Medical Surgical Hyperaldosteronism #4

Question

Which prescription does the nurse question when caring for a client admitted with secondary hyperaldosteronism? Select all that apply.

Answers

  1. Place on a 24-hour a day telemetry monitor
    • Rationale:

      This answer is not correct because this order should not be questioned. Placement on a telemetry monitor is appropriate since hyperaldosteronism causes hypokalemia, which can cause life-threatening cardiac arrhythmias.

  2. Furosemide 20 mg IV push every 12 hours
    • Rationale:

      This answer is correct because a prescription order of furosemide 20 mg IV push every 12 hours would not be indicated. The client would lose more potassium with a loop diuretic. IV fluids of 0.9% normal saline at 200 ml/hr should be questioned because this diuretic is a potassium-wasting (lowering) medication. It would cause further hypokalemia associated with hyperaldosteronism. The appropriate option for reducing fluid volume and blood pressure without lowering potassium is a prescription of spironolactone.

  3. IV fluids of 0.9% normal saline at 200 ml/hr
    • Rationale:

      This answer is correct because a prescription order of IV fluids of 0.9% normal saline at 200 ml/hr should be questioned because this would add more fluid and sodium to a client with fluid volume overload, hypertension, and hypernatremia.

  4. Spironolactone 50 mg PO twice daily
    • Rationale:

      This answer is not correct because spironolactone 50 mg PO twice daily should not be questioned. It is a potassium-sparing diuretic and will not lower the potassium while decreasing fluid volume and blood pressure.

  5. Monitor VS every 2 hours, report systolic BP >140
    • Rationale:

      This answer is not correct because this order should not be questioned. The VS should be monitored every 2 hours due to the risk of hypertension. A PRN order may be prescribed or an order written to report if the systolic blood pressure increases above 140 mm Hg.

Overview

Hyperaldosteronism is a condition of the endocrine system where one or both adrenal glands produce too much aldosterone hormone. Secondary hyperaldosteronism causes increased aldosterone levels from adrenal production. Symptoms are very similiar to symptoms of primary hyperaldosteronism. Treatment includes the use of spironolactone, a potassium sparing diuretic, to decrease fluid without decreasing the potassium further, placing on a telemetry monitor, monitoring VS, especially blood pressures, monitoring electrolytes, potassium and sodium, and if there is a tumor, removal of the tumor.

Explanation

Learning Outcomes

Hyperaldosteronism is a condition of the endocrine system where one or both adrenal glands produce too much aldosterone hormone. Aldosterone is an endocrine steroid hormone that’s main role in the body is to regulate water and salt, therefore a huge regulator of blood pressure. Too much aldosterone can produce extreme blood pressure in the body. Other effects of hyperaldosteronism is it causes hypokalemia (loss of potassium), hypernatremia (too much sodium), and increased water retention, causing increased blood volume. Symptoms of hyperaldosteronism include headache, confusion, polydipsia, polyuria, fatigue, weakness, and muscle cramps. Symptoms can worsen due to the hypokalemia, hypernatremia, water retention that causes increased blood volume and produce dangerous conditions including metabolic alkalosis, heart failure, seizures, cardiac failure, and stroke. Treatment includes the use of spironolactone, a potassium sparing diuretic, to decrease fluid without decreasing the potassium further, placing on a telemetry monitor, monitoring VS, especially blood pressures, monitoring electrolytes, potassium and sodium, and if there is a tumor, removal of the tumor.

Test Taking Tip

A thorough understanding of hyperaldosteronism is important to understand what prescriptions would be expected or what should be questioned.

Video Rationale