Medical Surgical Renal Failure #5

Question

A client in renal failure has lab studies which show the client to have a critical high potassium level, due to the kidney’s inability to remove serous potassium within the body. Which intervention by the nurse takes precedence?

Answers

  1. Place the client on a low potassium diet.
    • Rationale:

      This answer is not correct because placing a client on a low potassium diet is not going to address the critical value in an appropriate time frame. High levels of potassium in the blood can lead to a fatal arrhythmia, therefore a more expeditious intervention is required.

  2. Administer kayexalate enema to excrete potassium.
    • Rationale:

      This answer is not correct because although removing potassium is priority, it does not take precedence over continuous cardiac monitoring. Kayexalate excretes potassium through the intestines and the client should be on continuous cardiac monitoring to observe for risk of hypokalemia after administration of potassium lowering drugs.

  3. Administer loop diuretics intravenously.
    • Rationale:

      This answer is not correct because it does not take precedence over continuous cardiac monitoring. Whatever the intervention, continuous cardiac monitoring has to be done to observe the outcome of the intervention. Loop diuretics remove potassium through urine. Loop diuretics peak 10 to 30 minutes after intravenous administration.

  4. Begin continuous cardiac monitoring.
    • Rationale:

      This answer is correct because it is the best way the nurse can observe for arrhythmias in real time. Hyperkalemia causes wide, flat P waves, wide QRS complex, prolonged PR interval, depressed ST segment, and narrow, peaked T waves. This is caused by the metabolic acidosis that occurs as a result of renal failure.

Overview

When kidney damage occurs, the body is unable to excrete potassium through urine. Subsequently, the extra potassium goes into the bloodstream instead, raising the serum potassium level. Potassium plays an important role in heart rhythm.

Explanation

Learning Outcomes

Renal failure has a negative effect on potassium homeostasis within the body. Due to kidney damage, the body is unable to excrete potassium through urine. Subsequently, the extra potassium goes into the bloodstream instead, raising the serum potassium level. The flow of potassium in and out of the heart cells regulates the heartbeat. High potassium in the blood suppresses the electrical activity of the heart and can lead to a fatal arrhythmia. Many people have very few, if any, symptoms of hyperkalemia. For these reasons, it is imperative the client is placed on continuous cardiac monitoring to detect any changes in heart rhythm.

Test Taking Tip

Remember that with a critical level of potassium, you want to know what the heart is doing at all times. The best way to obtain this information is through continuous cardiac monitoring.

Video Rationale