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Soru

Zorluk: ZorPhysiological Adaptation

A client with a history of chronic kidney disease is brought to the emergency department after missing three scheduled hemodialysis treatments. The client reports severe muscle weakness and abdominal cramping. Assessment reveals a heart rate of 54 bpm, respiratory rate of 22 breaths/min, and blood pressure of 92/58 mm Hg. The cardiac monitor displays a prolonged PR interval, wide QRS complexes, and tall, peaked T waves. Which of the following interventions should the nurse implement first?

  1. A
    Administer intravenous regular insulin and 50% dextrose
  2. B
    Administer a rapid intravenous fluid bolus of 0.9% sodium chloride
  3. Administer intravenous calcium gluconateCevap
  4. D
    Administer oral sodium polystyrene sulfonate

Cevap

Administer intravenous calcium gluconate.
The client is exhibiting signs of severe hyperkalemia, as evidenced by the missed hemodialysis sessions and classic ECG changes (bradycardia, prolonged PR interval, wide QRS complexes, and tall, peaked T waves). A widening QRS complex is a critical warning sign of impending ventricular fibrillation or asystole. Intravenous calcium gluconate is the absolute first priority because it rapidly antagonizes the cardiac toxicity of hyperkalemia. It stabilizes the myocardial cell membrane and raises the threshold potential, preventing lethal dysrhythmias. While calcium gluconate does not actually lower serum potassium levels, it provides immediate cardiac protection, buying time for other therapies to work.

Adım Adım Çözüm

1
Analyze the client's history and presenting clinical signs.
The client has missed dialysis (impaired excretion), muscle weakness, and specific ECG changes (bradycardia, prolonged PR, wide QRS, peaked T waves).
To identify the underlying physiological crisis, which is severe hyperkalemia.
2
Evaluate the immediate threats to the client's life.
The wide QRS complex indicates an impending lethal cardiac dysrhythmia (ventricular fibrillation or asystole).
Prioritization requires addressing the most acute, life-threatening condition first (ABC framework and critical ECG changes).
3
Determine the mechanism of action for each available intervention.
Calcium gluconate stabilizes the cardiac membrane. Insulin/dextrose temporarily shifts potassium into cells. Sodium polystyrene slowly excretes potassium.
To match the pharmacological intervention with the immediate physiological need.
4
Select the intervention that acts fastest to prevent cardiac arrest.
Intravenous calcium gluconate is selected.
Myocardial stabilization must occur before therapies that shift or remove potassium are initiated when critical ECG changes are present.

Anahtar Kavram

Emergency Management of Severe Hyperkalemia
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Konular

Physiological Adaptation

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