護理師護理一名正在接受靜脈注射氯化鉀的病人，下列哪些發現需立即處理？（選所有適合的）
A nurse is caring for a client who is receiving intravenous potassium chloride. Which findings should the nurse identify as requiring immediate intervention? (Select all that apply.)
- ABurning at the IV site✓ 正解靜脈注射部位有灼熱感
- BSerum potassium level of 4.2 mEq/L血清鉀濃度為 4.2 mEq/L
- CPeaked T waves on the ECG✓ 正解心電圖出現高尖 T 波
- DDecreased urine output✓ 正解尿量減少
- EHeart rate of 62 bpm心率為每分鐘 62 次
氯化鉀具有極強的刺激性，靜脈外滲會導致組織壞死（Burning sensation）。高血鉀（Peaked T waves）代表毒性反應，應停止給藥。少尿或無尿是腎功能警訊，鉀離子若無法排出將迅速累積致命，故這三項皆為緊急處理對象。4.2 mEq/L 與心跳 62 bpm 為正常範圍。
Potassium chloride is highly irritating; extravasation from the vein can cause tissue necrosis (often felt initially as burning). Hyperkalemia (peaked T waves) indicates toxicity and the infusion should be stopped. Oliguria or anuria is a warning sign of renal impairment, since potassium that cannot be excreted will rapidly accumulate to fatal levels; these three findings require immediate intervention. A serum potassium of 4.2 mEq/L and a heart rate of 62 bpm are within normal limits.
美國醫院鉀離子給藥多依賴中央靜脈導管，台灣臨床常見周邊靜脈給藥，故滲漏風險評估更為重要。