James Karl San Antonio

CON 1A
DATE TRADE/ PHARMACOLOGIC INDICATION AND ADVERSE DESIRED NURSING RESPONSIBILITIES
ORDERED/ BRAND ACTION OF DRUG CONTRAINDICATIONS EFFECTS OF THE ACTION ON /PRECAUTIONS
(Generic name, NAME DRUG CLIENT
dosage, route, (disease related)
frequency)
Assessment
Hyperkalemia; Severe renal ● Assess for signs and
impairment; Untreated CNS: confusion, symptoms of hypokalemia
Bisacodyl Replacement. Addison’s disease; Severe restlessness, Replacement. (weakness, fatigue, U wave on
POTASSIUM
Prevention of tissue trauma; Hyperkalemic weakness. CV: Prevention of ECG, arrhythmias,
SUPPLEMENTS, ARRHYTHMIAS,
deficiency. familial periodic paralysis; deficiency. polyuria, polydipsia) and
PO, IV (Adults): ECG changes. GI:
Some products may contain hyperkalemia (see Toxicity and
40mEq Maintain acid-base tartrazine (FDC yellow dye #5) abdominal pain, Overdose).
balance, isotonicity, or alcohol; avoid using in diarrhea, ● Monitor pulse, BP, and ECG
and electrophysiologic patients with flatulence, nausea, periodically during
balance of the cell. Name vomiting; tablets, IV therapy.
Activator in many /bks_51510_deglin_dg/51510_ capsules ● Lab Test Considerations:
enzymatic reactions; p 02/21/2012 02:08PM Plate # only, GI ulceration, Monitor serum potassium before
essential to 0-Compositepg 1038 # 68 stenotic lesions. and periodically during therapy.
transmission of nerve 1038 POTASSIUM Local: irritation at Monitor renal function, serum
impulses; contraction SUPPLEMENTS IV site. Neuro: bicarbonate, and pH. Determine
of cardiac, skeletal, and known hypersensitivity or paralysis, serum magnesium level if
smooth muscle; gastric intolerance; Potassium acetate paresthesia. patient
secretion; renal injection contains aluminum, has refractory hypokalemia;
function; tissue which may become toxic with hypomagnesemia
synthesis; and prolonged use to high risk should be corrected to facilitate
carbohydrate groups effectiveness of
metabolism (renal impairment, premature potassium replacement. Monitor
neonates). serum chloride
because hypochloremia may
occur if replacing
potassium without concurrent
chloride.
● Toxicity and Overdose:
Symptoms of toxicity
are those of hyperkalemia
(slow, irregular heartbeat;
fatigue; muscle weakness;
paresthesia; confusion;
dyspnea; peaked T waves;
depressed ST
segments; prolonged QT
segments; widened QRS
complexes; loss of P waves;
and cardiac arrhythmias).
● Treatment includes
discontinuation of potassium,
administration of sodium
bicarbonate to correct
acidosis, dextrose and insulin to
facilitate passage
of potassium into cells, calcium
salts to reverse
ECG effects (in patients who
are not receiving digoxin),
sodium polystyrene used as an
exchange
resin, and/or dialysis for patient
with impaired
renal function.
Potential Nursing Diagnoses
Imbalanced nutrition: less than
body requirements
(Indications)
Implementation
● High Alert: Medication errors
involving too
rapid infusion or bolus IV
administration of potassium
chloride have resulted in
fatalities. See IV
administration guidelines below.
● For most purposes, potassium
chloride should be
used, except for renal tubular
acidoses (hyperchloremic
acidosis), in which other salts
are more
appropriate (potassium
bicarbonate, potassium
citrate, or potassium gluconate).
● If hypokalemia is secondary to
diuretic therapy,
consideration should be given to
decreasing the
dose of diuretic, unless there is
a history of significant
arrhythmias or concurrent
digitalis glycoside therapy.
● PO: Administer with or after
meals to decrease GI
irritation.
● Use of tablets and capsules
should be reserved for
patients who cannot tolerate
liquid preparations.
● Dissolve effervescent tablets
in 3–8 oz of cold
water. Ensure that effervescent
tablet is fully dissolved.
Powders and solutions should
be diluted
in 3–8 oz of cold water or juice
(do not use tomato juice if
patient is on sodium restriction).
Instruct patient to drink slowly
over 5–10 min.
● Tablets and capsules should
be taken with a meal
and full glass of water. Do not
chew or crush enteric-coated or
extended-release tablets or
capsules. Micro-K ExtenCaps
capsules can be opened
and sprinkled on soft food
(pudding, applesauce) and
swallowed immediately with a
glass of
cool water or juice.
● IV: Assess for extravasation;
severe pain and tissue necrosis
may occur. High Alert: Never
administer potassium IV push or
bolus.
Potassium Acetate
● Continuous Infusion: High
Alert: Do not administer
undiluted. Each single dose
must be diluted and thoroughly
mixed in 100–1000 mL of
dextrose, saline, Ringer’s or LR,
dextrose/saline,
dextrose/Ringer’s, or LR
combinations. Usually
limited to 80 mEq/L via
peripheral line (200
mEq/L via central line).
● Rate: High Alert: Infuse
slowly, at a rate up to
10 mEq/hr in adults or 0.5
mEq/kg/hr in children
on general care areas. Check
hospital policy for
maximum infusion rates
(maximum rate in monitored
setting 40 mEq/hr in adults or 1
mEq/kg/hr
in children).
● Y-Site Compatibility:
ciprofloxacin.
Potassium Chloride
● Continuous Infusion: High
Alert: Do not administer
concentrations of 1.5 mEq/mL
undiluted; fatalities have
occurred. Concentrated
products have black caps on
vials or black stripes
above constriction on ampules
and are labeled
with a warning about dilution
requirement. Each
single dose must be diluted and
thoroughly mixed
in 100–1000 mL of IV solution.
Usually limited to
80 mEq/L via peripheral line
(200 mEq/L via central line).
● Concentrations of 0.1 and 0.4
mEq/mL are intended for
administration via calibrated
infusion
device and do not require
dilution.
● Rate: High Alert: Infuse
slowly, at a rate up to
10 mEq/hr in adults or 0.5
mEq/kg/hr in children
in general care areas. Check
hospital policy for
maximum infusion rates
(maximum rate in monitored
setting 40 mEq/hr in adults or 1
mEq/kg/hr
in children). Use an infusion
pump.
● Solution Compatibility: May be
diluted in dextrose, saline,
Ringer’s solution, LR,
dextrose/saline,
dextrose/Ringer’s solution, and
dextrose/LR
combinations. Commercially
available premixed
with many of the above IV
solutions.
● Y-Site Compatibility: acyclovir,
alemtuzumab,
alfentanil, allopurinol,
alprostadil, amifostine,
amikacin, aminophylline,
amiodarone, amphotericin B
liposome, anidulafungin,
argatroban,
ascorbic acid, atracurium,
atropine, aztreonam,
benztropine, betamethasone,
bivalirudin, bleomycin,
bumetanide, buprenorphine,
butorphanol,
calcium chloride, calcium
gluconate, carboplatin,
carmustine, caspofungin,
cefazolin, cefoperazone,
cefotaxime, cefotetan, cefoxitin,
ceftaroline,
ceftazidime, ceftriaxone,
cefuroxime, chloramphenicol,
chlorpromazine, ciprofloxacin,
cisatracurium, cisplatin,
cladribine, clindamycin,
cyanocobalamin,
cyclophosphamide,
cyclosporine,
cytarabine, dactinomycin,
daptomycin, dexamethasone
sodium phosphate,
dexmedetomidine,
digoxin, diltiazem,
diphenhydramine, dobutamine,
docetaxel, dopamine,
doripenem, doxacurium,
doxorubicin hydrochloride,
doxorubicin liposome,
doxycycline, droperidol,
edrophonium,
enalaprilat, ephedrine,
epinephrine, epirubicin,
epoetin alfa, eptifibatide,
ertapenem, esmolol,
conjugated estrogens,
etoposide, etoposide
phosphate, famotidine,
fenoldopam, fentanyl, filgrastim,
fluconazole, fludarabine,
fluorouracil, folic
acid, furosemide, ganciclovir,
gemcitabine, gentamicin,
granisetron, heparin,
hydrocortisone,
hydromorphone, idarubicin ,
ifosfamide, imipenem/cilastatin,
indomethacin, insulin,
irinotecan,
isoproterenol, ketamine,
ketorolac, labetalol,
levofloxacin, lidocaine, linezolid,
lorazepam, magnesium sulfate,
mannitol, mechlorethamine,
melphalan, meperidine,
meropenem, metaraminol,
methotrexate, methoxamine,
methyldopate,
methylergonovine,
meticlopramide, metoprolol,
metronidazole, micafungin,
midazolam, milrinone,
mitoxandrone, morphine,
multivitamine,
mycophenolate, nafcillin,
nalbuphine, naloxone,
neostigmine, nesiritide,
nicardipine, nitroglycerin,
nitroprusside, norepinephrine,
octreotide,
ondansetron, oxacillin,
oxaliplatin, oxytocin, paclitaxel,
palonosetron, pamidronate,
pancuronium, pantoprazole,
papaverine, pemetrexed,
penicillin G, pentazocine,
pentobarbital, phenobarbital,
phentolamine, phenylephrine,
phytonadione,
piperacillin/tazobactam,
procainamide,
prochlorperazine, propofol,
propranolol, protamine,
pyridostigmine, pyridoxime,
quinupristin/
dalfopristin, ranitidine,
remifentanil, rituximab,
rocuronium, sargramostim,
scopolamine, sodium acetate,
sodium bicarbonate,
streptokinase,
succinylcholine, tacrolimus,
telavancin, teniposide,
theophylline, thiamine, thiotepa,
ticarcillin/
clavulanate, tirofiban,
tobramycin, tolazoline,
trastuzumab, trimetaphan,
vancomycin, vasopressin,
verapamil, vincristine,
vinorelbine, voriconazole,
warfarin, zidovudine, zoledronic
acid.
● Y-Site Incompatibility:
amphotericin B cholesteryl,
amphotericin B colloidal,
azithromycin,
dantrolene, diazepam,
diazoxide, haloperidol,
pentamidine, phenytoin,
trimethoprim/sulfamethoxazole.
Patient/Family Teaching
● Explain to patient purpose of
the medication and
the need to take as directed,
especially when concurrent
digoxin or diuretics are taken.
Take
missed doses as soon as
remembered within 2
hr; if not, return to regular dose
schedule. Do not
double dose.
● Emphasize correct method of
administration. GI
irritation or ulceration may result
from chewing
enteric-coated tablets or
insufficient dilution of
liquid or powder forms.
● Some extended-release
tablets are contained in a
wax matrix that may be expelled
in the stool. This
occurrence is not significant.
● Instruct patient to avoid salt
substitutes or lowsalt milk or
food unless approved by health
care
professional. Patient should be
advised to read all
labels to prevent excess
potassium intake.
● Advise patient regarding
sources of dietary potassium
(see Appendix M). Encourage
compliance
with recommended diet.
● Instruct patient to report dark,
tarry, or bloody
stools; weakness; unusual
fatigue; or tingling of
extremities. Notify health care
professional if nausea, vomiting,
diarrhea, or stomach discomfort
persists. Dosage may require
adjustment.
● Emphasize the importance of
regular follow-up
exams to monitor serum levels
and progress.
Evaluation/Desired Outcomes
● Prevention and correction of
serum potassium
depletion.
● Cessation of arrhythmias
caused by digoxin toxicity.