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Difficulty: HardReduction of Risk Potential

A licensed practical nurse (LPN) is reviewing the electronic health record of a client admitted with a mechanical small bowel obstruction. The client has a nasogastric (NG) tube connected to low continuous wall suction, which has drained 1,800 mL of fluid over the last 24 hours. Which assessment finding represents the greatest potential for a life-threatening complication and requires immediate reporting to the registered nurse?

  1. A morning serum potassium level of 2.8 mEq/LAnswer
  2. B
    A blood urea nitrogen (BUN) level of 34 mg/dL
  3. C
    A resting heart rate of 102 beats per minute and a blood pressure of 104/70 mm Hg
  4. D
    The client's report of a severely dry mouth and feeling excessively thirsty

Answer

A morning serum potassium level of 2.8 mEq/L
The correct answer is the serum potassium level of 2.8 mEq/L. Gastric secretions are rich in electrolytes, particularly potassium. The removal of 1,800 mL of gastric fluid significantly increases the risk for severe hypokalemia (normal range is 3.5 to 5.0 mEq/L). A level of 2.8 mEq/L is a critical value that can lead to fatal cardiac dysrhythmias, directly threatening circulation. This requires immediate escalation to the registered nurse for urgent intravenous replacement therapy.

Step-by-Step Solution

1
Analyze the intervention and its physiological effects.
The client has an NG tube to suction that has removed a large volume (1,800 mL) of gastric fluid.
Gastric fluid contains high concentrations of electrolytes, primarily potassium, chloride, and hydrogen ions.
2
Evaluate the risk potential based on the fluid loss.
The massive removal of gastric contents places the client at severe risk for metabolic alkalosis and hypokalemia.
Depletion of these specific electrolytes must be anticipated when reviewing laboratory data and assessing the client.
3
Prioritize the assessment findings to identify the most life-threatening complication.
A potassium level of 2.8 mEq/L is critically low and poses an immediate threat of fatal cardiac dysrhythmias.
While elevated BUN and borderline vital signs indicate dehydration, they are expected secondary issues. The critical electrolyte imbalance directly threatens circulation and requires urgent RN escalation.

Key Concept

Hypokalemia Risk with Nasogastric Suction
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Topics

Reduction of Risk Potential

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