Question

PN 200 Fundamentals of Nursing II Concept Map - Hypokalemia 7.10AM Mr. Sam Downs is admitted to your unit from the emergency room. He is 71 y/o/ male. Weight upon admission 156; Ht 5" 11":T 97.2; R 22 and shallow; P 102 and easily obliterated; B/P 102/76. NKA. Primary admitting diagnosis is altered mental status. He is lethargic and has difficulty responding to question rapidly but given time he can answer all questions. He is also very somnolent. He denies pain and can move all extremities freely with no limited range of motion. On assessment vou note that the heart rate is irregular and bowel sounds are diminished. You notice a Heparin lock in his left hand. His admission orders are as follows: CMP UA СВс EKG Start an IV of 09 % NS; 1000 cc to run over 12 hours. The drop rate is 15 gtts per cc. Insert retention catheter. Strict I & O Regular diet Metropolol 25 mgm by mouth twice daily Lasix 20mgm one tablet by mouth daily Potassium Chloride 10mEq one tablet by mouth daily. Lipitor 20mgm one tablet by mouth at bedtime. 1. Which of the above medications would you question when verifying orders? You receive the laboratory results and note the following as abnormal values: BUN 45 K 3.2 Hgb 22

Answer 1

1. I question about the medication of Lasix. Because Lasix is a diuretic that increases the excretion of urine and leads to low potassium levels. Already the patient has hypokalemia status and Lasix further decreases the potassium level results in complications. So I need to check for an alternative of loop diuretic or thiazide diuretic.

2. Laboratory results:

Normal values:

BUN - 7-20mg/dL

K - 3.5 - 5.0mEq/L

Hbg - 12.5 - 15.5g/dL

Hematocrit - 45 - 52%

Specific gravity - 1.010 - 1.030

pH - 7.35 - 7.45

Elevated BUN level indicates kidney dysfunction and concentrated urine. Low potassium level indicates hypokalemia. Elevated hematocrit indicates dehydration. Increased specific gravity and pH indicates alkalosis. Before calling the physician, the nurse should assess the signs and symptoms of dehydration, alkalosis, past medical history, etc.

12.30PM

1. GI suction further decreases the potassium level.

2. The physician fails to ask about patient conditions and lab values before giving instruction.

3. The nurse fails to inform the physician that the patient is hypokalemic.