
Specializes in ER, PED'S, NICU, CLINICAL M., ONCO..
An excess of K produces, oliguria first and then anury.
Intestinal cramps and diarrhea.
It is an eight year old child, therefore there is chest enough size to take an ECG. T waves too tall will demonstrate a serum K level beyond 5,6 mEq/liter. Besides the child must be dehydrated because the gastroenteritis, it is logical to think in K depletion.
A D5% in W 500 cc + 6 cc Na20%cl + 3 cc Kcl is our local IV therapy protocol for children dehydration.
Potassium is the principal intracellular and muscle cation. Its excess or defect lead to heart failure.
I've definitely gotta go with "C" The question clearly asks what you would do BEFORE giving the K so you would definitely make sure that they're body has a sufficient way to excrete fatal levels of potassium which is obviously checking urine output.
First - No RN's add KCL to IVs. All KCL additives are done by the pharmacy (You'll get a Type 1 citation from JCAHO if you've got KCl on your units!!!). As far as clinical assessment of the pedi patient before having IVF w/KCl, patient needs to have voided before hanging the K. Renal function needs to be validated before using KCl additives:D
As a nurse doing pediatric disaster care in the field for over 10 years (or maybe) we never did a pre-infusion EKG regardless if it was infectious vs trauma prior to administering KCL IV. Since all of the cases we had were demonstrating cardiac irregularities due to hypokalaemia, dehydration, or trauma. As someone pointed out previously, the response time required to save the life of a child is so tiny that any change pre-presentation to pre-infusions was only academic.
Renal function was the key. We did q 10 minute output checks and q 20 min K levels until spontaneous voiding of adequate amounts urine, the amount was determine by calculation GFR. Given everything else had been stabilized, at 45 to 60 minutes if evidence of GFR had not return, assumption of acute renal failure and appropriate treatment plan took over.
In children it is so much easier to resuscitate a heart and leave other major organs dead because of the attention to the heart. I have had the unfortunate experience to see multiple children, who were cared for by providers who focused only on the possibility of maintaining a stable cardiac rhythm and did not pay attention to the brain, lungs or kidneys resulting in the death of those organs.
First - No RN's add KCL to IVs. All KCL additives are done by the pharmacy (You'll get a Type 1 citation from JCAHO if you've got KCl on your units!!!). As far as clinical assessment of the pedi patient before having IVF w/KCl, patient needs to have voided before hanging the K. Renal function needs to be validated before using KCl additives:D
Sorry doesn't apply here - we add the K!! and everything else if it comes to that - we just plain do not have enough pharmacists to do the additives.
An excess of K produces, oliguria first and then anury.
gwenith, BSN, RN
3,755 Posts
There are a lot of differences in Paediatric and adult care and this just highlihgts one of those differences. There is an old saying - children are not just tiny adults.
Todd one of the reasons why 12 lead ECG's are not done as frequently on children as adults is 1) physical limitation = smaller chests - more difficulty 2) kids are often "moving targets" so more difficult to get a good reading and 3) less likely to BE a change pre-administration. At least nothing that you could not get off of cardiac monitoring.
If the question had stated "cardiac monitoring I would be inclined to agree but it stated ECG.