Nokea
The nurse is caring for a 68-year-old client in the emergency department.
Nurses' Notes,
Emergency Department
1020:
The client reports shortness of breath, a 2-lb weight gain over the past week, and lower extremity swelling. The client
reports slight chest discomfort during activity that is relieved with rest. Medical history is significant for hypertension.
myocardial infarction, heart failure, coronary artery disease, and chronic stable angina. Current medications include
metoprolol, furosemide, potassium chloride, lisinopril, and aspirin. The client takes all medications as prescribed except
one; he states, "I do not take that water pill because I got tired of having to go to the bathroom all the time."
S1 and S2 are present; a prominent S3 is heard. Respirations are labored with inspiratory crackles in the middle and at the
base of the lungs. The abdomen is soft and nontender with normoactive bowel sounds. There is 3+ pitting edema in the
bilateral lower extremities.
Vital Signs,
1020
T ,98.8 F (37.1 C)
P, 60
RR, 24
BP, 168/96
SpO2, 90% on room air
Laboratory Test and Reference Range, 1030
Sodium
136-145 mEq/L
(136-145 mmol/L),
133 mEq/L
(133 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
6.5 mEq/L
(6.5 mmol/L)
BUN
10-20 mg/dL
(3.6-7.1 mmol/L),
22 mg/dL
(7.85 mmol/L)
Creatinine
Male: 0.6-1.3 mg/dL
(53-114.9 umol/L),
1.5 mg/dL
(132.6 umol/L)
Female: 0.5-1.1 mg/dL
(44.2-97.2 umol/L)
The nurse receives prescriptions for medications to treat the client's hyperkalemia. For each medication, click to specify if the medication drives potassium from blood into cells, promotes potassium excretion, or stabilizes
myocardial cell membranes.
Correct Answer:
Rationale: Several medications can rapidly correct a client's hyperkalemia by:
• Driving potassium from blood into cells: The serum potassium level can be temporarily lowered by administering an albuterol
nebulizer and IV insulin. Although albuterol and insulin are not usually administered for this purpose, they also shift potassium from the
extracellular space to the intracellular space. Because insulin transports both glucose and potassium into the cell, dextrose is
administered in combination with insulin to prevent hypoglycemia. Albuterol is not often used alone for hyperkalemia; it is often
administered with insulin and dextrose to improve the potassium-lowering effect.
• Promoting potassium excretion: Administration of loop diuretics (ie, potassium-wasting diuretics such as furosemide) will increase
the amount of potassium excreted into the urine at the loop of Henle and also treat the client's acute fluid volume overload.
• Stabilizing myocardial cell membranes: Administration of calcium gluconate antagonizes potassium and protects the myocardium
from potassium-induced dyshythmias by blocking potassium's effects and reducing myocardial irritability. Calcium gluconate does not
alter serum potassium levels and is usually indicated if there are ECG changes with hyperkalemia.