Herdman, T., Kamitsuru, S. & Lopes, C. (2021). 2. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. When defined as a value of less than 3.6 mmol of potassium per . 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! In children, dosing is 0.5 to 1.0 mmol per L per kg over one hour (maximum of 40 mmol).23 Potassium should not be given in dextrose-containing solutions because dextrose-stimulated insulin secretion can exacerbate hypokalemia. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Possible causes of hypokalemia include the following: Possible causes of hyperkalemia include the following: Signs and symptoms of potassium imbalance include: To ensure proper functioning and homeostasis the body must maintain a dynamic equilibrium of fluids and electrolytes. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Prevent sudden hypotension.Changes in blood potassium levels can cause hypotension due to decreased levels of aldosterone, vasopressin, and responsiveness to the effects of angiotensin II. Generally, hypokalemia is a medical, not a surgical, condition. You have diarrhea. See permissionsforcopyrightquestions and/or permission requests. IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low potassium. Volume depletion is typically accompanied by increased potassium excretion in the kidneys. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. It gets potassium through the food you eat. Repeat measurement of serum potassium can help identify pseudohyperkalemia, which is common and typically results from potassium moving out of cells during or after sample collection.31 Other laboratory studies include measurement of serum blood urea nitrogen and creatinine, measurement of urine electrolytes and creatinine, and assessment of acid-base status. For more information, check out our privacy policy. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Medical-surgical nursing: Concepts & practice (3rd ed.). The patient is experiencing weakness, heart palpitations, and shortness of breath. List of NANDA Approved Nursing Diagnoses Nurse Hussein. 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. Carefully check the administration rate, with 2 nurses if needed. Priority nursing diagnoses allnurses. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 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. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). 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. Avoid using medical jargons and explain in laymans terms. Identify and discontinue dietary sources of potassium, such asbeans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas.Facilitates the reduction of potassium levels and may prevent the recurrence of hyperkalemia. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Other causes include certain medications and some adrenal and genetic conditions. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Monitor potassium every 6 hours or as needed. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. Inhaled Beta Agonists. 2. Dialysis should be considered in patients with kidney failure or life-threatening hyperkalemia, or when other treatment strategies fail.23,37 Other modalities are not rapid enough for urgent treatment of hyperkalemia.39, Currently available cation exchange resins, typically sodium polystyrene sulfonate (Kayexalate) in the United States, are not beneficial for the acute treatment of hyperkalemia but may be effective in lowering total body potassium in the subacute setting.25,39 Because sodium polystyrene sulfonate can be constipating, many formulations include sorbitol for its laxative effects. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. Volume depletion. Hypokalaemia ECG Changes. Certain antibiotics. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. The nerve impulses are created by the movement of sodium and potassium in and out the cells. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Medication intake. Monitor respiratory rate and depth. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. Nurses Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. To give the patient enough information on hypernatremia and its effects to the body. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Thieme. Bananas, spinach, broccoli, and some fish are high in potassium. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. Educate the patient about hyperkalemia. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. 5. The most common cause is excess loss from the kidneys or gastrointestinal tract. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. Patient information: See related handout on potassium, written by the authors of this article. Gitelman Syndrome UK [gitelmansuk]. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Nurses must closely monitor patients lab results and correct imbalances to prevent complications. 4. Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. Muscular weakness can affect respiratory muscles and lead to respiratory complications. Further evaluation may include measurement of serum glucose to evaluate for hyperglycemia, and measurement of serum renin, aldosterone, and cortisol to further investigate kidney and adrenal function. Hypokalemia can be life-threatening. 6. 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. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. Intravenous calcium, which helps prevent life-threatening conduction disturbances by stabilizing the cardiac muscle cell membrane, should be administered if ECG changes are present.24,25,35 Intravenous calcium has no effect on plasma potassium concentration. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. 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. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. Blood test. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. Too much potassium supplementation can cause hyperkalemia. Save my name, email, and website in this browser for the next time I comment. Educate the patient about high-potassium foods. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. (2020). Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Diabetic ketoacidosis. Because potassium can only be administered slowly and in small doses via a peripheral IV, a central line is recommended to correct hypokalemia more quickly. In order to function properly, the body requires several electrolytes, one of which is potassium. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Excessive sweating. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Blood pressure medications. Insulin causes potassium to shift inside the cell which can lower potassium levels. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. Distended neck and peripheral veins. Insulin and glucose . Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. Nursing Diagnosis: Risk for Decreased Cardiac Output. Wolters Kluwer India Pvt. If after five minutes, follow-up ECG continues to show signs of hyperkalemia, the dose should be repeated.37 Clinicians should be aware that intravenous calcium has a short duration, ranging from 30 to 60 minutes. Centrally potassium can be administered more quickly and in larger doses via this route. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. 3. To treat the kidney disease if this is the underlying cause of hyperkalemia. Educate the patient about the role of potassium in the body. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. IV potassium can cause serious extravasation and vein irritation. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma. An ECG is performed to check heart rhythm. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. Elsevier/Mosby. Search dates: February, September, and December 2014. St. Louis, MO: Elsevier. Therefore, potassium helps control the fluid inside the cell, while sodium . 1. Hyperkalemia can result from taking potassium chloride or salt substitutes. The oral potassium should be used in the dose 20-40 mEq three to four times a day (the lower dose is for patients receiving IV potassium, and the higher doses for patients receiving just the oral). The combination of furosemide and beta-blocker may reduce blood pressure and decrease heart rate. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. 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. 10. 5. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. This is commonly done through the administration of oral potassium supplement and high potassium diet. 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. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. Obtain ECG and observe signs of dysrhythmias.A potassium imbalance may result in alterations in ECG findings since potassium is essential for both depolarization (contraction) and repolarization (relaxation) of the heart. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. 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. Determine the patients independence in performing activities.Promote and assist in patient ambulation and independence in self care. 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. Because serum potassium concentration drops approximately 0.3 mEq per L (0.3 mmol per L) for every 100-mEq (100-mmol) reduction in total body potassium, the approximate potassium deficit can be estimated in patients with abnormal losses and decreased intake. Other diagnostic tests that may be performed are as follows: Potassium replacement. Therefore, although ECG changes should trigger urgent treatment, treatment decisions should not be based solely on the presence or absence of ECG changes.32, Peaked T waves are the prototypical, and generally the earliest, ECG sign of hyperkalemia. Too much or too little potassium in diet. Hinkle, J. L., & Cheever, K. H. (2018).
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