Medication question

I have to go with the ability to void, or more specifically the ability to MAKE urine. Why? Elevated K+ in renal failure patients is fatal.

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 am gonna say B because usually in most units K is ony given if there is a cardiac monitor available( like IMC or ICU)

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?

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.

Answer B sounds to be most logical.

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

Originally posted by pediRNCHAM

First - No RN's add KCL to IVs. All KCL additives are done by the pharmacy QUOTE]

That is true and i pointed this out in an earlier post on this subject :)

They gotta pee before you add K+!

Most of the patients we get from the EC have orders to add K+ Once the patient voids!

Hasta

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.

So I vote for output.