Page 409 - Critical Care Nursing Demystified

394 CRITICAL CARE NURSING DeMYSTIFIED

Nursing Interventions

Monitor the patient’s VS to determine if cardiac output is diminished by de-
creased pulse rate or if temperature elevation indicates an infection.

Observe potassium fluctuations to prevent and treat hyperkalemia early.
Monitor the patient’s ABGs for acidosis, which is caused by the inability of the
kidneys to excrete H ions and can create hyperkalemia by K –H exchange.
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Monitor the patient for ECG/EKG changes that include high-peaked
T waves, then widening of QRS and large, rounded T wave, concluding with
P wave flattening and prolongation of PR interval, which are symptoms of
hypokalemia.
Administer diuretics or sodium polystyrene if the hyperkalemia is mild
(less than 6 mEq/L) to excrete potassium (diuretic) or bind the potassium into
the gut with removal in fecal material.
Administer sorbitol with sodium polystyrene sulfate and/or give a cleansing
enema after administration to prevent constipation.
Administer calcium gluconate or chloride IV, which is the first priority in
severe, life-threatening hyperkalemia to stimulate cardiac contractions. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Administer glucose-insulin IV treatment for severe hyperkalemia to shift
potassium into the cell.
Administer sodium bicarbonate only if severe acidosis (pH less than 7.2 and
HCO less than 12 mEq/L) to correct metabolic acidosis.
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Administer calcium gluconate or chloride IV, which is the first priority in
severe, life-threatening hyperkalemia.
Teach the patient to avoid potassium-containing foods like green, leafy
vegetables and salt supplements, limiting potassium intake to 2 g/day to
prevent recurrence between dialysis.

NURSING ALERT

Cardiac dysrhythmias from hyperkalemia can be fatal. Patients in ARF and CRF need to
have their serum potassium monitored, especially if the hyperkalemia is of new onset.