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

Nurses Medications

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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!

Specializes in Critical Care.

Considering the OP got their license in 2011 I'm not sure how it is we're assuming they are a student.

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Specializes in Emergency Dept. Trauma. Pediatrics.

Is it just me or does this entire thread seem like an episode of the Twilight Zone??

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RNNPICU said:
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.

I think a/e stands for adverse effects, if I'm to use my clinical judgment, which clearly I haven't been doing because my one pt with an ileus asked for stool softeners since he says he has been constipated for days and I called the MD who proceeded to rip me the proverbial new one.

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Specializes in kids.
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.

Now I have an earworm!! Thx!!

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Specializes in kids.
MunoRN said:
Considering the OP got their license in 2011 I'm not sure how it is we're assuming they are a student.

Could be furthering their career? LPN to RN, ADN to BSN, BSN to MSN?

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Specializes in Medsurg/ICU, Mental Health, Home Health.
meanmaryjean said:
REO = Ransom E Olds (as in Oldsmobile) They produced the REO SpeedWagon. And that concludes Trivia Tuesday.

Fun fact Wednesday...

If I let my hair go natural and wear it out overnight, it resembles Kevin Cronin's (lead singer of REO Speedwagon) the next morning.

Sorry, I couldn't fight this feeling any longer.

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jennylee321 said:
This forum isn't a place to have s stranger do your homework.

hi jennylee321. what made you say this was a homework?

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FolksBtrippin said:
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 ***.

Hi FolksBtrippine, BSN, RN. Because you worded your suspicion smartly, I will respectfully comment on your suspicion. This is truly not a homework. Story through grapevines and I just got curious to what happened after the fact to the patient and the nurse because we didn't hear it from the story that we heard.

Thank you for all the hints and topics to ponder!

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RNNPICU said:
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.

hi RNNPICU, BSN, RN. Thank you for your reply. Yes, you are right. LBM is loose bowel movement. not sure if LBM was confirmed. MD ordered NS + 20mE of KCl. What was given was D5 0.5 NS + 20mEq of KCl. That's where my curiosity focused on. Repercussion, meaning what could have happened to the RN who gave the wrong IV? Based on the story, after IV administration, patient was fine, no change in LOC, no untowards effect from the IV.

Pt was on the IV bec MD ordered it bec of the LBM X7 in 15 hours.

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NuGuyNurse2b said:
I think a/e stands for adverse effects, if I'm to use my clinical judgment, which clearly I haven't been doing because my one pt with an ileus asked for stool softeners since he says he has been constipated for days and I called the MD who proceeded to rip me the proverbial new one.

Yes, a/e is adverse effect. At least that's what I was taught and I see it a lot written by several clinical disciplines.

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NutmeggeRN said:
Could be furthering their career? LPN to RN, ADN to BSN, BSN to MSN?

you mean IV's are topics for LPN-RN? ADN-BSN? BSN-MSN? I would think this topic is too basic for those degrees, no?

If this was homework, the answers I would need would be theoretical answers. Google and many other internet sites could provide that. I asked it here because I was looking for answers based on EXPERIENCE and I thought most members here are rich with experiences and are more than happy to share their expertise and knowledge.

So, to all who took my questions seriously and took their time to wring their brain for what they know, THANK YOU!

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soutthpaw said:
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.

Thank you so much southpaw! : )

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