University:
Monroe College
Course:
NUR 111 | Fundamentals of Nursing
Academic year:

2024
Views:

123

Pages:

3
Author:

Leslie Sun

Clinical Scenario: Hyperkalemia Patient Profile: • Name: John Smith • Age: 62 years old • Medical History: Chronic kidney disease (CKD), hypertension, diabetes mellitus type 2 • Current Medications: Lisinopril, Metformin, Furosemide, Potassium supplements Situation: John Smith presents to the emergency department (ED) with complaints of muscle weakness, fatigue, and palpitations. He reports that he has been feeling increasingly tired over the past week and noticed that his legs feel weak, especially when climbing stairs. He also mentions feeling palpitations. Assessment: • Vital Signs: o BP: 130/80 mmHg o HR: 110 beats/min (irregular) o RR: 18 breaths/min o Temp: 98.6°F • Physical Exam: o Mildly anxious, alert, and oriented o Generalized muscle weakness observed o Cardiac auscultation reveals irregular heart sounds o No edema or significant respiratory distress Laboratory Tests: • Electrolytes: o Sodium: 138 mEq/L o Potassium: 6.8 mEq/L (high) o Chloride: 102 mEq/L o Bicarbonate: 22 mEq/L • Blood Urea Nitrogen (BUN): 35 mg/dL • Creatinine: 3.2 mg/dL (elevated) • ECG: Shows peaked T-waves and possible widening of the QRS complex Diagnosis: The lab results confirm that John has hyperkalemia, likely due to his chronic kidney disease and potassium supplementation. Management Plan: 1. Immediate Interventions: o Administer calcium gluconate IV to stabilize the cardiac membrane. o Administer insulin and glucose IV to facilitate potassium shift into cells. o Administer sodium bicarbonate IV if indicated, to help shift potassium intracellularly. o Consider diuretics (e.g., Furosemide) to promote renal excretion of potassium. o Monitor ECG continuously for arrhythmias. 2. Further Management: Re-evaluate potassium levels after treatment. Review and adjust medications, particularly potassium supplements and ACE inhibitors. o Educate John about dietary potassium restrictions. o Schedule a follow-up appointment with nephrology for ongoing management of his CKD. 3. Patient Education: o Discuss signs and symptoms of hyperkalemia (e.g., muscle weakness, palpitations). o Importance of adhering to dietary restrictions and medication management. Outcome: John's potassium levels are monitored and begin to decrease after treatment. He is stabilized and discharged with a clear follow-up plan, including dietary counseling and regular lab checks for electrolyte levels. o o Situation: John Smith presents to the emergency department (ED) with complaints of muscle weakness, fatigue, and palpitations. He reports that he has been feeling increasingly tired over the past week and noticed that his legs feel weak, especially when climbing stairs. He also mentions feeling palpitations. Possible Diagnosis Hyperkalemia Hypokalemia Hyponatremia Hypernatremia ACTIONS TO TAKE Administer oxygen. Initiate 0.9% normal saline IV fluids. Ensure 1500 mg sodium diet. Obtain strict intake & output. Initiate 3% normal saline fluids. PARAMETER TO MONITOR ECG monitoring. Neurological status. Oxygen saturation. CBC BMP Musculoskeletal assessment.

Hyperkalemia Case Study

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