Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. 2697-2729). Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. 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. The most common cause is excess loss from the kidneys or gastrointestinal tract. 2. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. Hyperkalemia & Hypokalemia (Potassium Imbalances) Nursing Care Plans, Hyperkalemia: Risk for Electrolyte Imbalance, Hypokalemia: Risk for Electrolyte Imbalance, All-in-One Nursing Care Planning Resource E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health, Nursing Care Plans (NCP): Ultimate Guide and Database, Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing, Fluid Balance: Hypervolemia & Hypovolemia, Potassium (K) Imbalances: Hyperkalemia and Hypokalemia, Sodium (Na) Imbalances: Hypernatremia and Hyponatremia, Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia, Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia, Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans, Hypermagnesemia & Hypomagnesemia (Magnesium Imbalances) Nursing Care Plans. Monitor respiratory rate and depth. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. 5. As an Amazon Associate I earn from qualifying purchases. Urinalysis can also show the presence of potassium in the urine. Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. 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. Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting; sodium polystyrene sulfonate is reserved for subacute treatment. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. Potassium is contraindicated if oliguria or anuria is present. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. The infusion should be discontinued immediately if this occurs. The patient says: Ive been on Lasix for years now so I know what to expect, but I still think Ive been urinating more than usual. He also reports thirst and constipation, but he was careful not to drink excess water because of his heart failure. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. 3. She found a passion in the ER and has stayed in this department for 30 years. 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. Recommended nursing diagnosis and nursing care plan books and resources. Carefully check the administration rate, with 2 nurses if needed. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Diuretics. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). The patients lung sounds are clear. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Aphasia, muscle twitching, tremors, seizures. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. 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. Patient information: See related handout on potassium, written by the authors of this article. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. NurseTogether.com does not provide medical advice, diagnosis, or treatment. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. The majority of potassium is stored in the intracellular compartment. Diuretics (water retention relievers) Excessive laxative use. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Educate the patient about high-potassium foods. Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. Long-term goal: The patient will eat a broad variety of fruits and vegetables, with knowledge of a few high-potassium foods to eat in case of suspected hypokalemia. Excessive sweating. List of NANDA Approved Nursing Diagnoses Nurse Hussein. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . 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. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Intravenous Calcium. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. 1. 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. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. Centrally potassium can be administered more quickly and in larger doses via this route. 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. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Treatment of hyperkalemia. Certain antibiotics. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. You vomit a lot. Peripherally potassium should be administered no faster than 10 mEq per hour. Your kidneys control your body's potassium levels, allowing for excess . Potassium is mainly excreted in the kidneys. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. Studies suggest that some antibiotics can cause high potassium levels. Ackley and Ladwigs Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing interventions. do you see all the information i began to generate from those two pieces of information? 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 []. 1 - 3 Hyperkalemia (serum potassium level. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Avoid using medical jargons and explain in laymans terms. Potassium (K) is a major cation in intracellular fluid (ICF). This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Hypokalaemia ECG Changes. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Used in the treatment of potassium deficiency when oral replacement is not feasible. Hyperkalemia can result from taking potassium chloride or salt substitutes. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Pills should not be crushed but can be dissolved in 3.8 ounces of cold water or juice. Comer, S. and Sagel, B. Consider switching to a potassium-sparing diuretic. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. Gastric fluid contains little amount of potassium. 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. Medication intake. 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. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. We may earn a small commission from your purchase. Potassium can be obtained as a dietary supplement but is naturally available in many foods. Obtain daily blood sample from the patient. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. 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. Monitor heart rate and rhythm. Therefore, potassium helps control the fluid inside the cell, while sodium . Hinkle, J. L., & Cheever, K. H. (2018). (2015 Nov 22). Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia, an elevated level of potassium in the blood, can occur in patients with renal disease due to the kidneys reduced ability to excrete potassium, and in patients who have received massive blood transfusions due to the release of potassium from stored blood cells. There are subsets of patients that are susceptible to the development of hypokalemia. High alcohol intake. The diagnosis of hyperkalemia includes history taking and physical examination. Hyperkalemia-induced ventricular fibrillation is treated with calcium. Compromised regulatory mechanism. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders. 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. You have diarrhea. Educate the patient about the symptoms of hypokalemia. Potassium is a main intracellular electrolyte. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. 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. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. 1. A standing weight is the most accurate. 11. The rapidity and method of potassium repletion depends on the: 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. Instruct the client in the use of potassium-containing salts or salt substitutes, and taking potassium supplements safely.Prevention of hyperkalemia can be managed with diet, supplements, and other medications. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. [] Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. 5. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
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