1) What 4 etiologies in this case are responsible for causing hyperkalemia? How do each of the etiologies cause hyperkalemia? a) CKD- This patient has a history of Stage 5 renal failure, which requires him to receive regular dialysis. At this stage, oliguria occurs, resulting in a decreased renal excretion of potassium and a decrease of glomerular filtrate. Since this patient has not received regular dialysis (last performed x 5 days ago), metabolic acidosis may have occurred causing an increased shift in extracellular potassium. b) Possible cellulitis/inflammatory process to LLE- Patient presents with pain to LLE. Erythema and swelling noted to medial upper thigh. Cellular injury at site may cause alterations to the plasma membrane, which …show more content…
may cause K+ to shift to extracellular space. c) Medications- Lisinopril 20 mg po daily and Sulfamethoxazole-Trimethoprim DS (Bactrim)- Lisinopril, an ACE Inhibitor, is an anti-hypertensive that inhibits the function of the angiotensin-converting enzyme, causing vasodilation, which in turn decreases blood pressure. With the decrease of blood pressure, the level of aldosterone, which mediates the excretion of potassium though the urine, is decreased. As a result, the impairment and efficiency of urinary potassium excretion can occur. Bactrim, which may be used to treat Mr.X’s hx of pneumonia, also can cause hyperkalemia by interfering with the renin-angiotensin mechanism causing decreases of aldosterone. According to the medical website, uptodate.com, the secondary ingredient, Trimethoprim, can cause a higher incidence of hyperkalemia in HIV patients by appearing to mimic potassium-sparing diuretics. d) Anemia- This patient has a history of anemia, which may be related to his history of HIV treatment including medication therapy and other etiologies such as infection. These etiologies may cause RBC hemolysis, which in turn, can shift excess potassium to the extracellular space, causing hyperkalemia. Doig, A., & Huether, S. (2014). The Cellular Environment: Fluids and Electrolytes, Acids and Bases. In K. L.McCance, & S. E. Huether, Pathophysiology: The Biologic Basis for Disease in Adults and Children (pp. 117-119). St Louis, MO: Mosby Elsevier. Kaplan, N. (2015). Major side effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Retrieved September 22, 2015, from www.uptodate.com: http://www.uptodate.com/contents/major-side-effects-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-ii-receptor-blockers?source=preview&search=%2Fcontents%2Fsearch&anchor=H939716#H2 L.Einhorn, M.Hsu, Walker, L., & Moen, M. (2009). The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Int Med, 169(12):1156-1162 doi: 10.1001/archinternmed.2009.132. McCance, K. L., Grey, T. C., & Rodway, G. (2014). Altered Cellular and Tissue Biology. In K. L. McCance, & S. E. Huether, Pathophysiology: The Biologic Basis For Disease In Adults And Children (p. 75). St. Louis, MO: Mosby Elsevier. Richard H. Sterns, M. (2014). Electrolyte Disturbances with HIV Infection. Retrieved September 22, 2015, from www.uptodate.com: http://www.uptodate.com/contents/electrolyte-disturbances-with-hiv-infection?source=machineLearning&search=bactrim+hyperkalemia&selectedTitle=3%7E150§ionRank=3&anchor=H6#H6 2) How does magnesium deficiency affect potassium homeostasis? Magnesium and potassium are major cations of the body and both contribute to neuromuscular excitability. Normal levels of magnesium inhibit the movement of potassium out of the cell although with decreased levels of magnesium, potassium is enabled to move into the extracellular space causing hyperkalemia. Doig, A. K., & Huether, S. E. (2014). The Cellular Environment: Fluids and Electrolytes, Acids and Bases. In K. L. McCance, & S. E. Huether, Pathophysiology: The Biolologic Basis for Disease in Adults and Children (p. 122). St. Louis, MO: Mosby Elsevier. 3) What can you educate Mr. X to do at home that can help to maintain potassium homeostasis? The Journal of Advanced Nursing recognizes that patients undergoing hemodialysis may need education related to appropriate dietary intake. Patient education including appropriate monitoring of foods and knowledge of the kind of foods that increase potassium levels including lean beef, seafood, fruits and vegetables can be beneficial to the patient. Patient awareness of dietary potassium restrictions and supplementation is important to maintain homeostasis, as well as advising to the patient the importance of consultation with a dietary specialist. Baraz, S., Parvardeh, S., Mohammadi, E., & Broumand, B.
(2009). Dietary and Fluid Compliance: an educational intervention for patients having haemodialysis. Journal of Advanced Nursing, 60-68. Fiona Willingham, B. (2012). The Dietary Management of Patients with Diabetes and Renal Disease:Challenges and Practicalities. Journal of Renal Care, 140-151. 4) How does hyperkalemia affect the myocardium? Potassium is a cation responsible for neuromuscular contractility. Hyperkalemia causes a disruption of resting action potential and also can prevent repolarization of cardiac cells. Elevated levels may cause cardiac arrhythmias, such as T-wave elevation and lead to cardiac muscle paralysis. Eleanor Lederer, M. (2014). Hyperkalemia. Retrieved from www.emedicine.medscape.com: http://emedicine.medscape.com/article/240903-overview#a4 5) What is the relationship between albumin and calcium? Total serum calcium is bound to the albumin molecule and is considered inactive. Consequently, it is noted, when the level of albumin is decreased, the level of total calcium is also …show more content…
decreased. What is a serum ionized calcium?
Serum ionized calcium is considered a free calcium ion that has many physiologic functions. It maintains bone structure and is responsible for the function of cell receptors. It also is responsible for the transmission of nerve impulses and muscular contraction. Signs and symptoms of ionized calcium deficiency can include neuromuscular irritability and muscle tetany. David Goltzman, M. (2014). Diagnostic approach to hypocalemia. Retrieved from www.uptodate.com. Doig, A. K., & Huether, S. E. (2014). The Cellular Environment: Fluids and Electrolytes, Acids and Bases. In K. McCance, & S. E. Huether, Pathophysiology: The biologic basis for disease in adults and children (pp. 119-121). St. Louis, MO: Mosby Elsevier. 6) What is the etiology of Mr.X’s hypocalcemia and hyperphosphatemia? Related to Mr.X’s history of stage 5 CKD, abnormal calcium and phosphate levels will be contrary to each other. Patients with a history of renal failure with a high phosphate level may exhibit signs of hypocalcemia, such as the Trousseau or Chvostek’s sign. Eleanor Lederer, M. (2014). Hyperphosphatemia. Retrieved from www.emedicine.medscape.com:
http://emedicine.medscape.com/article/241185-overview
Sammy is rating his pain as a 10 out of 10 on a scale where 10 is the highest level of pain and 1 is the lowest. It is evident that some of the choices Sammy made prior to ending up in the emergency room were not beneficial to his health. Sammy has been discarding lunches and drinks as school, is feeling nauseas, having diarrhea, and was playing in 21 degrees Fahrenheit weather without a jacket. Sammy’s diarrhea may be explained by his electrolyte imbalance as a high potassium (K+) level can cause diarrhea. Due to the fact that sickled RBCs are blocking blood flow, oxygen cannot be delivered to the cells. As the cells produce lactic acid, the pH is lowered creating an acidotic environment. With an increase in hydrogen (H+) ions, K+ moves out of the cell into extracellular fluid (ECF) to maintain ionic balance, explaining a K+ level of 6.2 mEq/L (citation). Sammy’s arterial blood gas (ABG) results also play a role in determining Sammy’s condition. With a low pH of 7.28, PCO2 of 32, a PO2 of 64, and a HCO3 21 these results are indicative of metabolic acidosis. Sammy’s increased respiratory rate of 32 breaths per minute is the body’s was of compensating for increased levels of acid. The body increases respirations in order to excrete CO2 at a higher rate and increase the pH level. Unfortunately, the body can only keep this up for so long as this type of buffering system is physically
Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol. Aug 2000;11(8):1553-61.
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed, revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed to several abnormal labs.
This occurs when the systemic arterial blood is above 26mEq/liter and the blood pH is above 7.45 (Tortora, 2014). The cause of metabolic alkalosis is too much bicarbonate in the blood, prolonged vomiting, and extreme lack of potassium. When the regular compensatory mechanisms are not working, respiratory compensation through hypoventilation help bring back pH level to normal leaving HCO3- high. Lung assist in compensatory mechanism. Treating metabolic alkalosis consist of correcting Cl-, K+, and other electrolyte deficiencies by providing fluid solutions. Older age compromises the acid-base balance in metabolic alkalosis due to inadequate fluid intake of more water than Na+ which occur through vomiting, feces, or urine. These changes are associated with the kidney.
Obesity has become a very critical problem in the United States. According to the Centers for Disease Control and Prevention (CDC, 2011) in the past two decades there has been an increasingly dramatic increase in obesity seen within the United States. Evidence from research indicate a strong correlation between being over-weight or obese with incidences of coronary heart disease, type 2 diabetes, hypertension and cancers increases (CDC, 2011). A major complication associated with diabetes is the occurrence of nephropathy which can lead to end stage renal disease (ESRD).
Wyness, L. (2009). Understanding the role of diet in type 2 diabetes prevention. British Journal of Community Nursing, 14(9), 374.
Metabolic alkalosis is seen by an increase in the concentration of plasma bicarbonate relative to the concentration of carbonic acid, which shifts the pH to the alkaline side of the physiologic range (case study- pH 7.5). The main causes of metabolic alkalosis are loss of gastric juice or neutralization of gastric juice by antacids, chloride depletion, and excess adrenal corticosteroid hormones.
Indication: “Edema due to liver cirrhosis or nephrotic syndrome. Edema in patients with hypokalemia due to other diuretics.”
→Bartter’s Syndrome, or hypochloremic metabolic alkalosis, is a disorder involving a set of three other closely related disorders. These rare congenital Bartter-like syndromes share many pathophysiological simularities, but differ in the age of onset and the location of genetic problems in the nephron (Guay-Woodford).
The purpose of this paper is to take an in depth look at a renal diet which is designed for people suffering from certain kidney conditions. A renal diet can be described as a nutritional regime which is: “low in sodium, phosphorous and protein... [It] also promotes the importance of consuming high-quality protein and usually limits fluids. Some patients may also need to limit potassium and even calcium” (Nephcure). Throughout the course of this paper various aspects are addressed. these include: the role of the kidneys, the importance of professional guidance, the reasons why people follow a renal diet, monitoring sodium intake, monitoring potassium intake, monitoring phosphorus intake, protein consumption, and fluid control.
On these occasions, I rely on my nursing assessment, evaluation, and interventions, collaborative skills, and scientific knowledge to make sound clinical judgments for the benefit of my patients. As a hemodialysis nurse, I will persevere to comply with innovation in nursing practice, EBP, research, and education. I believe growth requires generation of innovative, improved ideas and practices for the betterment of the organization and patient satisfaction. For this reason, I will embrace technological advancements; empower front line staff to embrace change and innovation; and motivate staff to be change agents on the floor with the aim to provide better quality of care for our
When a person is deficient in potassium, an irregular heartbeat, high blood pressure, bone problems, muscle cramping, kidney stones and kidney problems may occur. Though doctors recommend eating a healthy diet as the first defense against these problems, if a person can't properly absorb potassium or they expel too much, supplements should be taken to prevent these problems.
Potassium works with sodium to aid in the digestion of food and in functioning of the eyes. People whose diets are low in potassium can develop hypokalemia, which in severe cases can be life threatening. Symptoms include irregular heartbeat, fatigue, muscle cramps and constipation. It is unusual for people to be deficient in potassium just because of getting too little of it in their diets, and usually is caused by other ongoing issues in the digestive system.
An acid base disorder is a change in the normal value of extracellular pH that may result when respiratory function is abnormal or when an acid or base load overwhelms excretory capacity. Acid base status is defined in terms of the plasma pH. The normal pH range level is between 7.35 and 7.45. Acidosis is a condition in which blood pH is below 7.35 and alkalosis is a condition in which blood pH is higher than 7.45. According to James L. Lewis, III, MD, “Acidosis and alkalosis are categorized as metabolic or respiratory, depending on their primary cause. Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the production of acids or bases and their excretion by the kidneys. Respiratory acidosis and respiratory alkalosis are caused primarily by changes in carbon dioxide exhalation due to lung or breathing disorders.”