A client with acute kidney injury is exhibiting profound muscle weakness. The bedside cardiac monitor suddenly displays a widened QRS complex and tall, peaked T waves. The laboratory reports a stat serum potassium level of . The healthcare provider has prescribed several urgent interventions. Arrange the following pharmacological actions in the priority sequence the nurse must implement them.
- 1Administer intravenous calcium gluconate.
- 2Administer intravenous regular insulin concurrently with 50% dextrose.
- 3Administer sodium polystyrene sulfonate via retention enema.
- 4Obtain a follow-up serum potassium level.
Cevap
The correct priority sequence is to first stabilize the myocardium with calcium gluconate, second shift potassium intracellularly with insulin and dextrose, third remove potassium from the body with sodium polystyrene sulfonate, and finally evaluate the client's response with follow-up laboratory tests.
The pathophysiology of severe hyperkalemia demands a specific sequence of interventions. The most immediate threat to life is cardiac toxicity, manifested by widened QRS complexes and peaked T waves. Therefore, calcium gluconate is always the first line of treatment to raise the threshold potential and stabilize the myocardium. Next, fast-acting agents like IV insulin and dextrose are used to rapidly shift potassium into cells. Slower-acting agents like sodium polystyrene sulfonate are then given for definitive removal from the body. Finally, evaluation of the therapy is required.
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Anahtar Kavram
In the presence of hyperkalemia with ECG changes, immediate myocardial stabilization with calcium gluconate must precede therapies that lower serum potassium.