Hyperkalemia in Kidney Disease
A 63-year-old client on hemodialysis three times weekly missed the last two sessions and comes to the emergency department reporting muscle weakness and palpitations.
Recognize cues
Vital signs: BP 168/94, HR 58 and irregular, RR 20, SpO2 96%. Potassium 6.9 mEq/L, BUN 82 mg/dL, creatinine 8.4 mg/dL. The ECG shows tall peaked T waves and a widening QRS. Weight is up 4 kg since the last dialysis.
Which finding requires the most immediate follow-up?
Take action
The provider orders continuous cardiac monitoring, IV calcium gluconate, IV regular insulin with dextrose, and emergent hemodialysis.
Which two actions should the nurse take first?
Evaluate outcomes
After treatment and dialysis: potassium 4.6 mEq/L, HR 76 and regular, ECG shows normal T waves and a narrow QRS. The client reports the palpitations have stopped and strength has returned.
Which finding best indicates the treatment is working?
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