Question

PN 105 Fundamentals of Nursing I Diuretics/Hypokalemia JS 72 years of age has had vomiting and diarhea for two days. He is on digoxin 0.25 mg per day and hydrochlorothiazide 50 mg per day. He complains of being dizzy. His blood pressure slightly is lower than usual. His serum potassium level is 3.2 mEq. The nurse assesses his physical status and note his muscles are weak and flabby, his abdomen is distended, and peristalsis is diminished. 1. What are the signs and symptoms of hypokalemia and note those that the patient is demonstrating. What contributing factors caused JS's potassium imbalance? 2. What interventions should be performed for alleviating this potassium imbalance? 3. Describe the relationship of hypokalemia, digoxin and hydrochlorothiazide and why this is serious for this patient? 4. JS is ordered IV infusions of 1 L of D5%/W with 30 mEq of potassium chloride and 1 L of 5%D/45%NS. He is also prescribed oral KKCL 15 mEq, three times per day for 2 days. Oral KCL is available in 15mEq/10mL 5. Explain the method for diluting KCL in IV fluids. Can KCL be given IM? SQ? IV push? Explain your rationale for your answer. What instructions should the nurse give JS for taking oral potassium supplements? 6. 7. What happens if JS urine output decreases while he is receiving IV fluids and oral potassium? What would be the nurse's responsibility? 8. Because JS is taking a diuretic and digoxin, what should the nurse include in her teaching plan being sure to state your rationale?

Answer 1

1. The signs and symptoms of hypokalemia are

• weak and thready pulse
• orthostatic hypotension
• muscle weakens
• leg cramps
• nausea
• vomiting
• constipation
• confusion
• coma
• arrhythmias
• Decreased GI motility
• abdominal distension

The patient demonstrates the signs and symptoms of vomiting, dizziness, Low Blood pressure, muscle weakness, abdominal distension, decreased peristaltic movement.

2. The contributing factor that causes low potassium in JS is

• Excessive vomiting
• diarrhea (electrolyte lost due to this)
• Diuretics leads to excessive loss of fluids and electrolyte.

3. The following intervention helpful in treating of potassium imbalance

• Treat the underlying cause of vomiting and diarrhea.
• Stop the diuretics.
• Oral potassium supplements.

4. Hydrochlorothiazide is a thiazide diuretic which prevents fluid retention in the body. It acts on aldosterone mediated and causes potassium loss in the collecting tubule. Taking of digitalis along with diuretics causes toxicity due to low potassium level. Digitalis toxicity also develops low magnesium level which further lowers the potassium level and results in a life-threatening situation.