Search dates: February, September, and December 2014. The patient thought apples were high in potassium. Hinkle, J. L., & Cheever, K. H. (2018). It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. 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. 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. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. Inform him/her the target range for serum potassium levels. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Non-steroidal anti-inflammatory medications (NSAIDs). Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Psychiatric Nursing . 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. The normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L. Hyperkalemia can result from taking potassium chloride or salt substitutes. The physical examination should include assessment of blood pressure and intravascular volume status to identify potential causes of kidney hypoperfusion, which can lead to hyperkalemia. Careful assessment for its early presence is needed especially for high-risk patients. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). 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. Consider switching to a potassium-sparing diuretic. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Potassium helps in utilizing carbohydrates and protein to produce energy. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. 11. before you can make any diagnosis you must consider many factors: a health history (review of systems) performing a physical exam assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) Here are some nursing interventions for patients with hyperkalemia: 1. Diarrhea. A slow intravenous potassium solution is given to raise the potassium level in the blood stream. St. Louis, MO: Elsevier. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). 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. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Hyperkalemia (Nursing) - StatPearls - NCBI Bookshelf Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. 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. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). 4. 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. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Data Sources: An Essential Evidence search was conducted. 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. and, i didn't Hypokalemia. Encourage deep breathing and coughing exercise. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). 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. Diabetic ketoacidosis. INTRODUCTION. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia secondary to hyperaldosteronism as evidenced by serum potassium level of 2.9 mmol/L, high aldosterone levels, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Evaluation of hypokalemia - Differential diagnosis of symptoms | BMJ To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Other diagnostic tests that may be performed are as follows: Potassium replacement. Including the client in the plan of care elicits participation. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. Renal function should be monitored for patients receiving potassium replacement. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. 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. The signs and symptoms of hypokalemia and hyperkalemia depend on how critical the potassium level is and how rapid the rise and fall in potassium levels happens: Hypokalemia and hyperkalemia typically happen as a result of another problem. Certain antibiotics. 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. Check for safety hazards in the patients environment.Assess the following environmental factors: 5. Review the patients current medications.Imbalanced potassium and the use of cardiac medications (used to treat dysrhythmias) greatly increase the risk for muscle weakness and potential falls. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Clinical manifestations and treatment of hypokalemia in adults She received her RN license in 1997. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. Administer prescribed potassium with precautions.Potassium can be administered IV or PO. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Discover the causes, symptoms, and treatments for these electrolyte imbalances. 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. The ECG can provide useful information for hypokalemia. 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. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. Obtain daily blood sample from the patient. 2. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-banner-1','ezslot_12',640,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-banner-1-0'); Long-term goal: At home, the patient will take a daily potassium supplement in addition to his regular diuretic. Please read our disclaimer. Nursing Diagnosis: Deficient Knowledge related to new diagnosis of hyperkalemia as evidenced by patients verbalization of I want to know more about my new diagnosis and care. Hyperaldosteronism Nursing Diagnosis and Nursing Care Plan 1. 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. Consider IV maintenance fluids with potassium added. Potential health risks are avoidable as long as the potassium levels are kept at a normal level. 5. When defined as a value of less than 3.6 mmol of potassium per . Save my name, email, and website in this browser for the next time I comment. The IV potassium can be given in a solution with normal saline . 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. Learn how your comment data is processed. It also decreases the risk of falls and fall related injuries. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. Bananas, spinach, broccoli, and some fish are high in potassium. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. St. Louis, MO: Elsevier. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Identify the client at risk or the cause of the hyperkalemia such as excessive intake of potassium or decreased excretion.Early identification and intervention can avoid complications. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. Teach the patient on how to follow a low potassium diet. If you continue to use this site we will assume that you are happy with it. 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. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. Occasionally, low potassium is caused by not getting enough potassium in your diet. Used in the treatment of potassium deficiency when oral replacement is not feasible. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). It gets potassium through the food you eat. Insulin and glucose . Normal Potassium Level 3.5-5.1 ( 2.5 or less is very dangerous) Most of the body's potassium is found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. The effect can cause slow peristalsis which can lead to constipation. Silvestri, L. A., Silvestri, A. E., & Grimm, J. Hypokalemia & Hyperkalemia Nursing Diagnosis & Care Plan Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. Hyperkalemia-induced ventricular fibrillation is treated with calcium. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Diuretics (water retention relievers) Excessive laxative use. All Rights Reserved. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Inhaled Beta Agonists. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. 2. Priority nursing diagnoses allnurses. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Renally mediated hyperkalemia results from derangement of one or more of the following processes: rate of flow in the distal nephron, aldosterone secretion and its effects, and functioning potassium secretory pathways. Our website services and content are for informational purposes only. Volume depletion. You vomit a lot. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium. PO potassium can cause stomach upset so its best to administer with food or after meals. However, a 2014 study suggests that severe hypokalemia is rare. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). These can include assistive devices, braces, and adaptive equipment. After 48 hours of nursing intervention, the client will be able to maintain serum potassium levels within the normal range. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. 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. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans Adjust the IV potassium dose and rate depending on the available IV access. 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. While others spare potassium from being excreted through the kidneys. Urine test. 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. Facilitates excretion of sodium and water while sparing potassium. Hypokalemia | NEJM - New England Journal of Medicine Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. 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. Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. 3. The patients lung sounds are clear. Potassium helps carry electrical signals to cells in your body. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. 1386-1388). Kidney problems. Peripherally potassium should be administered no faster than 10 mEq per hour. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Furosemide Nursing Considerations - NurseStudy.Net Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic Low potassium diet include eating apples, berries, pineapple, breads, and cereals. It is also needed in the formation of muscles in the body. Elsevier Health Sciences. Educate the patient about hyperkalemia. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. The main source of potassium is from food. Blood pressure medications. 6. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Blood test. 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 majority of potassium is stored in the intracellular compartment. She found a passion in the ER and has stayed in this department for 30 years. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. You have entered an incorrect email address! 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. Crackles. 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. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. Low magnesium levels. Diuretics. 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 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. Nursing Diagnosis (hypokalemia)-help? - allnurses Muscular weakness can affect respiratory muscles and lead to respiratory complications. Hypokalemia Article - StatPearls A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Hypokalemia NCLEX Review Notes - Registered Nurse RN Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. You have diarrhea. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Symptoms include fatigue, weakness, nausea, heart palpitations, shortness of breath, leg cramps, polyuria, polydipsia, and constipation. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. 4. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. The most common cause is excess loss from the kidneys or gastrointestinal tract. It can result in serious injury or death if it becomes too high or too low. Elsevier. 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. Thieme. Potassium is an essential mineral that is responsible for fluid balance, regulating nerve signals, and muscle contraction. It should ideally be done at the same time and same method (standing, bed weight, etc.) Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Rectal: 30 to 50 g every 6 hours in a retention enema.
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