Transcript
CHAPTER 25 </P></ANS></ANSSET></MCQSET>
Clinical Reasoning Checkpoint Answers
Mrs. T has just been admitted to your telemetry unit. She is 82 years old and reports that she has been homebound for about a week with “the flu.” She also reports that she had several days of nausea and vomiting and has not been eating or drinking much since she got sick. She informs you that she has a long history of “heart problems” and is taking a heart pill and a water pill daily, but has not been able to take either because of her nausea. Mrs. T had a complete lab panel drawn on admission and you have just been informed that her serum potassium level is 2.8 mEq/L. You go to her room to reassess her.
1. List at least two clinical findings consistent with hypokalemia for each of the assessments below:
A. Neurologic:
B. Cardiovascular:
C. ECG changes:
D. Gastrointestinal:
E. Musculoskeletal:
Answer: Assessment finding consistent with hypokalemia for each of the systems includes:
Neurologic – confusion, depression, lethargy
Cardiovascular – irregular pulse, postural hypotension
ECG changes – conduction abnormalities, flattened or inverted T waves, development of U waves and depressed ST segment.
GI – nausea, vomiting, ileus
Musculoskeletal – reports of fatigue, leg cramps, muscle weakness, paresthesias
2. Is Mrs. T is at risk for cardiac emergency? Why or why not?
Answer: Yes, you should be concerned that this patient is at increased risk for a potentially life-threatening cardiac event. Potassium levels less than 3.5 mEq/L or greater than 5.3 mEq/L are critically deranged and can result in cardiac arrest.
3. Should you be concerned about her potassium level because she has a history of coronary artery disease and is taking a heart pill? Why or why not?
Answer: You should be concerned about her potassium level since she has a history of coronary artery disease. In patients with a history of cardiac disease, even mild-to-moderate changes in serum potassium can cause cardiac dysrhythmias. In addition, she has reported to you that she is taking a “heart pill”; if this is digoxin, she could also have digoxin toxicity, which is a potentially serious cardiac complication. Obtaining a list of her current drugs right away will be important. If her drug list is not available, it would be advisable to obtain a dig.
[[[COMMENT BY Bret (2013-06-24T11:13:00Z)]]]
:
Abbreviation here and below OK?
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level to rule out dig. toxicity.
4. From her recent history, what are the most likely causes of her hypokalemia?
Answer: There are many potential causes for high-acuity patients to develop hypokalemia; however, in Mrs. T’s case, her recent history of nausea and vomiting, her inability to eat or drink, and the fact that she has been taking a water pill (diuretic) are all potential causes. The elderly often exhibit hypokalemia due to loss of appetite and poor diet.
5. What nursing diagnoses would be most applicable to Mrs. T’s hypokalemia?
Answer: Appropriate nursing diagnoses that may apply to Mrs. T and her hypokalemia include decreased cardiac output, RC (risk of complications) of dysrhythmias, and RC of electrolyte imbalances. She is likely to have a fluid imbalance as well—either fluid volume deficit related to her vomiting and lack of taking in fluids or foods; or she could potentially have fluid volume excess related to a heart failure state. Further assessment is certainly warranted.
6. If Mrs. T is experiencing fluid volume deficit from her vomiting. What would you anticipate her serum sodium level would be?
Answer: If she is experiencing fluid volume deficit, you would anticipate more concentrated serum electrolyte levels; therefore, elevated serum sodium would be anticipated.
7. It is determined that Mrs. T is experiencing fluid volume deficit. The provider orders a moderate fluid challenge. What type of IV fluid would the provider likely order?
A. D5W
B. 0.9 normal saline
C. Hypertonic saline
Answer: The provider would likely order 0.9 saline because it is an isotonic fluid. Isotonic fluids will expand her intravascular volume without causing shifts between fluid compartments. Because of her age, however, she will require close monitoring to assure that she does not develop heart failure from fluids being administered too rapidly or from over-hydration.
