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8/6/2019 Nursing Resposibilities of Patient on Kcl
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POTASSIUM
POTASSIUM
POTASSIUM
POTASSIUM
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HIGH ALERT MEDICATIONS
Medications that have highest risk of causing injury when misused are knownas high alert medications.
eg:- KCL, MGSO4, 50%dextrose, dopamine
hcl, dobutamine, NaHCO3.
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� Protein and glycogen synthesis
� Cellular metabolism and growth
� Conducting nerve impulses
� R egulates acid base balance
� Cardiac conductionnormal range: 3.5- 5 meq/L
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Serum potassium levels are primarilyregulated by kidneys. If excess or lack of potassium can cause fatal cardiacarrhythmias.
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ACTION OF KCL
It is used to treat hypokalemia
( k+ <3.5meq/l)
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ETIOLOGY
� Excess loss from kidney and GI tract
� Diarrhea
� Gastric suction or lavage
� Prolonged vomiting( HEG)
� Use of diuretics
� Use of certain antibiotics
� Acute alcoholism
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� Muscle weakness
� Dizziness
� Hypotension
� Diarrhea� Confusion
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� Leg cramps
� Polyuria
� Ecg changes( ST depression,
shallow, flat orinverted t wavesand prominent uwave)
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Treatment
Oral therapy: forprophylaxis and for milddeficiency. Dosage : 16-24 meq/ day
Iv therapy: severe
deficiency and who cannottolerate oral potassium.Dosage : 40-100meq/day.
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R oute of administration
Oral Iv
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³DON¶T GIVE BY DIRECT IV´
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�� IV intermittent therapy for urgent IV intermittent therapy for urgent Potassium replacement:Potassium replacement:
peripherally maximum 20meq/ 250ml
over 1 hr.
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in central line :20meq/100ml in 1 hour.
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IV InfusionsIV Infusions
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Adverse Effects
GI : irritates gi tract, abdominaldiscomfort,nausea, vomiting, diarrhea.
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CNS : paresthesia of limbs, flacid paralysis.
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� CVS: cardiac arrythmias, cardiac arrest, postinfusion phlebitis, heart block, hypotension.
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Side Effects
� Hyperkalemia
� Cardiac arrest
� Thrombophlebitis
� Extravasation
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Serum k + >5.5meq/l
Etiology :
� increased k intake
� Decreased k excretion
� Tubular unresposiveness to aldosterone
� R edistribution of k+ in extra cellular space
� Untreated addisons disease
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Signs and symptoms
� Palpitation
� Skipped heart beats.
� Ecg changes: tall t wave, widened
qrs complex, prolonged PR interval,flat p wave.
� Numbness of hand and feet.
� Dyspnea
� Anxiety
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Diagnosis
� Lab value
Serum k+ > 5.5 meq/l
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Treatment
� Abnormal ECGyes
calcium
gluconate
� Continuous ECG monitoring
� Hyperglycemia insulin
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No
Administer insulin and glucose
Consider albuterol
Consider sodium bicarbonate
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Give exchange resin or consider hemodialysis
� Follow k+ result until k + <5.5meq/L.
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Contra indication
patients with severe renal impairment
oliguria,
anuria,
acute dehydration,
heat cramps,
hyperkalemia.
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Nursing considerations
� Teach the patient howto prepare the powderand how to take drugs.
� Tell patient to take itwith or after meals withfull glass of water orfruit juice to decrease
GI irritation.
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� Discuss dietary source of k: vegetables like potato,carrots, mushroom,beans , tomato, spinach,etc.
� Fruits: dates, orange,pear, raisins, banana etc.
� Meat: chicken, beef andveal meat.
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� Teach the signs and symptoms of hyperkalemia,
report any discomfort at iv site.
� Warn not to use salt substitute without prescription.
� Monitor serum electrolyte frequently.� ECG monitoring and observe for any changes.
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� Jowaher Abdulla Abdullaziz Harby, PG,9 wks
with HEG, serum k+ is 2.7 meq/L. Urineketone is +++. MSOD ordered inj.kcl60meq/24 hrs in 3L R L/NS alternatively.
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CALCULATION
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� KCL= 60 meq/24hrs.
� So for 1hr = 60/24= 2.5meq/hr.
� One IV bottle is 500ml, that is for 4 hrs.
� So in each bottle, 2.5
*
4= 10meq of KCL
should be added.
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