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Asked by Dayana08

 

 

You report the critically high potassium to the ER physician.  As a nurse, you know a false elevation can occur when a lab draw is hemolyzed, so you suggest a repeat test (this can be done in two minutes at the bedside with a point of care machine in your department).  The IV nurse is able to start a 22 gauge IV in the right forearm, so you draw a new blood sample and obtain a point of care potassium result of 6.6 (variances occur between lab and point of care).  New orders are obtained after reporting this finding to the physician. You are to give one ampule (1g) IV push calcium gluconate, 8 units regular insulin subcutaneously, albuterol nebulizer, and Kayexalate oral suspension. 

What is the reasoning behind this combination of medications?  Which medication is lowest priority at this time?

 

 

 

You administer the calcium gluconate, insulin, albuterol, and attempt to give Kayexalate but the patient feels nauseous and vomits the little bit of Kayexalate she was able to take. Betty’s vital signs are BP 208/110, HR 108, SpO2 95% on 2L/min nasal cannula.  The Chest x-ray results return while you are giving medications, and show the patient has pneumonia.  A WBC of 16 supports this finding.  Orders of 1 gram IV push Ceftriaxone and 1250mg IV Vancomycin are obtained.  At this time the lab calls to report additional critical values of Hematocrit of 15% and a Hemoglobin of 4.8 g/dL.  The patient is requesting to eat and has been since arrival. 

At this time, what are your priorities?  What additional orders do you anticipate, as well as any repeat tests?

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 141