Question

Mrs Dean is 75-year - old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydrmophone 0.2 mg every 4 hours as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEg/L

Qn 1: what are possible causes of a low potassium level?

Qn 2: what action should the nurse take in relation to the serum potassium level ?

Qn 3: What clinical manifestations might the nurse assess in Mrs Dean?

Answer 1

1. The main reason for hypokalemia or low potassium level in Mrs Dean is the use of furosemide, a loop diuretics. The NPO status also adds to the problem. The low suction may contribute to the hypokalemia by the loss of gastric hydrochloric acid.

Loop diuretics act by inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb of the renal system. The inhibition of sodium-potassium-chloride co-transporter pump can lead to a significant increase in the distal tubular concentration of sodium, reduced hypertonicity of the surrounding interstitium, and less water reabsorption in the collecting duct irrespective of the usual reabsorption of about 25% of the sodium load. Loop diuretics act by altering the transporter mechanism (sodium and water and leads to both diuresis and natriuresis or increased sodium loss. The loop diuretics also increase sodium release to the distal segment of the distal tubule and thereby increases potassium loss and causes hypokalemia.

2. Nursing interventions for Mrs Dean include:

Assess the patient frequently

Repetition of lab investigations

Inform the physician

Monitor for signs and symptoms

Administer potassium supplements like KCL, RL as per physicians order

Do gastric suction with caution

3. The possible clinical manifestation is:

Nausea and vomiting

Muscle weakness

Leg cramps

Fatigue

Hypoactive reflexes, paresthesias

Polyuria

Abdominal distention and decreased bowel motility

Ventricular asystole or fibrillation

Low blood pressure

Ileus, abdominal distension\

In an ECG: flattened T waves, prominent U waves, ST depression, and prolonged PR interval.