Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Intravenous calcium should be administered if hyperkalemic ECG changes are present. Now, my body feels very weak., Vomitus of yellowish fluid approximately 70 cc times three episodes for two days, Diarrhea; Watery stools times 4 episodes for two days, Presence of an elevated U wave on ECG result, Altered electrolyte balance related to active fluid loss secondary to vomiting and diarrhea. We may earn a small commission from your purchase. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. 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. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. An ECG is performed to check heart rhythm. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Carefully check the administration rate, with 2 nurses if needed. Indications for urgent treatment include severe or symptomatic hypokalemia or hyperkalemia; abrupt changes in potassium levels; electrocardiography changes; or the presence of certain comorbid conditions. To treat the kidney disease if this is the underlying cause of hyperkalemia. Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Potassium supplementation is the main treatment for hypokalemia. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. (1998). Treatment-related side effects such as cytotoxic drugs. Hemolysis or breakdown of red blood cells, Rhabdomyolysis or the breakdown of muscle tissues, Burns, trauma, and other tissue injuries can also cause the release of potassium from the cells. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. 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. It is appropriate to increase dietary potassium in patients with low-normal and mild hypokalemia, particularly in those with a history of hypertension or heart disease.15 The effectiveness of increased dietary potassium is limited, however, because most of the potassium contained in foods is coupled with phosphate, whereas most cases of hypokalemia involve chloride depletion and respond best to supplemental potassium chloride.6,15, Because use of intravenous potassium increases the risk of hyperkalemia and can cause pain and phlebitis, intravenous potassium should be reserved for patients with severe hypokalemia, hypokalemic ECG changes, or physical signs or symptoms of hypokalemia, or for those unable to tolerate the oral form. Please read our disclaimer. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. Gastric fluid contains little amount of potassium. Medical-surgical nursing: Concepts & practice (3rd ed.). Imbalanced levels can be caused by alterations in the intake and excretion of potassium. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Treatment-related side effects, such as certain medications or chemotherapy, can also contribute to hyperkalemia by altering potassium levels in the body, leading to a risk for electrolyte imbalance. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Buy on Amazon, Silvestri, L. A. Diabetic ketoacidosis. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. There are subsets of patients that are susceptible to the development of hypokalemia. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). 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. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Nursing diagnoses handbook: An evidence-based guide to planning care. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Nursing Diagnosis: Imbalanced Nutrition Less than Body requirements related to hypokalemia as evidenced by nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. 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. The most common cause is excess loss from the kidneys or gastrointestinal tract. Symptoms include fatigue, weakness, nausea, heart palpitations, shortness of breath, leg cramps, polyuria, polydipsia, and constipation. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. We use cookies to ensure that we give you the best experience on our website. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Generally, hypokalemia is a medical, not a surgical, condition. All-in-One Nursing Care Planning Resource E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental HealthIncludes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Typically, 10 units of insulin are administered, followed by 25 g of glucose to prevent hypoglycemia.37 Because hypoglycemia is a common adverse effect even with the provision of glucose, serum glucose levels should be monitored regularly. 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. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. Administer a slow intravenous potassium solution as prescribed. His temperature is 37.4 C, heart rate is 122 beats per minute, blood pressure is 142/84 mmHg, respirations are 20 breaths per minute, and oxygen saturation is 98% on room air. Bananas, spinach, broccoli, and some fish are high in potassium. Distended neck and peripheral veins. During the treatment, however, low potassium may result due to the administration of insulin. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. 2. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Obtain daily blood sample from the patient. A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. Comer, S. and Sagel, B. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Weight should be performed every day to help assess fluid volume status. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. 4. As an Amazon Associate I earn from qualifying purchases. Potassium helps in utilizing carbohydrates and protein to produce energy. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. Certain antibiotics. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. Non-steroidal anti-inflammatory medications (NSAIDs). St. Louis, MO: Elsevier. 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. Copyright 2023 American Academy of Family Physicians. Patient information: See related handout on potassium, written by the authors of this article. 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. Swearingen, P. (2016). Potassium is a main intracellular electrolyte. Boiling potatoes and cutting vegetable sin small pieces are also recommended. 2. Patients with a serum glucose level of more than 250 mg per dL (13.9 mmol per L) typically do not require coadministration of glucose. Hypokalemia means low blood potassium levels. Kidney problems. 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. 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. Short-term goal: By the end of the shift the patients potassium will normalize and the patient will experience a resolution of symptoms. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Data Sources: An Essential Evidence search was conducted. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Excessive alcohol intake is known to reduce potassium levels. Hypokalaemia ECG Changes. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. 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. It also decreases the risk of falls and fall related injuries. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. You have diarrhea. The main source of potassium is from food. 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. This content is owned by the AAFP. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[468,60],'nurseship_com-large-mobile-banner-1','ezslot_4',646,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-1-0'); The patient is admitted to the hospital for Hypokalemia. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. If experiencing hyperkalemia, limit these foods in the diet. St. Louis, MO: Elsevier. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. 1. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). Other diagnostic tests that may be performed are as follows: Potassium replacement. She received her RN license in 1997. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Adjust the IV potassium dose and rate depending on the available IV access. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. 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. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized.

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