ST, a 64-year-old patient, has heart failure (HF), which is being controlled with digoxin (Lanoxin), furosemide (Lasix), and a low-sodium diet. She is taking potassium chloride (KCl) 20ââ¢Â¯mEq per day orally. Three days ago, ST had flulike symptoms such as anorexia, lethargy, and diarrhea. Her fluid and food intake was diminished. She refused to take the KCl and stated that the drug makes her sick. She has been taking the digoxin and furosemide daily. The nurseâs assessment during the home visit includes poor skin turgor, poor muscle tone, irregular pulse rate, and decreased bowel sounds. The nurse obtained a blood sample for serum electrolytes; results indicated potassium (K) 2.9ââ¢Â¯mEq/L, sodium (Na) 137ââ¢Â¯mEq/L, and chloride (Cl) 96ââ¢Â¯mEq/L.
1. List reference values for serum potassium (K), serum sodium (Na), and serum chloride (Cl). Are STâs electrolyte levels within normal range? Explain your answer.
2. Match STâs physical findings with the corresponding electrolyte imbalance.
3. What are the reasons for the electrolyte imbalance?
4. ST said she was not taking KCl because the drug makes her sick. What information can you give her concerning the administration of potassium?
5. What is the effect of furosemide on digoxin when there is a potassium deficit? Explain your answer.
6. Why should the nurse assess ST for digitalis toxicity? List the signs and symptoms of digitalis toxicity. ST was referred to the health care provider because of her serum potassium deficit and its effect on digoxin. A repeat serum potassium determination was taken, and the result was 2.8ââ¢Â¯mEq/L. A liter of 5% dextrose in water with KCl 40ââ¢Â¯mEq/L was administered over 4 hours.
7. How many milliequivalents of KCl per hour would ST receive? Does this amount constitute an acceptable?
dosage?
8. Why is it important that the nurse monitor the rate of intravenous fluids containing potassium, the hourly
urine output, and vital signs?
9. Because of the low serum potassium level, what other electrolyte value should be checked? Explain your answer. After STâs serum electrolytes returned to normal, the health care provider instructed her to continue taking the prescribed KCl dosage daily with her other medications.
10. ST asks why she has to continue taking these drugs. What is the nurseâs best response?
11. The nurse instructs ST to eat foods rich in potassium.
Which foods are the richest sources of potassium?
