Priority assessment..Respiratory or cardiovascular?

[Blu rose]

Hi,

I am having trouble figuring out which one would be the priority assessment for a patient with eating disorders and having shortness of breath + hypokalemia. Would it be respiratory? I thought I would get the oxygen saturation and see if the person needs oxygen adminstration. But, then, he has hypokalemia as well. It can lead to dysrhythmia. (I don't have the blood pressure readings because it was not provided on the case scenario).

Getting more confused..could it be neurological since hypokalemia can hinder with the Na-K pumps in the brain and something may go wrong with the patient's LOC?

Forgot to mention that the patient had a fainting episode too.

I have a huge physical assessment test tomorrow and I'm freaking out!

Any timely help will be appreciated! =)

[Blu rose]

Hypokalemia is a common cause of death in eating disorders. SOB is not.

Irregular heart rate will effect perfusion, and with perfusion altered, respiration will be effected.

But, dollars to donuts, the potassium (while not horribly low) is worth replacement- and not knowing how often or how severe the eating disorder behavior is going on (or the specifics- diuretics, laxatives, vomiting, excessive exercise, starvation - all or some of those) doesn't help- but the fainting also suggest cardiac arrhythmia in someone who has not been noted to have cardiac abnormalities.

She can't breath because she's trashed her potassium, and has an irregular heart rate, activity intolerance, and causing fainting. Another purge could leave her dead on the bathroom floor. No joke.

You MIGHT hear irregular heart rates- but it's more likely to show up on an EKG that is ongoing for a bit. Hypokalemia has a specific EKG pattern.

Cardiac: hypokalemia

fainting

weakness/SOB

Respiratory: she has symptoms, but not caused by a pulmonary problem. Address it as part of the cardiac issues.

Neuro- it's possible for eating disorder patients to have abnormal EEGs and brain shrinkage (severe cases) but with the only semi-neuro symptom being fainting, I'd still go cardiac.

Good luck :)

It makes sense. I was thinking that eventhough cardiovascular assessment is a priority in this case, your first intervention will be to administer oxygen and then, get an order to start an IV, right?

Thank you, xtxrn :)

[pockunit, ADN, RN]

A K level that low gets priority over resp stuff, no question. With no levels and not much to go on, ABCs would be the way to go, however. In this case, though, absolutely go with F&E.