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Joanne Smith, 79 y/o, has been hospitalized for 3 weeks for Community Acquired Pneumonia (CAP)
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As we first meet Mrs. Smith, she is lying on the bed and speaking with nurse Nicole. She does not appear in any distress.
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Nurse Nicole takes a call from lab with abnormal lab results.
Results:
Na 149
K 6.7
Here BUN and creatinine are elevated, and her eGFR is 34.
What do they abnormal labs mean for Mrs. Smith? What priority interventions should you consider?
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Nurse Nicole calls the provider. She receives the following orders:
Observation
12 Lead ECG
Have drug chart available
Obtain IV access
Obtain venous blood gas (VBG)
??
Explain the rationale for the orders.
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Nurse Nicole obtains a recent set of vital signs.
T afebrile
HR 98
RR 16
BP 130/90
SpO2 98% room air
Do any of these vital signs cause concern? Explain your rationale either way.
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The provider arrives to the bedside and assess the patient. Nurse Nicole informs him the venous blood gas result for potassium is 6.7.
Mrs. Smith currently has no complaints. He specifically asks her if she has any chest pain, palpitations or weakness.
What is the clinical reasoning for these symptoms?
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Mrs. Smith is currently taking the following medications:
Ramipril 5 mg PO daily
Metformin 500 mg PO twice daily
Simvastatin 40 mg PO daily
Why is she taking these medications?
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The provider has written orders for Mrs. Smith:
1. Discontinue Ramipril
2. Calcium Gluconate 10 mL IV stat
3. 10 units Rapid Acting Insulin IV stat
4. 50 mL of 50% Glucose IV stat
5. ECG in 30 minutes
6. Potassium level in 2 hours, then in 6 hours
7. Glucose monitoring every hour for 6 hours
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Explain the rationale, onset, mechanism of action, and/or expected result of the orders above.
Please provide details for you to enhance your understanding of hyperkalemia and management of the condition.
Hyperkalemia can be fatal, and effective understanding of the interventions can make a difference in a positive or negative outcome for your patient.
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1. Discontinue Ramipril
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2. Calcium Gluconate 10 mL IV stat
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3. 10 units Rapid Acting Insulin IV stat
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4. 50 mL of 50% Glucose IV stat
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5. ECG in 30 minutes
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6. Potassium level in 2 hours, then in 6 hours
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7. Glucose monitoring every hour for 6 hours
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User12028492084
HYPERKALEMIA-student397ac37a0187f7c1ef479a336945447bce11b26edfa083367e6d4b0797c161ed7.docx
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