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1. Question
Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions should the nurse take to plan for preparation and administration of the potassium? Select all that apply.
Correct
Option A,B,E,F are correct answer:
Rationale: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely, because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the primary health care provider if the urinary output is less than 30 mL/hr.
Incorrect
Option A,B,E,F are correct answer:
Rationale: Potassium chloride administered intravenously must always be diluted in IV fluid and infused via an infusion pump. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. The nurse should ensure that the potassium is diluted in the appropriate amount of diluent or fluid. The IV bag containing the potassium chloride should always be labeled with the volume of potassium it contains. The IV site is monitored closely, because potassium chloride is irritating to the veins and there is risk of phlebitis. In addition, the nurse should monitor for infiltration. The nurse monitors urinary output during administration and contacts the primary health care provider if the urinary output is less than 30 mL/hr.
Guidelines for the Use of Potassium Chloride
Recommended Neonatal Dose, Route, and Interval
Initial oral replacement Therapy:
5-1 mEq/kg/day in divided doses
Small, more frequent aliquots preferred (every feed or every other feed)
Adjust dosage based on monitoring of potassium concentrations
1mEq K = 74.6 mg KCl
Acute treatment of symptomatic Hypokalemia
Begin with 0.5 to 1 mEq/kg IV to infuse at 0.3-0.5mEq/kg/hr (Max rate = 1mEq/kg/hr)
Maximum concentration: 40 mEq/L for peripheral & 80 mEq/L for central venous infusions.
Chief Indications
Treatment of Hypokalemia
Adjunct to diuretic therapy
Prevention of digoxin toxicity potentiated by hypokalemia
Possible Adverse Reactions:
Hyperkalemia
PO administration may cause GI irritation, vomiting, diarrhea, bleeding.
IV administration may cause irritation, pain or phlebitis at the infusion site.
Rapid IV infusion may cause cardiac arrhythmias.
Contraindications & Precautions
Hypersensitivity to potassium chloride products
Severe renal impairment or hyperkalemia
Use with caution in patients with cardiac disease
Nursing Implications
Monitor serum potassium concentrations. If serum potassium level is not rising with effective potassium supplementation, consider checking a magnesium level.
Continuous cardiac monitoring is mandatory for IV replacement especially for central infusions
Peripheral Line Concentration = 0.1mEq/mL; Central Line Concentration = 0.2mEq/mL
Watch IV site for signs of irritation or phlebitis.
KCl oral supplementation will be diluted by pharmacy to a concentration of 1mEq/mL
