NS with KCl 20mEq ordered; 0.5% Dextrose and .45NaCl with KCl 20mEq given

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Patient reported to have LBM X 7 since morning (its now 7pm). Aide reported only 1 BM all day, soft and formed.

MD ordered NS with KCl 20mEq.

0.5% Dextrose and .45NaCl with KCl 20mEq given, patient tolerated well.

Patient has NO history of DM or not on sugar watch.

What could be the a/e of the given IV? What would be the anticipated nursing measures? Documentation? Corrections? Repercussion?

Thank you all!

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Specializes in NICU, ICU, PICU, Academia.

Is this homework? If so, what do YOU think?

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Well as a student, I will say that 5% 1/2 NS is hypotonic so it will force water out of the vessels and into the cells, you can possibly expect edema or 3rd spacing. but as the patient does not have DM which means you are not going to push them towards DKA HHS, then there is little to worry about. they can be used as maintenance fluids esp if the patient is dehydrated. (most hospital patients meet this). the other thing is that it's also given with insulin when recovering from hyperglycemia and the FSBS

Also I think you mean 5% dextrose not 0.5% .05= 5% .5= 50% which is usually in a 50ML bolus used for acute hypoglycemia.

Real nurses will correct me if I guessed wrong...

I would do an incident report and document what was used and how much and any s/s related to fluid overload. edema, lung sounds etc. I'd ask the charge nurse if the MD needs to be informed and who does it.

What I don't know is how you are required to document it in the patient chart.

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Specializes in NICU, ICU, PICU, Academia.
wrst said:
Hi meanmaryjean. this is not a homework. it was a discussion I heard from a colleague who heard it from a colleague, who heard it from a colleague.

What could be the a/e of the given IV? What would be the anticipated nursing measures? Documentation? Corrections? Repercussion?

^^ This makes me skeptical. Again- what do YOU think? How did the 'colleague' respond?

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Thank you southpaw! : )

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The colleague who shared the story was not the owner of the story so I didn't know how the owner handled/responded.

Asking my question back to me, I thought it that it needed to be documented appropriately such as "Md ordered_____, ________given. Patient monitored closely. No a/e (if really no a/e) of _____. Would you have other or better ideas?

Nursing measures: close assessment of pt x 3 days or per facility protocol.

Would you have other ideas?

Corrections? I don't know what would be the correction on the nurse's part but maybe ask. Should it be coming from the md? Would you have other suggestions?

Repercussion: I don't know...Would you know?

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meanmaryjean said:
What could be the a/e of the given IV? What would be the anticipated nursing measures? Documentation? Corrections? Repercussion?

^^ This makes me skeptical. Again- what do YOU think? How did the 'colleague' respond?

Is this how all the "nurses eat their young" rumors start.? So what if its a homework assignment. They asked because they were not able to find the answer. I know we have not been taught what gets reported and to who, ramifications of the mistake from a disciplinary POV. would be great if you could answer those questions. I learned in another thread here that when asked to do something unethical or out of your scope of practice by an MD, you are not to chart that event but put it only in and incident report. So does the same apply here or do you need to change the given med to show the actual IV fluid used and make a notation in the chart. We are here to learn... BTW, do you think my answer was correct?

Thanks

Southpaw

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
soutthpaw said:
Is this how all the "nurses eat their young" rumors start.? So what if its a homework assignment. They asked because they were not able to find the answer. I know we have not been taught what gets reported and to who, ramifications of the mistake from a disciplinary POV. would be great if you could answer those questions. I learned in another thread here that when asked to do something unethical or out of your scope of practice by an MD, you are not to chart that event but put it only in and incident report. So does the same apply here or do you need to change the given med to show the actual IV fluid used and make a notation in the chart. We are here to learn... BTW, do you think my answer was correct?

Thanks

Southpaw

Then the OP should have been specific about how the story actually came about, what was done about it and what were her thoughts on the matter. Then we could weigh in with what we agree with and what we disagree with.

That's a discussion. Just throwing out a random question with no thought process attached smells like homework. Before we contribute, we need some assurance that we're not just doing a lazy person's homework for him/her.

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Specializes in Med/Surge, Psych, LTC, Home Health.
wrst said:
Hi meanmaryjean. this is not a homework. it was a discussion I heard from a colleague who heard it from a colleague, who heard it from a colleague.

"Heard it from a friend who, heard it from a friend who, heard it from another you've been messin around..." REO Speedwagon

Sorry, had to. Couldn't help it.

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Specializes in NICU, ICU, PICU, Academia.
NurseCard said:
"Heard it from a friend who, heard it from a friend who, heard it from another you've been messin around..." REO Speedwagon

Sorry, had to. Couldn't help it.

REO = Ransom E Olds (as in Oldsmobile) They produced the REO SpeedWagon. And that concludes Trivia Tuesday.

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Specializes in PICU.

What is a/e? Is LBM loose bowel movement? If so, I would want to talk with the Aide just to make sure there wasn't a confusion with patients.

Fluids sound okay if you meant D5 1/2NS +20MeQKCl, typical fluids. Not sure what you mean by repercussions ? Except maybe if pt is NPO.

I think there is some missing information such as why pt is on IV fluids, depending on the answer would have different nursing implications.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

It does seem suspiciously like someone is trying to get a nurse to do their homework. I don't believe the "colleague" story.

But I like Southpaw's attempt to tackle and understand.

I am not impressed by op's response as op did not even try to tackle the fluid/electrolyte dilemma.

Op (and southpaw) here are some things to research in order to answer the questions.

How does diarrhea relate to electrolytes? What does it do to acid-base balance when a patient has diarrhea? How about serum potassium levels and diarrhea?

Will this patient have too much sodium in the blood or too little as a result of the IV infusion? What will that do to the patient's potassium? Hint: research the relationship between potassium and sodium.

Think about the signs and symptoms of the various electrolyte imbalances: hyperkalemia, hypokalemia, hypernatremia, hyponatremia. Which do you think you will see in this patient, if any? Also, how will the electrolute imbalance affect acid-base balance? What will you see in the case of acidosis or alkalosis?

What are your interventions assuming ant of the above conditions are present? Let's say there are no symptoms. Are we good to just walk away? What do we do?

What do we document? Is this a med error? What is the priority when a med error occurs? HINT: it's not your WOW.

Why do we document meds? HINT: It's not to cover the nurse's ass.

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