Tuesday, June 20, 2023

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L.. Pulse

A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first?

  • a- Blood pressure
  • b- Respirations
  • c- Temperature
  • d- Pulse

Answer D.

An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse.
The client’s blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later.
The nurse also can delay assessing respirations and temperature because these aren’t affected by the serum potassium level.

What is hypokalemia?

Hypokalemia is an electrolyte imbalance, with a low level of potassium in the blood. The normal value of potassium in adults is 3.5 to 5.3 mEq / L.
Potassium is one of the body's many electrolytes. It is found inside the cells. Normal potassium levels are important for the functioning of the heart and nervous system.

What causes hypokalemia?

The body regulates blood potassium levels by moving it in or out of cells. When there is a degradation or destruction of the cells, potassium leaves the cell into the bloodstream and its exaggerated excretion causes hypokalemia. Trauma or excess insulin, especially if you are diabetic, can cause a movement of potassium to the cells and blood levels drop (hypokalemia).
Potassium is excreted (or "purged" from the body) by your kidneys. Certain medications or conditions can cause the kidneys to excrete excess potassium. This is the most common cause of hypokalemia.

Other causes include:

  • Loss of potassium from the body.
  • Some medications, such as loop diuretics (furosemide) can cause a loss of potassium. Other medications include steroids, licorice, sometimes aspirin and certain antibiotics.
  • Renal dysfunction (kidney failure): The kidneys may not work well due to a condition called Renal Tubular Acidosis (ATR). In this case the kidneys will excrete too much potassium. Medications that cause ATR include Cisplatin and Amphotericin B.
  • Faced with the loss of body fluids due to vomiting, diarrhea or excessive sweating.
  • Endocrinological or hormonal problems (such as an increase in aldosterone levels): aldosterone is a hormone that regulates potassium levels. Certain diseases of the endocrinological system, such as Aldosteronism or Cushing's Syndrome, can cause potassium loss.
  • Insufficient potassium intake.

What are the symptoms of hypokalemia that should be taken into account?

  • It is possible to have no symptoms, unless blood potassium levels are very low.
  • You may have muscle weakness, fatigue or cramping.
  • The doctor may notice a decrease in reflexes.
  • You may have changes in the electrocardiogram (ECG or EKG).

What you can do if blood test results indicate hypokalemia:

  • Follow the doctor's instructions to increase the level of potassium in the blood. If the results of your blood tests show that the levels are too low, your doctor may prescribe potassium supplements, either in pills or intravenously (IV).
  • If you take heart medication and have a chronic low blood potassium level (long term), you may be recommended a high potassium diet. Foods high in potassium include most fresh fruits and vegetables. Some specific examples include:
  1. Oranges and orange juice.
  2. Green leafy vegetables, such as spinach and vegetables (cabbage and kale).
  3. Potatoes.
  • Avoid caffeine and alcohol, as they can cause electrolyte disorders.
  • Follow all the doctor's recommendations regarding laboratory tests.

Medicines that your doctor may prescribe for hypokalemia:

The doctor may prescribe medications to increase blood potassium levels, including:
  • Potassium-sparing diuretics: they are also known as "water retention pills" as they help increase blood potassium levels by allowing your kidneys to retain potassium while you urinate more. A widely used example of this medicine may be spironolactone.
  • Potassium and magnesium supplements: to correct the level of potassium in the blood and bring it to a "normal" level. You should also take magnesium. These medications can be taken in pills or intravenously (IV) if you have a severe deficit of these electrolytes.

When to call the doctor:

If you have the following symptoms, consult your doctor:
  • Increased urinary frequency, painful urination, weight loss.
  • If you notice symptoms of low blood sugar levels, such as tremor, sweating and tiredness.
  • If you develop signs of confusion. Shortness of breath, chest pain or discomfort; Swelling of the lips or throat should be evaluated immediately, especially if you started with a new medication.
  • If you feel your heart beating quickly or if you feel palpitations.
  • Nausea that affects the ability to eat and is not relieved by prescription medications.
  • Diarrhea (4 to 6 episodes in 24 hours) that is not relieved with antidiarrheal medications or with a change in diet.


We recommend that you talk with your doctor about your condition and your treatment. The information presented here is for practical and educational purposes only, and does not replace your doctor's opinion.