Medicine question?

ParkerBC,MSN,RN, PhD, RN · Mar 29, 2011

I am going to take a stab in the dark on this one with the information you provided. First, is it safe to assume your patient has CHF? You mentioned the input and output and I also know Lisinopril is not only used to regulate BP, but it is also given to CHF patients. I looked up to make sure, but I don’t see where Potassium is contraindicated with Lisinopril. Also, CHF causes electrolyte imbalance (r/t fluid retention), in this case, hypokalemia. So, it would make sense your patient would be given Potassium.

Remember that Potassium ‘s function includes: establishes resting membrane potential and essential in the repolarization phase of action potentials in nervous and muscle tissue, aids maintenance of fluid volume in cells, and helps regulate pH.

If I am way off…let me know. I like figuring these things out J

nrice28 · Mar 29, 2011

Thanks for trying.. :) But lisinopril is an ACE inhibitor for mild to high levels of hypertension. (also for CHF patients) No she does not have CHF-that I know of..and her amount of lisinopril is indicated for the maintanience catogory. so with that in mind...yes, lisinopril is contraindicated with a potassium rich diet or other sources of potassium. Its a potassium sparing drug..which means, it makes your body retain it. So if she is already getting a potassium sparing drug then she really shouldn't be getting an IV with potassium..granted it was only a liter over 12 hrs..but still its really contraindicated. I have emailed my professor but thought I would throw it up on here in hopes one of the nurses that have WAY more experience than me could answer. Thanks for your input! I mean, it helps me to try to explain it. But you would think that they would give her a diuretic of some sort..but they didn't. Also another interesting thing I just realized is that she took Dulcolax (bulk forming laxative) and they also gave her senna(stimulant laxative) they are also contraindicated b/c they interact with each other. Man, this care plan is hard b/c I dont' really know what to put for nursing assessment. I mean, do I write what I literally saw..or what I should do? its so confusing.. Thanks again though, hey, if anything you wont forget about lisinopril now. lol.. just sayin..

SolaireSolstice, BSN, RN · Mar 29, 2011

What was your patient's potassium level BEFORE the KCL was administered?

And on the laxatives, was your patient on opiates? Certainly after a knee replacement, and before, the immobility factor would encourage increased use of some type of laxative. And I don't find anything about these two drugs being contraindicated for use together, in fact, Senna's PROTOTYPE was Bisacodyl (ie: Dulcolax). How long had it been since your patient had a bowel movement?

ParkerBC,MSN,RN, PhD, RN · Mar 29, 2011

Interesting…it doesn’t state in Epocrates that Potassium is contraindicated. I had a patient on lisinopril and was being given K. When I asked the doctor, he state because of low K r/t fluid shift. My patient was CHF. Were the patients kidneys compromised? That was a lot of fluid going in and very little coming out. I hope someone chimes in….it would be an interesting question to have answered.

ParkerBC,MSN,RN, PhD, RN · Mar 29, 2011

"oh-this is for an orthopedic pt total rt knee replacement"

Totally missed this

:banghead:

nrice28 · Mar 29, 2011

Just to let you see where I am getting some of my info from you can look here..Parkerbeancurd..

http://www.drugs.com/drug-interactions/kcl-with-lisinopril-1912-14126-1476-0.html

about the dulcolax in my drug hand book it sys that Senna (docusate sodium 5) and bisacodyl (Dulcolax) interact with eachother. Maybe thats why it says to take the senna at night before bed. so you can take both. Sorry I got carried away with my crazy findings..lol. . But yes, she deff. needed to be on some sort of laxative b/c of the pain meds. OH- looking at her med profile.. the dulcolax was a one time dose..so forget that one..sorry. :) thanks you guys so much for the help. Care plans are kinda confusing.

nrice28 · Mar 29, 2011

"oh-this is for an orthopedic pt total rt knee replacement"
Totally missed this

LOL..no prob...her primary reason was for the osteoarthritis and total rt knee surgery her secondary diagnoses were the hypertension and hypothyroidism..(which could atribute to constipation) :)