Running head: CLINICAL EXEMPLAR: HYPERKALEMIA 1

Treating Hyperkalemia

Kimone Wright

University of South Florida College of Nursing

Running head: CLINICAL EXEMPLAR: HYPERKALEMIA 2

Treating Hyperkalemia
A clinical exemplar is a patients story that is told to demonstrate a registered nurses
experience and clinical practice (Pacini, 2013). It describes a unique clinical situation that may
be important to the nurse, and includes the nurses thoughts, feelings, intentions, actions, critical
thinking, and decision-making process regarding that situation (Pacini, 2013). During
preceptorship, my preceptor and I had an experience that I deem important. This story is
important to me because it reminds me of the many responsibilities we have as nurses, including
being our patients advocate.
After taking report on our patient and doing our first-shift assessment, we reviewed our
patients record. We confirmed that our patient presented to the emergency department, on the
previous day, with complaints of weakness, bilateral shoulder pain, and abdominal cramps. Her
lab results showed that her potassium level was 6.9 upon admission. She was diagnosed with
hyperkalemia and was given sodium polystyrene sulfonate (Kayexalate) along with potassium
cocktail to treat the hyperkalemia. She was admitted on the medical surgical floor for
observation and further management of her diagnosis. We recognized that the patients
potassium went down from 6.9 to 6.4. However, this was still elevated. 10 units of regular
insulin, calcium gluconate, and sodium polystyrene sulfonate (Kayexalate) were ordered by the
physician assistant for the high potassium level. However, there was no D5W ordered to go with
the insulin. We became concerned. My preceptor contacted the charge nurse and then called the
physician and expressed our concerns. The physician told my preceptor to discontinue the insulin
and administer the calcium gluconate, and sodium polystyrene sulfonate (Kayexalate).
We knew there was a problem after recognizing the patients elevated potassium level and
the order for 10 units of regular insulin, calcium gluconate, and Kayexalate, without an order for
D5W. Treatments for hyperkalemia include supplying calcium to the body through an IV to treat
the effects on muscles and the heart or administering glucose and insulin through an IV to
decrease potassium levels long enough to correct the cause (American Heart Association, 2017).
To clarify the order, we needed to speak with the patients physician or physicians assistant. My
preceptor felt more comfortable talking with the physician. We brought the situation to the
charge nurses attention and then called the physician. We made the decision to call the
physician before administering the medication because insulin was ordered without glucose and
this was against the protocol. We eventually administered sodium polystyrene sulfonate
Running head: CLINICAL EXEMPLAR: HYPERKALEMIA 3

(Kayexalate) and the calcium gluconate after the doctor adjusted the order. We were a lot more
comfortable administering the medications on the new order.
The patients history of chronic kidney disease, diabetes mellitus, and congestive heart
failure puts her at risk for developing hyperkalemia. Potassium plays a crucial role in electric
signal functioning of the hearts middle thick muscle layer, known as the myocardium. When the
level of potassium is above the normal level (hyperkalemia), this can interfere with proper
electric signals in that muscle layer and lead to different types of heart arrhythmias (American
Heart Association, 2017). If the hyperkalemia was not fixed, the patient could have had
arrhythmias that could potentially become life-threatening.
It was necessary that we contacted the physician immediately after we noticed the elevated
potassium level and the medication orders. It was crucial that we administered the right
medication to this patient as soon as possible to prevent life-threatening arrhythmias that could
have potentially led to death or other serious complications. I believe we made the right decision
by calling the physician when we had questions about the order. The physician adjusted the order
and the patients potassium decreased from 6.4 to 5.4 a few hours after we administered the
sodium polystyrene sulfonate (Kayexalate) and the calcium gluconate. Also, the patient did not
develop any further complications and we achieved the desired outcome.
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Reference

American Heart Association (2017). Hyperkalemia (High Potassium). Retrieved from

http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartF
ailure/Hyperkalemia-High-Potassium_UCM_488806_Article.jsp#.WWoomojyvIU
Pacini, C. M. (2013). Writing Exemplars. Retrieved from https://www.med.umich.edu/nursing-
PDE/framework/docs/writingExemplars.pdf