What are nurses allowed to do?

Katie71275 · Jun 27, 2012

Hmm good question..

You know, when I have had patients on K+ in the hospital, there have always been standing orders on what to do if the K+ reached a certain level. The Kayexalate was a standing order for us.

I can see why it's the right answer....that is a high number and the patient will probably be having lethal dysrythmias at this level...

ETA-I don't think you can just give the med if it's not on their orders if it's not a standing order.

Nurse Kyles, BSN, RN · Jun 27, 2012

For questions in school and on NCLEX, it is implied that you have an order for the drug when it is an option. I got my fair share of those type of questions wrong too. I never really understood that until I took the Kaplan NCLEX prep coorifice. Our instructor informed us that in "NCLEX Land" you always have an order when it is an option. Good Luck!

windowrn · Jun 27, 2012

I wonder what your other choices were. There are things that you can do for a patient with a high potassium level that are neither transferring (which is very rarely the right answer - instructors and NCLEX want to know what you know, not have you pass the buck) or administering a medication. Administering might be the right answer, but without knowing the other choices, I cannot really say.

As far as in the real world, no you cannot technically administer the kayexelate and then get an order. Often your patients will have standing orders which would allow this. Otherwise, a K+ of 6.1 is worthy of a stat call to the doctor after checking vitals. While waiting for the doc to call you back you will likely have the tech get ready to run an EKG and hook the patient up to tele, make sure that the patient has IV access and get ready to administer kayexelate and/or D5W with insulin (depending upon whether patient is symptomatic). You should be staying with the patient and having the techs and charge nurse work with you to get ready for the anticipated orders. There's obviously more, but that's a start for a new nurse perspective.

PatMac10,RN, RN · Jun 27, 2012

I've had questions similar to yours. Sometimes I get a question that asks "what medication is best that should be prescribe for patient x, who has symptoms of xxx". My first thought is, "I'm thinking from a nursing mindset, not that of a provider" so why am I being asked a question about what medication is best to prescribe?

I asked my instructor about this, who was in her last semester of FNP school at the time, and she said that as nurses we must advocate for optimal patient care and that knowing available treatment options to promote optimal care helps us in our advocating. She said we, as general nurses/ students, of course do not prescribe medications and therapies, but we should know general treatment standards and guidelines for general issues so we can anticipate orders and deliver safe care more efficiently.

By knowing the standard of care for a particular problem, we can recognize a deviation from this care and take the necessary steps to address the deviation. In the majority of cases, most healthcare facilities have protocol in place for abnormal lab or vital measurements and values. In cases where a protocol or standing order is in place, the nurse may administer certain treatments, medications, or implement certain procedures without the direct order of a physician at the time of the issue. Sometimes callling the physician, delays life-saving care. Our main focus is patient safety and well-being. Potassium is touchy, so I would imagine that the nurse in the question was "assumed" to be working under a standing order or protocol. However, we all know what assuming can lead to, especially with Nursing and NCLEX questions. Assuming can be dangerous.

Esme12, ASN, BSN, RN · Jun 27, 2012

NO! You may NOT administer any medical treatment without an order......unless a patient is actively coding...... and unless you are a critical care RN you just start CPR and call a code.

The treatment for an elevated K+, in the absence of standing orders for treatment (which is an order for treatment). A nurse does need to know standard treatment options to know what to"ask for" or to know whether the order being given is appropriate.

Treatment can either be kayexalate PO, PR or IV Dextrose (50% dextrose) and insulin and sometime bicarbonate.

Hyperkalemia is defined as a condition in which serum potassium greater than 5.3 mEq/L. Medscape: Medscape Access requires registration but it is FREE and is an excellent resource and source of information.

KelRN215, BSN, RN · Jun 28, 2012

I took an exam today and one question was like "the patient's potassium level was 6.1 (being higher than normal value) what wouold be the first action the nurse would take?" ok so, obviously I would address the hyperkalemia issue. BUT one of the options was to administer (kayxelate???) I did not choose this option rather i chose ot transfer the patient ot the ICU because i wasnt sure if the nurse could administer any drugs without an order. The transfer was wrong because it does not fix the hyperkalemia and could potentially complicate the patient's condition if it was delayed until after the transfer.
So, in cases where a patient is undergoing an electrolyte imbalance, what should a nurse do? should she telephone the physician and possibly obtain an emergency telephone order? or can nurses implement emergency care to fix the imbalance without a doctor's order?

What were the other options and what did your professor say was the right answer?

In the real world, I would place the patient on the cardiac monitor and call the physician to notify them of panic value.

Transferring an otherwise stable patient to the ICU because of one lab value out of range is not necessarily the best course of action. You may very well be able to treat this patient on the floor just fine.