Part 2.

Essay
1. What is the reason why hypotonic sodium solution (0.3% sodium chloride) is more
preferred than D5W in the treatment of hypernatremia? (3 points)
Because it allows gradual reduction in the serum Sodium level. It lessens
risk of Cerebral Edema. When sodium level is rapidly reduced, it causes
temporary decrease in plasma osmolality below that of fluid in the brain tissue,
causing harmful cerebral edema.

2. What is the major drive for respiration to those individuals whose PaCO2 is chronically
greater than 50 mm Hg and why? (5 points)
Hypoxemia (low O2 in the blood) because if the PaCO2 us chronically
greater than 50 mmHg, the respiratory center becomes relatively insensitive to
CO2 as a respiratory stimulant.

3. Why hyperkalemia is usually associated with metabolic acidosis? (3 points)

In Acidosis, where blood pH decreases, Hydrogen ions increase in the ECF and
move into the cell. To keep the ICF electrically neutral, an equal amount of K+
iins leave the cell, causing hyperkalemia.

4. Why hypokalemia is usually associated with metabolic alkalosis? (3 points)

In Alkalosis (elevated blood pH), H+ ions increase in the ICF and move out of the
cell. To keep the ICF electrically neutral, K+ ions move from the ECF to ICF,
causing hypokalemia.

5. Why is high –carbohydrate parenteral nutrition a risk factor for hypokalemia?(3 points)
Because insulin promotes entry of K+ into skeletal muscle and hepatic cells,
patients with persistent insulin hypersecretioj may experience hypokalemia. (P.
30, module 3)
6. Why potassium is never given by IV push or intramuscularly? (3points)
This is to avoid replacing Potassium too quickly. (p. 36, module 3)

7. What are the nursing responsibilities for the preparation and administration of the
potassium? (10 points)

Hypokalemia can be life-threatening.

Monitor for its early presence in patients at risk. Fatigue, Anorexia, Muscle
Weakness, decreased bowel motility, paresthiasis, and dysrhythmias are signs
and symptoms that mandate the assessment of serum K+ concentration.
Monitor ECG. Patients receiving digitalis who are at risk for hypokalemia should
be monitored closely for signs and symptoms of digitalis toxicity. Potassium
deficiency potentiates the action of digitalis.
The oral route is ideal to treat mild to moderate hypokalemia because oral K+
supplements are absorbed well. Be careful in administering oral K+ particularly in
older adults who have lower lean body mass and total-body K+ levels, and
therefore, lower K+ requirement. Also because of physiological impaired renal
function as one ages, K+ may be retained in the body more. Oral K+
supplements can produce small bowel lesions. Patient must be assessed for and
cautioned about abdominal distention, pain, or GI bleeding.
Potassium is never given by IV push or IM to avoid replacing K+ too quickly. It
must be given with an infusion pump. The nurse must monitor I & O. Potassium
should only be administered with adequate urine output. A decreased urine
output (<20 mEq/L) for 2 consecutive hours is a signal to stop the infusion and
notify physician immediately. Since Potassium is excreted primarily by the
kidneys, when oliguria occurs, K+ administration can cause a harmful increase in
body’s serum K+.
Be careful in selecting a premixed solution, of KCl-containing IV fluid because of
its concentration (10-40 mEq/100mL). BUN and Creatinine levels are monitored
for patient’s renal function, and urine output as well. During replacement therapy,
it is important to closely monitor patient for signs and symptoms of worsening
hypokalemia and in some cases, development of hyperkalemia.