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HYPOKALEMIA-student3afbc2c822dd4e6d32914eeaa099b16e7c1480a2500e28526dd519c1cc25f6a7b.docx

HYPOKALEMIA- Case Study

Joyce W is a young lady presenting to the ED after being found by her fiancé unresponsive in the bathroom with large amounts of vomitus. He immediately called 911 and she was transported to the hospital.

When we first meet Joyce, she is lying on the cart with her fiancé Austin at her bedside. She appears awake and alert. Nurse Terri enters. She reports the vital signs have already been completed. Nurse Terri asks Joyce if she has any pain (which Joyce denies) and informs her of the plan to complete an assessment.

Nurse Terri reviews the details previously stated. She asks Joyce if this has ever happened before. Joyce reports she does have issues with vomiting. She continues to elaborate on this event.

What are 3 possible diagnoses to consider at this time?

Explain your rationale.

As a nurse, what labs or diagnostics would you request/expect to be ordered?

Explain your rationale.

After hearing more about events Joyce reveals, does this change any of your priorities at this time?

Explain your rationale.

After seeing the lab results, what are your priorities? Be specific with your responses.

Hematology		Chemistry		Urinalysis
CBC		CMP		U/A
WBC	13.8	Na	131	Color	amber
RBC	3.95	K	3.1	Appearance	clear
Hgb	19.1	Cl	95	Glucose	neg
HCT	50.2	CO2	18	Bilirubin	neg
MCV	96	Glucose	78	Ketones	pos
MCH	31.2	Ca	8.4	Spec Grav	1.030
MCHC	32.6	BUN	22	Blood	neg
RDW	13.2	Creat	1.4	pH	5.4
PLT	322	GFR	90	Protein	neg
MPV	10.4	Albumin	3.9	Urobili	0.8
Neutrophils	78	Total protein	6.2	Nitrite	neg
Bands	23.7	Bili	0.9	Leukocyte est	neg
Lymphocytes	28	ALP	106
Monocytes	4.9	AST (SGOT)	22
Eosinophils	2.1	ALT (SGPT)	33
Basophils	0.5

Refer to the Electrolyte Replacement Protocol. What should you administer to this patient based on the lab results?

See Protocol at the end of this case.

Are there any other considerations for her discharge plan that were not addressed?

List her discharge plans:

1. _________________________________________

2. _________________________________________

3. _________________________________________

4. _________________________________________

Scenario from Montgomery College Nursing Simulation: Eating Disorder

https://www.youtube.com/watch?v=_Ql9MabJWqk

Intravenous Potassium Protocol

Current Serum Potassium Level	IV Administration- Peripheral IV Access	Monitoring
Below 3 mEq/L	Give KCl 10 mEq/100mL IVPB (premixed bag) every hour x 4 doses Infuse each bag over 1 hour	Call Physician Check K+ one hour after the 4th dose
3 to 3.3 mEq/L	Give KCl 10 mEq/100mL IVPB (premixed bag) every hour x 4 doses Infuse each bag over 1 hour	Check K+ one hour after the 4th dose
3.4 to 4 mEq/L	Give KCl 10 mEq/100mL IVPB (premixed bag) every hour x 2 doses. Infuse each bag over 1 hour	Check K+ 15 minutes after the 2nd dose
4.1 to 5.1 mEq/L	No Treatment	No Treatment
Above 5.1 mEq/L	Call Physician	Call Physician
If patient has complaints of burning and irritation at infusion site, contact pharmacy to make Potassium IVPB in 250 mL NS. Add 5 mL (50 mg) of lidocaine 1% to IVPB of Potassium

Oral Potassium Protocol

Current Serum Potassium Level	Oral Administration	Monitoring
Below 3 mEq/L	Give PO KCl 20 mEq (tablet or liquid) every 2 hours x 3 doses	Call Physician Check K+ level one hour after the 3rd dose
3 to 3.3 mEq/L	Give PO KCl 20 mEq (tablet or liquid) every 2 hours x 2 doses	Check K+ level one hour after the 2nd dose
3.4 to 4 mEq/L	Give PO KCl 20 mEq x 1 dose	Check K+ level in 12 hours or at next scheduled lab draw, whichever comes first after the dose
4.1 to 5.1 mEq/L	No Treatment	No Treatment
Above 5.1 mEq/L	Call Physician	Call Physician