A patient with acute renal failure (ARF) is admitted due to uncontrolled type 1 diabetes mellitus and hyperkalemia. The nurse administers an IV dose of regular insulin per sliding scale.
What is the most important intervention for the nurse to include in this patient’s plan of care?
A.
Monitor the patient’s cardiac activity via telemetry.
B.
Assess glucose via fingerstick every 4 to 6 hours.
C.
Evaluate hourly urine output for return of normal renal function.
D.
Maintain venous access with an infusion of normal saline.
The Correct Answer and Explanation is:
The most important intervention for the nurse to include in this patient’s plan of care is:
A. Monitor the patient’s cardiac activity via telemetry.
Explanation:
In a patient with acute renal failure (ARF) and hyperkalemia, the most critical intervention involves monitoring cardiac activity via telemetry. This is because hyperkalemia, or elevated potassium levels in the blood, has significant implications for cardiac health.
Hyperkalemia and Cardiac Risk: Potassium plays a crucial role in maintaining normal cardiac function. Elevated potassium levels can disrupt the heart’s electrical activity, leading to potentially life-threatening arrhythmias, such as ventricular fibrillation or asystole. These arrhythmias can cause sudden cardiac arrest if not promptly identified and managed. Regular insulin administration is a common treatment for hyperkalemia because it helps drive potassium into the cells, thereby lowering serum potassium levels. However, while insulin helps reduce the potassium level, it doesn’t immediately resolve the risk of cardiac complications.
Monitoring Cardiac Activity: Telemetry monitoring allows continuous observation of the patient’s heart rhythm and can quickly detect any changes that indicate arrhythmias or other cardiac issues related to hyperkalemia. This monitoring is essential because it provides real-time data that can be used to guide further treatment decisions and ensure timely intervention if cardiac issues arise.
Other Interventions:
- Assess glucose via fingerstick every 4 to 6 hours (B): While monitoring glucose levels is important, especially in a patient with uncontrolled type 1 diabetes, it is not the most immediate concern in the context of acute renal failure and hyperkalemia.
- Evaluate hourly urine output for return of normal renal function (C): While monitoring urine output is critical in assessing renal function, the immediate risk of cardiac complications due to hyperkalemia takes precedence.
- Maintain venous access with an infusion of normal saline (D): Maintaining venous access is important for overall management but does not directly address the immediate risk of cardiac disturbances associated with hyperkalemia.
In summary, telemetry monitoring is the most crucial intervention because it helps detect and address the potentially severe cardiac effects of hyperkalemia, ensuring prompt treatment and reducing the risk of serious cardiac events.