Question

A young woman is brought to the Emergency Department by a neighbor who noticed her sitting, confused, on her front steps. The patient is a 24-year-old female and unable to give a valid history at this time. Admission data include the following: o Neurological: Confused o Pulmonary: Respirations 28 breaths/min and shallow, lungs clear o Cardiovascular: Irregular rapid pulse, palpitations o Gastrointestinal: Hypoactive bowel sounds o Musculoskeletal: Muscle weakness, cramps, fatigue 1. The preceptor identifies a nursing diagnosis of risk for decreased cardiac output related to electrolyte imbalance. What is the electrolyte imbalance that is being presented by this patient? In light of the patient's confusion and the severity of the other symptoms, the ED provider orders a STAT BMP and the electrolyte imbalance is confirmed. Orders are given for replacement therapy to begin immediately. 2. What is a BMP and how will this test give the provider give the provider information about the patient’s electrolyte status? What is the normal range for the electrolyte the ED staff suspects may be out of balance? 3. What medication will the nurse anticipate to be ordered to correct this electrolyte problem and by what route should it be given? What are nursing responsibilities specific to the administration of this medication? Due to a bed shortage, the patient remains in the ED for treatment for the next 12 hours. At that time her confusion has cleared and her apical pulse is now regular though still somewhat tachycardic at 102 beats/min. She tells the nurse she had been using her grandmother's "water pills" to help her lose weight. 4. What is the significance of this information? 5. It is decided to discharge her home with instructions regarding dietary intake to ensure good serum levels of the compromised electrolyte. What foods should be included in these instructions?

Answer 1

Electrolytes: are minerals present in blood and body fluids that carry an electric charge. The balance of the electrolytes is essential for the normal functioning of cells and organs.

#1. Potassium imbalance is the cause of low cardiac output in this case. The normal potassium level is 3.5 to 5.0 mEq/L (stands for milliequivalent per litre of blood and this is a unit measure used to eveluate the level). Low potassium levels can cause many reasons. In this case, patient was using 'water pills' which is a diuretic considered to be the most common cause of low potassium levels.The symptoms of hypokalemia ( low potassium level) includes a) muscle weakness b) nausea or vomiting c) confusion d) palpitations ( irregular heartbeat) e) abdominal cramping f) constipation and g) shortness of breath.

#2. BMP stands for Basic Metabolic Panel - is a blood test consists of a set of eight biochemical tests and is one of the the most common lab tests ordered by health care providers to find out information about current status of a person's metabolism including a) functions of kidney b) blood glucose level and c) electrolyte and acid/base balance. Potassium plays a leading role in cell health and the normal value of potassium ranges from 3.5 to 5.0mEq/L.

#3. The medication prescribed at the time of hypokalemia is Potassium-sparing diuretics( For instance; Spironolactone). Potassium-sparing diuretics are diuretics that results in increased urine production and also lower blood pressure while increasing serum levles of potassium.It is used only in patients with normal renal function who are prone to significant hypokalemia. It should be given along with other diuretic drugs or otherwise it tend to increase the potassium levels to potentially dangerous high. It is available in the form of tablets which can be given orally.

#4. Water pills is a diuretics used to drain fluids from the body through urine. It eliminates the sodium and water from the body. In this case, the use of water pills may seem to aid the weight loss process, but these can lead to fatigue, nausea, muscle weakness or cramping and also may end up with irregular heartbeat. On the other hand, water pills donot reduce body fat but only the amount of fluid from the body that is retaining.

#5. The best way to increase potassium intake can be done by eating more potassium rich-foods like fruits, vegetables, beans and nuts. The recommended daily intake (RDI) of potassium is 4,700mg. They includes a) Yams b) Beans c) White potatoes d) Sweet potatoes e) Avacado f) Pinto beans g) Bananas h) Oranges i) Meats: beef, fish, turkey j) greens, mushrooms, peas and tomatoes. It is considered that a medium banana contains 422mg of potassium. Excess intake of potassium may lead to hyperkalemia ( increase in potassium levels).