Question

Mr. Tan is a 69-year-old patient who is admitted from the Emergency Room with a diagnosis of hypokalemia after 48 hours of vomiting, and diarrhea. The patient's potassium level is 2.9 upon admission. The patient's creatinine level is 0.9 mg/dL and the BUN is 10 mg/dL.

• As the primary nurse, use the SBAR mnemonic to contact the attending physician for desired orders to care for Mr. Tan.
• The admitting resident asks you if the ER physician checked a magnesium level. Discuss why he/she asked you this laboratory result? Assess the current creatine and BUN levels.
• Identify three clinical manifestations associated with hypokalemia with causative factors, and include nursing interventions.
• During the administration of the potassium, Mr. Tan begins to scream in pain and says something is wrong with the IV. Identify interventions that might remedy the patient's discomfort.

Answer 1

Situation: A 69 old man admitted with complaints of severe vomiting and diarrhea

Background :Mr. Tan is a 69 year old male with diagnosis of hypokalemia admitted for vomiting and diarrhea for the past 48 hours

Assessment :The patient's blood investigation reveals potassium :2.9, creatinine :0.9mg/dL ,BUN :10mg/dL

Recommendation :I would suggest that the patient be started with electrolyte replacement therapy with potassium intravenous infusion .

¤ The level of magnesium has to be strictly checked in patient diagnosed with hypokalemia because low level of magnesium us the chief cause for hypokalemia. If this is not treated then it can simply aggregate the condition if the patient quickly.

¤ The creatinine and BUN levels are within normal limits

Creatinine:0.9mg/dL (0.5-1.2 mg/dL)

BUN :10mg/dL (7-20 mg/dL)

¤The clinical manifestation of hypokalemia and its causes are

• Weakness
• Muscle cramps
• Tingling sensation
• Gastrointestinal disturbances like diarrhea
• Dyspnea

Cause

• vomiting
• diarrhea
• Hypomagnesemia
• Medication

Nursing interventions

• Assess for signs and symptoms of potassium deficiency to take appropriate precaution measures
• Administer potassium supplements orally ,IV as per order
• Provide potassium rich diet
• Administer antiemetics and anti diarrhoeal drugs

The interventions to reduce the discomfort are

• Ensure the IV line is intact with no redness, swelling ,tender vein. If present insert a new IV line
• Ice application can reliebe pain
• Adjust the rate as per the standard and protocol because this medication is irritant in nature
• Infirm the patient about the concentration of the medication so that the patient gets prepared psychologically to an extent