The client with acute renal failure has a serum potassium level of 5.8 mEq/L. The nurse would plan which of the following as a priority action?
A. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration.
B. Encourage increased vegetables in the diet.
C. Place the client on a cardiac monitor.
D. Check the sodium level.
Correct Answer: C. Place the client on a cardiac monitor.
The client with hyperkalemia is at risk for developing cardiac dysrhythmias and cardiac arrest. Because of this, the client should be placed on a cardiac monitor. Observe ECG or telemetry for changes in rhythm. Changes in electromechanical function may become evident in response to progressing renal failure and accumulation of toxins and electrolyte imbalance. Peaked T wave, wide QRS, prolonged PR interval is usually associated with hyperkalemia.
Option A: Fluid intake is not increased because it contributes to fluid overload and would not affect the serum potassium level significantly. Monitor BP and HR. Fluid volume excess, combined with hypertension (common in renal failure) and effects of uremia, increases cardiac workload and can lead to cardiac failure. In ARF, cardiac failure is usually reversible.
Option B: Vegetables are a natural source of potassium in the diet, and their use would not be increased. During the oliguric phase, hyperkalemia is present but often shifts to hypokalemia in the diuretic or recovery phase. Any potassium value associated with ECG changes requires intervention. Note: A serum level of 6.5 mEq or higher constitutes a medical emergency.
Option D: The nurse may also assess the sodium level because sodium is another electrolyte commonly measured with the potassium level. However, this is not a priority action at this time. Investigate reports of muscle cramps, numbness of fingers, muscle twitching, hyperreflexia. Neuromuscular indicators of hypocalcemia, which can also affect cardiac contractility and function.
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