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Zorluk: ZorPharmacological Therapies

During morning rounds at an extended care facility, a resident with a history of hypertension and chronic kidney disease reports a new onset of muscle weakness and palpitations. The client's medication administration record includes scheduled oral doses of valsartan, hydrochlorothiazide, and a potassium chloride supplement. A basic metabolic panel drawn earlier this morning reveals a serum potassium level of 6.8 mEq/L6.8\text{ mEq/L} (6.8 mmol/L6.8\text{ mmol/L}). Based on the practical nurse's scope of practice, which action is the priority?

  1. A
    Administer the medications as prescribed and document the laboratory value, as elevated potassium is an expected finding in chronic kidney disease.
  2. B
    Initiate an intravenous push of calcium gluconate to protect the myocardium from dysrhythmias.
  3. Withhold the valsartan and potassium chloride, remain with the client, and immediately alert the registered nurse.Cevap
  4. D
    Elevate the client's legs and encourage deep breathing exercises to manage the palpitations before rechecking the pulse.

Cevap

Withhold the valsartan and potassium chloride, remain with the client, and immediately alert the registered nurse.
The client is exhibiting signs of severe hyperkalemia (potassium of 6.8 mEq/L), which can cause fatal cardiac dysrhythmias, manifested by the client's palpitations. Valsartan is an angiotensin II receptor blocker (ARB) that can increase serum potassium, and the potassium chloride supplement will further elevate the level. The practical nurse must recognize this critical laboratory value, withhold the contributing medications, stay with the unstable client, and immediately escalate the situation to the registered nurse for emergency intervention.

Adım Adım Çözüm

1
Analyze the client's laboratory results and presenting symptoms.
The serum potassium level of 6.8 mEq/L is critically high (normal 3.5-5.0 mEq/L), and palpitations indicate a potential cardiac dysrhythmia.
Identifying critical abnormalities is the first step in clinical decision-making.
2
Evaluate the scheduled medications for potential interactions with the laboratory findings.
Valsartan (an ARB) and potassium chloride supplements both increase serum potassium levels.
Administering these medications would exacerbate the severe hyperkalemia.
3
Determine the appropriate action based on the practical nurse's scope of practice.
The nurse must withhold the contraindicated medications and escalate to the registered nurse immediately.
A practical nurse cannot independently prescribe treatments or administer IV push medications for hyperkalemia, but is responsible for withholding harmful medications and reporting critical findings.

Anahtar Kavram

Recognizing critical laboratory values and medication contraindications within the practical nursing scope of practice.
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Pharmacological Therapies

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