Examkin

Soru

Zorluk: Çok zorPhysiological Adaptation

A client with end-stage renal disease misses two dialysis sessions and presents to the emergency department with profound muscle weakness. The initial serum potassium level is 7.6 mEq/L7.6\text{ mEq/L} (7.6 mmol/L7.6\text{ mmol/L}), and the 12-lead electrocardiogram (ECG) reveals absent P waves, a widened QRS complex, and tall, peaked T waves. The healthcare provider prescribes several emergency interventions. Arrange the following nursing actions in the correct priority order from first to last.

  1. 1Administer intravenous calcium gluconate.
  2. 2Administer an intravenous bolus of regular insulin and 50%50\% dextrose.
  3. 3Administer oral sodium polystyrene sulfonate.
  4. 4Draw a follow-up serum potassium level.

Cevap

The correct priority sequence is: 1) Administer intravenous calcium gluconate, 2) Administer an intravenous bolus of regular insulin and 50% dextrose, 3) Administer oral sodium polystyrene sulfonate, 4) Draw a follow-up serum potassium level.
The correct priority for treating symptomatic hyperkalemia follows the principle of protecting the heart first, shifting potassium second, and eliminating potassium third. Calcium gluconate acts in 1 to 3 minutes to stabilize the myocardium and prevent lethal arrhythmias. Regular insulin with dextrose shifts potassium into cells over 15 to 30 minutes, providing a temporary reduction in serum levels. Sodium polystyrene sulfonate is then administered to permanently bind and excrete potassium from the gastrointestinal tract. Finally, drawing a follow-up serum potassium level evaluates the effectiveness of these treatments.

Adım Adım Çözüm

1
Identify the life-threatening physiological abnormality.
The client has severe hyperkalemia (7.6 mEq/L7.6\text{ mEq/L}) accompanied by significant ECG changes (widened QRS, peaked T waves).
Recognizing impending cardiac arrest dictates the immediate need for myocardial stabilization over potassium reduction.
2
Select the intervention for immediate myocardial stabilization.
Intravenous calcium gluconate is administered first.
Calcium directly antagonizes the membrane effects of hyperkalemia. Without it, the client is at imminent risk for ventricular fibrillation.
3
Select the intervention for rapid intracellular potassium shifting.
Intravenous regular insulin and 50%50\% dextrose are administered second.
This quickly lowers the serum potassium level temporarily, buying time for permanent elimination therapies to take effect.
4
Select the intervention for total body potassium elimination.
Oral sodium polystyrene sulfonate is administered third.
This permanently removes potassium from the body via the gastrointestinal tract but has a delayed onset of action (hours).
5
Select the evaluation step.
A follow-up serum potassium level is drawn last.
After administering all acute emergency treatments, the nurse must assess the therapeutic response.

Anahtar Kavram

In the setting of severe hyperkalemia with electrocardiographic changes, myocardial stabilization with intravenous calcium is the absolute first priority, preceding any interventions designed to lower the serum potassium level.
Bu soruyu puanla

Konular

Physiological Adaptation

Bu konudan daha fazla soru