Question

KL, a 57-year-old woman, has heart failure that is being controlled with digoxin, furosemide, and a low-sodium diet. She is taking potassium chloride (KCl) 20 mg per day orally. Three days ago, KL had flulike symptoms that included anorexia, nausea, lethargy, and diarrhea. Her fluid and food intake diminished, and she refused to take the KCl, saying it makes her sick. She continues to take the digoxin and furosemide. The nurse's assessment during the home visit includes poor skin turgor, poor muscle tone, irregular pulse rate, and decreased bowel sounds. A blood sample indicates potassium (K) 2.9 mEq/L.

• Match KL's physical findings with her electrolyte imbalance.
• What are the reasons for the electrolyte imbalance?
• What teaching regarding the administration of KCL can be provided for KL?
• What is the effect of furosemide on digoxin when there is a potassium deficit?
• Why should the nurse assess for digitalis toxicity?
• What should be included in a teaching plan for KL?

Answer 1

Physical findings and electrolyte imbalance:

Anorexia,nausea,lethargy and diarrhea are the symptoms of electrolyte imbalance.Decreased muscle tone,decreased bowel sounds and irregular pulse rate might be due to hypokalemia as KL's potassium is 2.9 m E q/L (normal value is 3.5 - 5 m E q / L).

Reasons for electrolyte imbalance.

• Presence of diarrhea
• Use of digoxin and furosemide can lead to hypokalemia as furosemide doesnot have potassium sparing effect.
• Administration of KCL was stopped,fluid and food intake diminished and was on Furosemide which is a diuretic (removes sodium and chloride).

Teaching on administration of KCL

• Instruct the patient to take plenty of oral fluids to decrease stomach discomfort.
• Explain importance of dietary replacement of  potassium including green leafy vegetables,cucumbers,oranges etc along with the KCL administration.
• Explain symptoms of hypokalemia and hyperkalemia.
• Teach her to take own pulse.

Effect of furosemide on digoxin

Furosemide removes excess fluid from the body as it is a diuretic.It can also lower potassium level.A low level of potassium in the body can lead to digoxin /digitalis toxicity.

Reason to assess digitalis toxicity

Digitalis toxicity happens when there is low serum potassium.In case of KL,the serum potassium level is 2.9 m E q/L.Moreover she is on furosemide which also lowers potassium level.So it is important that the nurse should assess for digitalis toxicity.

Teaching plan for KL

• Teach her to inform the symptoms like weakness,muscle cramps,nausea,visual problems and decreased appetite.
• Advice her not to stop medication without informing the physician.
• Advice her to maintain adequate hydration.
• Take digoxin regularly as directed and try not to miss any dose.
• Teach symptoms of digoxin toxicity