Medication question

I don't think the question is so much of waiting him to actually void. My impression is that this question might be asking about renal function. So yes you could put a foley in, but should wait until there is some urine ouput first. I maybe reading into this question, but my guess is C

Okay, so what's the answer?

since kcl is excreted by the kidney, c is the answer, because if there is not an indication of urine output, kcl excess can lead to major problem [cardiac] if not excreted and it should be administered slowly.

I dunno. I don't see where renal function plays into this. If there was a renal disease I would think they would have to be very careful with administering K+. And as stated in the question, an IV is running so they must be trying to rehydrate meaning there would be a lack of voiding at this point. They also state pt has gastroenteritis, not renal impairment. Hyperkalemia would lead to arrhythmia that would show in an ECG. I gotta stick with B.

Can nurse add KCL to an IVI? here in uk we are not allowed to add things like that to IVI's. our fluids come already done with them added. e.g the fluids we use have added potassium of 10 or 20 mmols. Apparently there has been mistakes made by nurses up and down the country when other drugs were added so it was made that no nurses can add anything to a bag of fluid. Sorry if i have ventured off the question but i was surprised you can add things to your IVI's.

Originally posted by Todd SPN

I dunno. I don't see where renal function plays into this. If there was a renal disease I would think they would have to be very careful with administering K+. And as stated in the question, an IV is running so they must be trying to rehydrate meaning there would be a lack of voiding at this point. They also state pt has gastroenteritis, not renal impairment. Hyperkalemia would lead to arrhythmia that would show in an ECG. I gotta stick with B.

First when hydrating a pt., renal function always comes into the situation. Yes rehydration is done in gastroenteritis, d/t diarrhea, especially per IV when vomiting. But that doesn't mean you don't have to assess whether or not kidneys are normal, and GI fld losses can lead to acute renal failure.

Second I thnk you meant to write hypokalemia, and yes both can cause ECG changes, but this is not a priority in accessing this pt. prior to giving K+ , but renal function is IMO.

I would have to agree with B as the best answer here, due to the potential cardiac implications.

Correct me if I'm wrong guys- but the hydration/electrolye imbablances are implied, hence the IV to begin with. If the child is already dehydrated-the output may be minimal to start with anyway, atleast initally. I'm alittle out of sorts with Gastroenteritis-but I would probably expect to see HYPER-active bowel sounds and diarrhea, so the independant bowel movements and active BOSO wouldn't be of primary concern. Right?

Interesting discussion though..........

jenac I don't understand why there would be concern about giving the K+ d/t cardiac concerns. That is a reason for replacing it, not for getting a ECG first??? If there is an irregularity, what would you do different??? Would you not give the K+???, if the pt. K+ were low????

Originally posted by Brownms46

First when hydrating a pt., renal function always comes into the situation. Yes rehydration is done in gastroenteritis, d/t diarrhea, especially per IV when vomiting. But that doesn't mean you don't have to assess whether or not kidneys are normal, and GI fld losses can lead to acute renal failure.

Second I thnk you meant to write hypokalemia, and yes both can cause ECG changes, but this is not a priority in accessing this pt. prior to giving K+ , but renal function is IMO.

I don't argue the fact about renal function coming into the equation, I'm just thinking that might be reading into the question. I did mean hyperkalemia as I was thinking there is a chance of toxicity from the K+ infusion and that would show on a ECG.

By looking strictly at the question, I see no mention or hint of renal problems, so I assume the focus should be on the actions/reactions and side effects of the K+ that could affect the pt. Anyway, I understand what you are saying. It's a tough question.

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.:).

I'm still sticking with checking EKG but i can see more reasoning than i did previously into checking ability to void. However, again, i a kid can't mechanically void then that is a whole other can of worms and it sounds to me like ability to void here is a mechanical issue (which can be remedied) versus a physiological process. So my question also is why don't we check every adults ability to void before administering K+ ?

The question is a poorly worded question and without doubt probably had a 10 point weight on a final exam somewhere.

"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?