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Zorluk: Çok zorPhysiological Adaptation

A client with acute kidney injury is admitted to the progressive care unit. The client's most recent serum potassium level is 8.2 mEq/L8.2 \text{ mEq/L} (8.2 mmol/L8.2 \text{ mmol/L}). The bedside cardiac monitor suddenly displays a widened QRS complex and absent P waves. Arrange the following actions in the physiological priority order the nurse should perform them.

  1. 1Assess the client's airway, breathing, and circulation while calling for rapid assistance.
  2. 2Administer prescribed intravenous calcium gluconate.
  3. 3Administer prescribed intravenous regular insulin concurrently with 50%50\% dextrose.
  4. 4Administer prescribed sodium polystyrene sulfonate via retention enema.
  5. 5Obtain a follow-up 12-lead electrocardiogram (ECG) and repeat the serum basic metabolic panel.

Cevap

The correct priority sequence is: 1) Assess airway, breathing, and circulation while calling for assistance, 2) Administer intravenous calcium gluconate, 3) Administer intravenous regular insulin and 50% dextrose, 4) Administer sodium polystyrene sulfonate, 5) Obtain a follow-up ECG and serum potassium level.
The sequence reflects the physiological urgency of hyperkalemic cardiotoxicity. After verifying basic life support (ABCs), the absolute highest priority is stabilizing the cardiac membrane with calcium gluconate to prevent ventricular fibrillation. Once the heart is protected, the nurse rapidly shifts potassium into the cells using insulin. Finally, the nurse eliminates the potassium from the body entirely using sodium polystyrene sulfonate, followed by re-evaluation of the client's status.

Adım Adım Çözüm

1
Assess the client's airway, breathing, and circulation while calling for rapid assistance.
The nurse ensures the client has not already progressed to pulseless cardiac arrest and mobilizes the emergency response team.
A widened QRS complex with profound hyperkalemia can rapidly degenerate into ventricular fibrillation or asystole. Assessing ABCs is the foundational step in any acute deterioration.
2
Administer prescribed intravenous calcium gluconate.
The myocardial threshold potential is raised, restoring the normal gradient between the resting membrane potential and threshold potential.
Calcium does not lower serum potassium, but it immediately stabilizes the cardiac cell membrane within 1 to 3 minutes, protecting the heart from lethal dysrhythmias while other treatments take effect.
3
Administer prescribed intravenous regular insulin concurrently with 50% dextrose.
Potassium is temporarily shifted out of the bloodstream and into the intracellular space.
Insulin stimulates the sodium-potassium ATPase pump, rapidly driving potassium into the cells (within 15-30 minutes). Dextrose is required to prevent profound iatrogenic hypoglycemia.
4
Administer prescribed sodium polystyrene sulfonate via retention enema.
Potassium is exchanged for sodium in the large intestine and excreted in the stool.
Intracellular shifting is temporary. A cation-exchange resin is required to permanently eliminate potassium from the body, though its onset of action takes hours.
5
Obtain a follow-up 12-lead electrocardiogram (ECG) and repeat the serum basic metabolic panel.
The healthcare team evaluates the efficacy of the interventions.
Continuous monitoring and follow-up diagnostics dictate whether the sequence needs to be repeated or if the client requires emergency hemodialysis.

Anahtar Kavram

In acute symptomatic hyperkalemia with electrocardiogram changes, physiological adaptation requires prioritizing myocardial stabilization (calcium) before intracellular shifting (insulin) or elimination (polystyrene sulfonate).
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Physiological Adaptation

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