Intravenous Calcium. Search dates: February, September, and December 2014. Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy []. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. Potassium supplements are used to treat severe hypokalemia. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. (2015 Nov 22). Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Diarrhea. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This is a community of professional nurses gifted with literary skills who share theoretical and clinical knowledge, nursing tidbits, facts, statistics, healthcare information, news, disease data, care plans, drugs and anything under the umbrella of nursing. Learn how your comment data is processed. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Diuretics. For more information, check out our privacy policy. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. If able to eat and drink, administer PO potassium. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. Muscular cramps or twitching hyperkalemia or high potassium levels in the blood can cause alteration in the voltage of the nerve cells causing unregulated muscle contractions. Muscle wasting and paralysis can result from very low potassium levels. Although redistributive hyperkalemia is uncommon, a cautious approach is warranted because treatment may not involve attempts to eliminate potassium, and correction of the underlying problem can provoke rebound hypokalemia. Assess the level of consciousness and neuromuscular function, including sensation, strength, and movement.The client is usually conscious and alert; however, muscular paresthesia, weakness, and flaccid paralysis may occur. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Please follow your facilities guidelines and policies and procedures. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. 3. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. Intravenous potassium should be reserved for patients with severe hypokalemia (serum potassium < 2.5 mEq per L [2.5 mmol per L]), hypokalemic ECG changes, or physical signs or symptoms of hypokalemia, or for those unable to tolerate the oral form. Hypokalemia (serum potassium level less than 3.6 mEq per L [3.6 mmol per L]) occurs in up to 21% of hospitalized patients and 2% to 3% of outpatients.13 Hyperkalemia (serum potassium level more than 5 mEq per L [5 mmol per L] in adults, more than 5.5 mEq per L [5.5 mmol per L] in children, and more than 6 mEq per L [6 mmol per L] in neonates) occurs in up to 10% of hospitalized patients and approximately 1% of outpatients.4,5 The body's plasma potassium concentration is closely regulated by a variety of mechanisms. The normal blood potassium level is 3.5 5.0 mEq/L. Strategies to prevent chronic hyperkalemia include instructing patients to eat a low-potassium diet, discontinuing or adjusting medications, avoiding nonsteroidal anti-inflammatory drugs, and adding a diuretic if the patient has sufficient renal function. The rapidity and method of potassium repletion depends on the: knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. Fluid loss from the body such as vomiting and diarrhea causes depletion of the electrolyte potassium partly because potassium is actually lost with gastric fluid. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Crackles. Electrolyte imbalance associated with potassium imbalance (hypokalemia/hyperkalemia) can be caused by conditions affecting the regulation, intake and excretion, and movement of potassium in the cellular space. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. 1 - 3 Hyperkalemia (serum potassium level. Possibly evidenced by Ascites. Implement safety measures when administering IV potassium.Because IV potassium infusion can cause phlebitis as a complication, the nurse should regularly check the IV site for indications of phlebitis or infiltration. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Saunders comprehensive review for the NCLEX-RN examination. 2. Because of their increased risk of developing hyperkalemia, patients with underlying renal dysfunction merit special attention.22, Severe hyperkalemia (more than 6.5 mEq per L [6.5 mmol per L]) can cause muscle weakness, ascending paralysis, heart palpitations, and paresthesias. All information expressed here are courtesies of the respective authors. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. Evaluation begins with a search for warning signs or symptoms warranting urgent treatment (Figure 1).7,14 These include weakness or palpitations, changes on electrocardiography (ECG), severe hypokalemia (less than 2.5 mEq per L [2.5 mmol per L]), rapid-onset hypokalemia, or underlying heart disease or cirrhosis.7,15 Most cases of hypokalemia-induced rhythm disturbances occur in individuals with underlying heart disease.10 Early identification of transcellular shifts is important because management may differ. This is commonly done through the administration of oral potassium supplement and high potassium diet. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Your kidneys or adrenal glands don't work well. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. For hypokalemia associated with diuretic use, stopping the diuretic or reducing its dosage may be effective.15 Another strategy, if otherwise indicated to treat a comorbid condition, is use of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), beta blocker, or potassium-sparing diuretic because each of these drugs is associated with an elevation in serum potassium. Boiling potatoes and cutting vegetable sin small pieces are also recommended. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Nursing Diagnosis: Risk for Decreased Cardiac Output. Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). 7. Review drug regimen for medications containing potassium or affecting potassium excretion such as spironolactone (Aldactone), hydrochlorothiazide (Maxzide), amiloride (Midamor), and penicillin G.Requires regular monitoring of potassium levels and may require alternate drug choices or changes in the dosage or frequency. Significant leukocytosis (> 75,000 cells per mm, Acute kidney injury/chronic kidney disease, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Calcium chloride, 10 mL of 10% solution IV over 5 to 10 minutes, or calcium gluconate, 30 mL of 10% solution IV over 5 to 10 minutes, Stabilizes cardiac muscle cell membrane; no effect on serum potassium or total body potassium, May potentiate digoxin toxicity; calcium chloride can cause phlebitis and tissue necrosis, Regular insulin, 10 units IV followed immediately by 50 mL of 50% glucose (25 g) IV, Shifts potassium into cells; no effect on total body potassium, May cause hypoglycemia; glucose is unnecessary if serum glucose level is > 250 mg per dL (13.9 mmol per L); additive effect when combined with albuterol, Can cause tachycardia and thus should be used with caution in patients with underlying heart disease; potassium-lowering effect not reliable in all patients; additive effect when combined with insulin, Sodium polystyrene sulfonate (Kayexalate), Binds potassium in exchange for sodium; lowers total body potassium, Association with gastrointestinal complications, particularly when combined with sorbitol; should be avoided in patients at risk of abnormal bowel function. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). These can include assistive devices, braces, and adaptive equipment. List of NANDA Approved Nursing Diagnoses Nurse Hussein. Read theprivacy policyandterms and conditions. The combination of furosemide and beta-blocker may reduce blood pressure and decrease heart rate. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively sample clinical applications, prioritized action/interventions with rationales a documentation section, and much more! Nursing Diagnosis: Risk for Hypernatremia Potentially Related To Dehydration Severe diarrhea Fever Vomiting Poorly controlled diabetes Certain medications Kidney disease Diabetes insipidus Extensive burns Evidenced By Extreme thirst Fatigue Headache Nausea Lethargy Confusion Muscle twitching or spasms Seizures Coma Desired Outcomes To accurately measure the input and output of the patient. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Stress the importance of the clients notifying future caregivers when a chronic condition potentiates the development of hyperkalemia, such as oliguric renal failure.May help prevent hyperkalemia recurrences. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. Insulin and Glucose. High potassium levels can be treated through: Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue. Polyuria -potassium is mainly excreted through the kidneys. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance Author disclosure: No relevant financial affiliations. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma. Buy on Amazon, Silvestri, L. A. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. While others spare potassium from being excreted through the kidneys. Careful monitoring during treatment is essential because supplemental potassium is a common cause of hyperkalemia in hospitalized patients.21 The risk of rebound hyperkalemia is higher when treating redistributive hypokalemia. Careful assessment for its early presence is needed especially for high-risk patients. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Diabetic ketoacidosis. Hypotension Extreme thirst Elevated heart rate Weakness Cramps in the legs Reduced urine production Dry mucosal membranes Decreased skin elasticity Accelerated respiration Hypovolemia that leads to hypovolemic shock is a potentially fatal condition. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. A more practical approach is calculation of the urine potassium-to-creatinine ratio from a spot urine specimen; a ratio greater than 1.5 mEq per mmol (13 mEq per g) is indicative of renal potassium wasting.18 If no cause is identified with the initial workup, assessment of thyroid and adrenal function should be considered. 1. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Potassium helps in utilizing carbohydrates and protein to produce energy. Hypokalemia. each day. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Copyright 2015 by the American Academy of Family Physicians. Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. Our website services and content are for informational purposes only. A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. 4. The goals of acute treatment are to prevent potentially life-threatening cardiac conduction and neuromuscular disturbances, shift potassium into cells, eliminate excess potassium, and resolve the underlying disturbance. Hypokalemia is serum potassium concentration < 3.5 mEq/L (< 3.5 mmol/L) caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. Data Sources: An Essential Evidence search was conducted. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. 5. The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. Nursing assessment for hyperkalemia patients focuses on monitoring for signs and symptoms of life-threatening cardiac dysrhythmias, as well as identifying and addressing the underlying cause of hyperkalemia. Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. For example, a decline in serum potassium from 3.8 to 2.9 mEq per L (3.8 to 2.9 mmol per L) roughly corresponds to a 300-mEq (300-mmol) reduction in total body potassium. Findings on ECG are neither sensitive nor specific for hyperkalemia. There is an additive effect when albuterol is combined with insulin.38 Albuterol's potassium-lowering effect is mitigated in some patients, particularly those with end-stage kidney disease; therefore, albuterol should not be used as monotherapy.30, Sodium Bicarbonate. If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed. Planning:- The nurse will monitor for dysrrythmias, assess electrocargraphic Recordings and report changes that are related to cardiopulmonary resuscitation may be required but is seldom successful with severe hypokalemia because the heart muscle wil, respond. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. Treatment-related side effects such as cytotoxic drugs. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Rectal: 30 to 50 g every 6 hours in a retention enema. Prompt intervention and possible ECG monitoring are indicated for patients with severe hypokalemia (serum potassium < 2.5 mEq per L) or severe hyperkalemia (serum potassium > 6.5 mEq per L [6.5 mmol per L]); ECG changes; physical signs or symptoms; possible rapid-onset hyperkalemia; or underlying kidney disease, heart disease, or cirrhosis. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. Potassium helps carry electrical signals to cells in your body. It may have a role as adjuvant therapy, particularly among patients with concurrent metabolic acidosis.24,39,40, Potassium can be removed via the GI tract or the kidneys, or directly from the blood with dialysis. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. We may earn a small commission from your purchase. Medication use is a common cause of hyperkalemia, particularly in patients with baseline renal dysfunction or hypoaldosteronism.27 Medication-induced hyperkalemia is most often a result of the medication interfering with potassium excretion. (1998). However, diuretics, particularly loop diuretics, may play a role in the treatment of some forms of chronic hyperkalemia, such as that caused by hyporeninemic hypoaldosteronism.39,44 Fludrocortisone is an option for hyperkalemia associated with mineralocorticoid deficiency, including hyporeninemic hypoaldosteronism.29. Here are some nursing interventions for patients with hyperkalemia: 1. After 48 hours of nursing intervention, the client will be able to maintain serum potassium levels within the normal range. Blood pressure medications. Articles submitted here are original but are checked for minor typographical errors, and are formatted for site compatibility.This is a site that continuously improves and broadcasts healthcare information relevant to today's ever-changing world. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. Other ECG changes include P-wave flattening, PR-interval prolongation, widening of the QRS complex, and sine waves.19 Hyperkalemia-induced arrhythmias include sinus bradycardia, sinus arrest, ventricular tachycardia, ventricular fibrillation, and asystole.19. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. Elsevier. Elsevier/Mosby. It should be noted that the recommended dose of nebulized albuterol (10 to 20 mg) is four to eight times greater than the typical respiratory dose. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. INTRODUCTION. Insulin and glucose . The bodys muscles depend highly on potassium level to function adequately. Create a daily weight chart and a food and fluid chart. We use cookies to ensure that we give you the best experience on our website. Swearingen, P. (2016). Adjust the IV potassium dose and rate depending on the available IV access. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. Other recommended site resources for this nursing care plan: Other nursing care plans related to endocrine system and metabolism disorders: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers. The most accurate method for evaluating urinary potassium excretion is a 24-hour timed urine potassium collection; normal kidneys excrete no more than 15 to 30 mEq per L (15 to 30 mmol per L) of potassium per day in response to hypokalemia. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Muscular weakness can affect respiratory muscles and lead to respiratory complications. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. Psychiatric Nursing . Treating these conditions involves monitoring and preventing hypo/hyperkalemia. 1. Hypokalemia is treated with oral or intravenous potassium. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. This helps the patient gain muscle strength and confidence in performing self care. Albuterol, a beta2 agonist, is an underutilized adjuvant for shifting potassium intracellularly.24,37 All forms of administration (i.e., inhaled, nebulized, and intravenous where available) are effective. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Aphasia, muscle twitching, tremors, seizures. Monitor respiratory rate and depth. Monitor potassium every 6 hours or as needed. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. However, a 2014 study suggests that severe hypokalemia is rare. Kidney problems. Weight should be performed every day to help assess fluid volume status. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-large-mobile-banner-2','ezslot_6',662,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-2-0');Risk for decreased cardiac tissue perfusion related to severe potassium deficiency as evidenced by heart palpitations, tachycardia, and presence of PVCs. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Carefully check the administration rate, with 2 nurses if needed. A risk for diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and nursing interventions are aimed at prevention. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Place the patient on high potassium diet as per the physicians order. Other diagnostic tests that may be performed are as follows: Potassium replacement. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Encourage deep breathing and coughing exercise. Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. The patients lung sounds are clear. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . Inform the healthcare team about the patients level of risk of falls.Effective communication among healthcare team members encourages collaboration and teamwork, which promotes the safety and prevention of fall incidents for the patient. Hypernatremia can cause lethargy, personality changes, and confusion. To replace potassium lost by the body. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Hyperkalemia can result from taking potassium chloride or salt substitutes. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Abnormal potassium levels commonly occur due to the following: Abnormal potassium levels can easily become a medical emergency as it can cause life-threatening cardiac arrhythmias.
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