Questions and Answers
What is the purpose of heat and cold application in joint care?
Total Knee Arthroplasty (TKA) is a conservative management method.
False
What is the purpose of Continuous Passive Motion (CPM) Machine in TKA?
To promote mobility and ambulation
Match the following joint replacement surgeries with their corresponding descriptions:
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What is a common risk associated with immobility after TKA surgery?
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Glucosamine and chondroitin are prescription medications used to treat joint pain.
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What is osteoporosis primarily characterized by?
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Osteomalacia is a condition associated with decreased calcification in bones.
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At what age is peak bone mass typically achieved?
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Post-menopausal women are at higher risk for osteoporosis due to a decrease in _____ levels.
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Match each term to its correct definition:
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Which of the following is NOT a risk factor for osteoporosis?
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Bone pain is often a symptom of osteoporosis in its early stages.
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Name one type of osteoporosis.
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The imaging test commonly used to assess bone density is called _____ scan.
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What is a common lifestyle change recommended to prevent osteoporosis?
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What is the primary treatment for Rheumatoid Arthritis (RA)?
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Rheumatoid factor is detected by CP.
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What is the purpose of monitoring liver enzymes and creatinine in patients taking methotrexate?
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Arthrocentesis checks for _______________________ in RA patients.
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Match the following medications with their actions in RA treatment:
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What is a potential adverse response to methotrexate?
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Etanercept is a type of NSAID.
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Why is it important to discuss contraception with patients taking methotrexate?
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What is a common adverse effect of estrogen therapy?
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Osteomyelitis is typically seen in non-diabetic patients.
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What is the primary usage of estrogen therapy in postmenopausal women?
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Osteomyelitis is an infection of the _______________________ tissue caused by bacteria, virus, parasites, or fungi.
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Hyperbaric oxygen therapy is used to treat osteomyelitis.
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Match the following types of fractures:
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What is crepitus in the context of fractures?
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Acute Compartment Syndrome (ACS) is a _______________________ emergency.
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What is a symptom of Acute Compartment Syndrome (ACS)?
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Which of the following is a key action to prevent dislocation after a Total Hip Replacement (THA)?
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It is acceptable for patients after THA to kneel in order to perform daily activities.
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What device is commonly used to promote mobility in patients after surgery to prevent deep vein thrombosis (DVT)?
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Patients after THA should perform deep __________ and use an incentive spirometer.
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Match the signs and symptoms of hip dislocation after THA with their descriptions:
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Which of the following statements is true regarding postoperative care for THA?
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Physical therapy is optional after Total Hip Replacement.
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What is the primary goal of using an incentive spirometer after surgery?
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To avoid complications, it is important for patients after THA not to __________ the knee past the belly button.
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What should patients do if they experience acute chest pain or shortness of breath after surgery?
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What is the maximum rate at which potassium can be infused intravenously?
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Potassium tablets should be crushed or chewed for faster absorption.
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What is the recommended potassium level at which a patient's potassium should be checked 4 hours after the last dose?
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Potassium is absorbed better and more comfortably when administered ______.
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Match the following potassium levels with their corresponding actions:
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If a patient's creatinine level is greater than 2 with normal body weight, potassium should be administered.
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Which of the following is NOT a factor that can lead to hypokalemia?
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Potassium is primarily an extracellular cation.
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What is the primary role of the kidneys in potassium balance?
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Low potassium levels can lead to a condition called ______, which can cause muscle weakness and paralysis.
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Match the following signs and symptoms with their corresponding potassium imbalance:
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Which of the following is a common treatment for hyperkalemia?
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Hypokalemia can be caused by excessive intake of potassium.
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What is a common dietary intervention for patients with renal disease who need to restrict potassium intake?
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The medication ______ can cause a decrease in serum potassium levels.
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Magnesium is not affected by fluid volume changes, similar to potassium.
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Which medication is used for pushing potassium into cells?
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Kayexalate binds with potassium in the bowels, allowing its excretion.
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What is the maximum rate for administering intravenous potassium?
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Always monitor the patient's __________ status when administering potassium.
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Match the potassium treatment options with their descriptions.
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What is a notable contraindication for using potassium protocols?
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It is acceptable to give intravenous potassium as a rapid IV push.
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What tool should always be used when administering intravenous potassium?
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What should be done if a patient's creatinine level is more than 2 with normal body weight?
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Potassium tablets can be crushed or chewed to increase absorption.
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What is the maximum infusion rate for potassium in mEq/100 mL?
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If the potassium level is 3.5, it should be checked _____ hours after the last potassium dose.
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When should a physician's instructions be followed in addition to given medical instructions?
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What is the maximum recommended rate for administering intravenous potassium?
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Kayexalate is an intravenous medication that directly reduces potassium levels in the blood.
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What should be monitored closely when administering potassium intravenously?
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Insulin works quickly to push potassium into ______.
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Match the following potassium treatment options with their functions:
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Which of the following is a contraindication to using potassium protocols?
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It is acceptable to give IV push potassium if a patient is experiencing severe hypokalemia.
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Protocols for administering potassium must always be checked because they are subject to ______.
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What is the primary function of potassium in the body?
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Hypokalemia can result from excessive intake of potassium.
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What condition is characterized by elevated potassium levels in the blood?
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Potassium is primarily absorbed in the body when magnesium levels are ______.
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Match the following potassium levels with their corresponding conditions:
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Which of the following is a common treatment for hypokalemia?
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Diuretics can lead to hyperkalemia.
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Name one symptom of hypokalemia.
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______ is a condition that can result in muscle twitching and paralysis due to high potassium levels.
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What can cause potassium levels to drop quickly during an illness?
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Study Notes
Objectives of Musculoskeletal Disorders Care
- Identify pathophysiology and clinical manifestations of musculoskeletal disorders.
- Recognize diagnostic tests and develop/evaluate a plan of care.
- Discuss pharmacological interventions and identify complications.
Musculoskeletal System Overview
- Comprises the skeletal (bones and joints) and muscular systems.
- Bones store calcium and phosphorus, and protect vital organs.
- Red marrow in bones generates blood cells.
- Muscle issues often follow bone-related problems.
Osteopenia & Osteoporosis
- Osteopenia: reduced bone density.
- Osteoporosis: severe osteopenia leading to significant bone deterioration.
- Falls in older patients commonly result in major health declines.
Osteoporosis Terminology
- Osteomalacia: softening of bones due to calcification issues.
- Osteoporosis is characterized by decreased bone mass.
- Bone remodeling involves osteoblasts (build bone) and osteoclasts (consume bone).
- Peak bone mass is typically reached by age 30, influenced by estrogen levels.
Types of Osteoporosis
- Generalized (Primary: due to aging, hormonal changes; Secondary: due to medications like glucocorticoids).
- Regional (localized, often after fractures or seen in astronauts).
Risk Factors for Osteoporosis
- Family history, age (increased risk after age 50), and inadequate nutrition (calcium and Vitamin D deficiency).
- Lack of weight-bearing exercise increases risk.
- Smoking, alcohol use, hormone deficiencies, low body weight, and certain medications (diuretics, steroids) contribute to risk.
Signs and Symptoms of Osteoporosis
- Often asymptomatic until fractures occur.
- Symptoms include bone pain, height loss, neck/lower back pain, and stooped posture.
Diagnostic Testing for Osteoporosis
- Lab tests: Calcium and Vitamin D levels.
- Imaging: Dual-energy X-ray absorptiometry (DXA) for assessing bone mineral density.
Prevention and Treatment of Osteoporosis
- Adequate vitamin D from sunlight; limited dietary sources.
- Engage in weight-bearing exercises (30 min, 3-4 times/week).
- Estrogen therapy can help but carries risks of thrombosis.
Osteomyelitis
- Infection of bone caused by bacteria, viruses, or fungi.
- Can be exogenous (external source), endogenous (from bloodstream), or contiguous (originating from nearby tissue).
- Common in diabetes patients and IV drug users.
Clinical Manifestations of Osteomyelitis
- Acute: fever, chills, swelling, tenderness, erythema, localized pain.
- Chronic: may exhibit foot ulcers, drainage, pain depending on blood circulation.
Risk Factors for Osteomyelitis
- Immunosuppression, malnourishment, chronic illnesses, certain medications, and presence of wounds or artificial joints.
Diagnosis of Osteomyelitis
- Laboratory tests indicating leukocytosis.
- Cultures from blood or infected area.
- Imaging via X-ray, MRI, and bone biopsy for definitive diagnosis.
Treatment of Osteomyelitis
- Nonsurgical: Antibiotic therapy (often IV), pain control, hyperbaric oxygen therapy.
- Surgical: Debridement, excision of infected bone, possible amputation.
Fractures Overview
- Classifications: Complete (all the way through) and incomplete; closed (skin intact) and open (skin broken).
- Pathologic fractures occur from minimal trauma due to underlying conditions like osteoporosis.
Clinical Manifestations of Fractures
- Pain, loss of function, deformity, crepitus (crunching sound), ecchymosis, and edema noted.
Complications of Fractures
- Acute: Increased risk of venous thromboembolism, infection, acute compartment syndrome, and fat embolism syndrome.
- Chronic: Delayed healing and chronic pain.
Acute Compartment Syndrome (ACS)
- A medical emergency; occurs when swelling compromises artery and nerve function in limbs.
- Early signs include severe pain, paresthesia, weak pulses, pallor, increased pressure, and potential paralysis.
Medications for Rheumatoid Arthritis (RA)
- NSAIDs for inflammation, steroids for flare-ups, and disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate and etanercept.
- Monitor liver enzymes and patient education on teratogenic effects and infection risks.### Joint Management
- Joint positioning and body posture are crucial, requiring active movement.
- Heat and cold applications can alleviate pain.
- Platelet-rich plasma (PRP) treatment uses the patient’s own platelets to aid local tissue repair.
- Addressing obesity is vital for promoting weight loss and reducing joint stress.
Physical Therapy and Support
- Physical therapy strengthens muscles to support skeletal stability.
- Assistive devices like walkers and canes enhance mobility.
- Over-the-counter supplements such as glucosamine and chondroitin support joint health.
- Medical marijuana may provide pain relief for some patients.
Joint Replacement Overview
- Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA) are common orthopedic procedures.
- Considered when conservative management fails.
Total Knee Replacement (TKA)
- Cartilage degradation leads to pain; replacing cartilage alleviates discomfort.
Nursing Management for TKA
- Emphasizes infection prevention during and after surgery.
- Implement effective pain control measures, including catheters for targeted infusion.
- Mobilization is critical; patients should ambulate on the day of surgery.
- Continuous Passive Motion (CPM) devices enhance range of motion post-surgery.
- Deep Vein Thrombosis (DVT) prevention includes mobility encouragement and anticoagulant therapy.
Post-Operative Guidelines for TKA
- Use an incentive spirometer and encourage coughing and deep breathing to prevent respiratory issues.
- Advise against kneeling to protect the knee incision.
- Avoid hyperflexion and hyperextension to prevent dislocation risks.
Total Hip Replacement (THA)
- Replaces the femur's ball and pelvis socket; a complex procedure with extensive implications.
Nursing Management for THA
- Post-operative care includes dislocation prevention measures.
- Use abduction pillows to maintain leg positioning.
- Prohibit adduction and severe flexion at the hip.
- Elevate toilet seats and monitor dressing integrity.
- Collaborate closely with physical therapy for strength recovery.
- Continuous Strain Devices (SCDs) and compression stockings may be necessary for circulation.
Preventing Hip Dislocation After THR
- Maintain straight leg positioning with no internal rotation.
- Avoid bending the hip beyond 90 degrees or moving the knee past the midline.
- Provide support between legs to prevent dislocation.
Signs and Symptoms of Hip Dislocation
- Sudden increased pain and swelling at the surgical site.
- Acute groin pain and possible audible “popping” sounds.
- Observed abnormal foot rotation and reduced mobility of the affected limb.
Discharge Planning for TKA/THA
- Arrange for ongoing physical therapy.
- Focus on prevention of infections, DVT, and dislocation.
- Establish follow-up appointments and define red flags that warrant immediate medical attention, such as chest pain or breath shortness.
Potassium Overview
- Normal serum potassium levels range from 3.5 to 5.0 mEq/L.
- Potassium serves as an intracellular cation vital for muscle contraction, cardiac function, nerve impulses, and acid-base regulation.
Potassium Balance and Kidney Function
- Proper kidney function is essential for potassium balance; it adjusts potassium levels via excretion or reabsorption.
- Significant changes in serum potassium levels are seen with renal failure, reflected by increased potassium.
Hypokalemia Causes
- Occurs with excessive intake, deficient intake, kidney failure, loss of body fluids, medications, or hypomagnesemia.
- Diuretics significantly contribute to hypokalemia, leading to potential hyponatremia.
- Insulin administration lowers serum potassium by driving potassium into cells.
Hyperkalemia Causes
- Caused by excessive potassium intake, kidney failure, or tissue/crush injuries that release potassium from cells.
Dietary Considerations
- Patients with renal disease need careful monitoring of potassium intake; holiday foods often contain high potassium levels.
Signs and Symptoms of Hypokalemia
- Cardiac: Dysrhythmias and bradycardia.
- CNS: Lethargy, confusion, irritability, and anxiety.
- Muscular: Weakness, paralysis, shallow respirations.
- GI: Nausea, vomiting, constipation, and paralytic ileus.
Signs and Symptoms of Hyperkalemia
- Increased irritability and anxiety.
- Muscle twitching that may progress to paralysis.
- Bradycardia resulting from altered nerve impulses in muscles.
Treatment for Hypokalemia
- Identify and correct the underlying cause.
- Potassium replacement therapy can be oral or IV.
- Nutritional therapy with potassium monitoring.
- Cardiac and respiratory functions must be carefully monitored.
Treatment for Hyperkalemia
- Dialysis is often required for severe hyperkalemia.
- Medications like Kayexalate can help remove excess potassium.
- Insulin administration can push potassium back into cells for quick action.
Administering Intravenous Potassium
- Administer slowly, no faster than 10 mEq/hr, using a pump to avoid vein irritation.
- Always be cautious, as excessive potassium can cause fatal cardiac dysrhythmias.
- Monitor blood sugar when giving insulin with potassium.
Protocol Guidelines
- Familiarize yourself with protocols and contraindications; do not memorize them as they may change.
- Monitor patients on potassium; assess creatinine levels and dietary restrictions.
- Ensure proper administration techniques and patient safety checks prior to administering potassium.
Special Considerations
- Avoid potassium administration in patients with creatinine levels above 2 or those weighing less than 40 kg if normal creatinine.
- Check potassium levels frequently if critically low; follow up within four hours post-dose as needed.
Potassium Overview
- Normal serum potassium levels range from 3.5 to 5.0 mEq/L.
- Potassium serves as an intracellular cation vital for muscle contraction, cardiac function, nerve impulses, and acid-base regulation.
Potassium Balance and Kidney Function
- Proper kidney function is essential for potassium balance; it adjusts potassium levels via excretion or reabsorption.
- Significant changes in serum potassium levels are seen with renal failure, reflected by increased potassium.
Hypokalemia Causes
- Occurs with excessive intake, deficient intake, kidney failure, loss of body fluids, medications, or hypomagnesemia.
- Diuretics significantly contribute to hypokalemia, leading to potential hyponatremia.
- Insulin administration lowers serum potassium by driving potassium into cells.
Hyperkalemia Causes
- Caused by excessive potassium intake, kidney failure, or tissue/crush injuries that release potassium from cells.
Dietary Considerations
- Patients with renal disease need careful monitoring of potassium intake; holiday foods often contain high potassium levels.
Signs and Symptoms of Hypokalemia
- Cardiac: Dysrhythmias and bradycardia.
- CNS: Lethargy, confusion, irritability, and anxiety.
- Muscular: Weakness, paralysis, shallow respirations.
- GI: Nausea, vomiting, constipation, and paralytic ileus.
Signs and Symptoms of Hyperkalemia
- Increased irritability and anxiety.
- Muscle twitching that may progress to paralysis.
- Bradycardia resulting from altered nerve impulses in muscles.
Treatment for Hypokalemia
- Identify and correct the underlying cause.
- Potassium replacement therapy can be oral or IV.
- Nutritional therapy with potassium monitoring.
- Cardiac and respiratory functions must be carefully monitored.
Treatment for Hyperkalemia
- Dialysis is often required for severe hyperkalemia.
- Medications like Kayexalate can help remove excess potassium.
- Insulin administration can push potassium back into cells for quick action.
Administering Intravenous Potassium
- Administer slowly, no faster than 10 mEq/hr, using a pump to avoid vein irritation.
- Always be cautious, as excessive potassium can cause fatal cardiac dysrhythmias.
- Monitor blood sugar when giving insulin with potassium.
Protocol Guidelines
- Familiarize yourself with protocols and contraindications; do not memorize them as they may change.
- Monitor patients on potassium; assess creatinine levels and dietary restrictions.
- Ensure proper administration techniques and patient safety checks prior to administering potassium.
Special Considerations
- Avoid potassium administration in patients with creatinine levels above 2 or those weighing less than 40 kg if normal creatinine.
- Check potassium levels frequently if critically low; follow up within four hours post-dose as needed.
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Description
This quiz covers the care of patients with musculoskeletal disorders, including pathophysiology, clinical manifestations, diagnostic tests, and developing a plan of care.