Hyperkalemia

Clinical Picture
The patient may have:
-Muscular weakness
-Cardiac dysrhythmias
-ECG abnormalities
-Nausea

Immediate Intervention
-Assess VS; note cardiac rate & rhythm
-Administer oxygen
-Assess for patient IV access
-Assess recent laboratory results (BUN, creatinine,electrolytes)
-Notify physicianor NP
-Document patient's status,phone call to physician or NP & physician or NP response

Focused Assessment
-Monitor VS, & assess cardiac rhythm if available
-Assess LOC & orientation
-Assess musculoskeletal function
-Assess previous 2 days I&O

Stabilizing & Monitoring
-Obtain IV access
-Administer potassium-binding resins (Kayexalate) orally or rectally
-Monitor cardiac rhythm, I&O,serial potassium levels & other laboratory test
-Chart patient status & convey to physician

Be Prepared To
-Set up cardiac monitoring
-Administer IV calcium,sodium bicarbonate,insulin & glucose or furosemide per order
-Order or obtain laboratory test
-Order a 12-lead ECG
-Transfer to telemetry unit

Possible Etiologies
-Medication
-Chemotherapy
-Acute or chronic renal failure
-Hypoaldosteronism trauma
-Hemolysis
-Digitalis poisoning
-Acidosis
-Burns
-Insulin deficiency
-Uncontrolled hyperglycemia
-Excessive use of salt substitutes
-Metabolic acidosis

Bradycardia

Clinical Picture

-HR <60 bpm
-Nausea & vomitting, dizziness or lighteadedness.
-Sign- Altered LOC, Chest pain, Short of breath(SOB), Hypotension, pulmonary congestion, &/@ cyanosis

Immediate Interventions

-Have a patient sit or lie down in bed
-Administer supplemental oxygen
-Assess BP
-Notify physician or NP
-Obtain a 12-lead ECG
-Check for patient IV access
-Document patient's status,phone call to physician or NP, & physician @ NP response.

Focused Assessment

-Assess level of consciousness & orientation
-Assess BP & HR
-Assess respirations rate & effort; assess SaO2 if readily available
-Assess skin for colour, moistness, & temprature. Assess for associated symptoms (chest pain, SOB, hypotension)
-If patient on telemetry or cardiac monitor, assess ECG

Stabilizing & Monitoring

-Monitor VS
-Set up cardiac monitoring & monitor rate & rhythm
-Assess recent laboratory results
-Chart patient status & convey status to physician or NP

Be Prepared To

-Administer oral or IV medications as ordered
-Obtain or order laboratory tests
-Titrate oxygen to SaO2 >90%
-Obtain IV access if none available
-Assist with external pacing
-Transfer to ICU or telemetry unit

Possible Etiologies

-Medication toxicity
-Vasovagal response
-Hyperkalemia
-Hypothermia
-Hyperthyroidism
-Sepsis
-Severe infection
-Hypoglycemia
-Excellent physical condition (athletes)
-Myocardial infarction
-Shock