Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 11 Fluids and Electrolytes^433


PROGNOSIS


As potassium levels rise, the risk of cardiac arrhythmias also increases. An extreme
elevation creates a medical emergency. Correction or management of the underly-
ing cause is necessary to help restore the electrolyte balance.


HALLMARK SIGNS AND SYMPTOMS



  • Weakness and dizziness due to neuromuscular changes

  • Abdominal distention

  • Nausea, vomiting, diarrhea due to change in membrane potential on GI system

  • Palpitations due to arrhythmias

  • Arrhythmias due to changes in normal cardiac conduction

  • Cardiac arrest


INTERPRETING TEST RESULTS



  • Potassium level > 5 mEq/L.

  • EKG shows peaked T-waves, widened QRS-waves, ventricular asystole, car-
    diac arrest.


TREATMENT


The treatment choices will depend on the severity of the potassium elevation.
Decreasing further intake, enhancing renal excretion, and cellular uptake are all
goals of treatment.



  • Monitor cardiac rhythm.

  • Administer intravenous insulin and glucose to move potassium from extra-
    cellular fluid to intracellular fluid.

  • Administer calcium gluconate intravenously.

  • Administer NaHCO 3 to move potassium from extracellular fluid to intracel-
    lular fluid.

  • Administer diuretics to remove potassium from body.

  • Administer kayexalate to remove potassium from body via GI tract.

  • Monitor electrolyte levels.

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