Pharmacology Case Study

1. Identify the foods in his diet that may be contributing to his hypekalemia. a. Foods that his in potassium in his diet and may contributing to his hyper kalemia include; potatoes, spinach, fruits, salt substitutes, and the bacon, possibly the butter on the toast 2. Which ECG changes would be typical for a patient such as this? b. QT wave is elongated 3. Formulate relevant nursing diagnosis for this patient based on the data provided. c. Risk for ineffective health maintenance related to insufficient knowledge of recommended diet.

Risk for decreased cardiac output related to hyperkalemia Risk associated with spironolactone contraindication in patients with hyerkalemia cardiac monitoring, k+ monitoring, monitor breathing and circulation. IV administration of calcium gluconate, glucose, and insulin, if ineffective possible dialysis (hemodialysis or peritoneal) Diuretics to assist with excretion of excess K+. Education regarding foods and complications ect. Assess patients understanding of appropriate salt substitutes and potassium replacements.

Counseling for possible emotional distress related to medical noncompliance and possibility of relation to said hyperkalemia, patient may feel responsible and distressed. 4. Discus the etiology of the patients symptoms. d. Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract.

5. Explain whether the nurse should clarify the doctors orders before administering the enema.e. Yes the nurse should definantly double check the order first, this patient has hyper tension first of all, and this enema will raise sodium levels depending on the severity of the hypertension this enema could be fatal. Also the enema could take days to work , the Doctor may want to look at a more rapid treatment option such as dialysis. 6. Will the patient continue to take the spironoloctane? f. No, spironoloctane is a potassium raising drug not good for hyperkalemia. 7.

Develop a teaching plan for this patient. a. Diet: Patient may need to change the way or what they eat to control their blood levels of potassium. Patient may need to limit how much potassium consumed. Foods that are high in potassium include bananas, citrus fruits, tomatoes, cantaloupe, honeydew melon, peaches, and potatoes. Juices that are high in potassium include orange juice, citrus juices, and tomato juice. Do not use salt substitutes. Ask caregiver or dietitian to help plan a diet. b. Medicines:

Keep a current list of medicines Take medicine as directed c. Contact Healthcare provider: numbness or pricking of your arms or legs. vomiting (throwing up) or have an upset stomach. d. Seek Care IMMEDIATELY: feel very weak or very tired. have any changes in your breathing, including difficulty breathing. have an abnormal heartbeat e. Support: Collect local hyperkalemia support group contact information, and hyperkalemia associations phone numbers and websites for patient and patient family.

Current medications: Avandia (rosiglitazone) 2mg BID Glucophage (metformin) 500mg OD Lasix (furosemide) 40 mg daily Potassium supplements (KCl) 20 meq daily Lopressor (metoprolol) 25 mg BID Prinivil (lisinopril) 5 mg daily Allopurinol (zyloprim) 100mg daily Advair 1 inhalation BID He …

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