Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. It should ideally be done at the same time and same method (standing, bed weight, etc.) Monitor potassium every 6 hours or as 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. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Hypokalemia Nursing Care Plan - RN speak Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. 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). 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. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Potassium disorders are common. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Data Sources: An Essential Evidence search was conducted. 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. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. About 98% of the bodys potassium is found inside the cells and the rest is found extracellularly. Comer, S. and Sagel, B. Insulin and Glucose. 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. After 48 hours of nursing intervention, the client will be able to maintain serum potassium levels within the normal range. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). (1998). Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Place the patient on high potassium diet as per the physicians order. You have entered an incorrect email address! Hyperkalemia can result from taking potassium chloride or salt substitutes. 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. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Obtain daily blood sample from the patient. Potassium is an essential mineral that is responsible for fluid balance, regulating nerve signals, and muscle contraction. Inhaled Beta Agonists. Nursing Diagnosis: Risk for Decreased Cardiac Output. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Please follow your facilities guidelines and policies and procedures. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. ECG should be considered if the potassium level is greater than 6 mEq per L; if there are symptoms of hyperkalemia; if there is suspicion of rapid-onset hyperkalemia; or among patients with underlying kidney disease, heart disease, or cirrhosis who have a new case of hyperkalemia. nursing care plan for HYPOKALEMIA plsss. - allnurses To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. 1386-1388). A more recent article on potassium disorders is available. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Potassium Disorders: Hypokalemia and Hyperkalemia | AAFP The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L). Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Muscle wasting and paralysis can result from very low potassium levels. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. The most common cause is excess loss from the kidneys or gastrointestinal tract. 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. 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. There are different types of test and diagnosis for hypokalemia disease, those are given in the below: S. Electrolytes / Potassium, Magnesium, Calcium, Phosphorous, TSH, Aldosterone, ECG, . Abnormal heart rhythm and palpitation- the brain sends nerve signals to the heart muscles to make them contract and beat. When defined as a value of less than 3.6 mmol of potassium per . Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). Continuous telemetry should be implemented when administering medications that affect cardiac status. The patient is experiencing weakness, heart palpitations, and shortness of breath. 2. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Thieme. 11. Gitelman Syndrome UK [gitelmansuk]. INTRODUCTION. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. 2. Indications for prompt intervention are symptoms of hyperkalemia, changes on ECG, severe hyperkalemia (greater than 6.5 mEq per L), rapid-onset hyperkalemia, or underlying heart disease, cirrhosis, or kidney disease.24,30,3335 Potassium should be monitored often because patients are at risk of redeveloping hyperkalemia until the underlying disorder is corrected and excess potassium is eliminated. 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. The effect can cause slow peristalsis which can lead to constipation. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. However, case reports linking the concomitant use of sodium polystyrene sulfonate and sorbitol to GI injury prompted a U.S. Food and Drug Administration boxed warning.41,42 More recent reports implicate sodium polystyrene sulfonate alone.43 Therefore, use of the drug with or without sorbitol should be avoided in patients with or at risk of abnormal bowel function, such as postoperative patients and those with constipation or inflammatory bowel disease.42, There is no evidence supporting the use of diuretics for the acute treatment of hyperkalemia. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Crackles. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. Further replenishment can proceed more slowly, and attention can turn to the diagnosis and management of the underlying disorder.15 Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L), based on expert opinion.15. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. It can result in serious injury or death if it becomes too high or too low. She has worked in Medical-Surgical, Telemetry, ICU and the ER. 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. Psychiatric Nursing . 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. She has more than 10 years of clinical and teaching experience and worked as a licensed Nursing Specialist in JCI-accredited hospitals in the Middle East. Distended neck and peripheral veins. Hyperkalemia-induced ventricular fibrillation is treated with calcium. 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. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. Hypokalemia | Definition & Patient Education - Healthline Buy on Amazon, Silvestri, L. A. Other laboratory tests include serum glucose and magnesium levels, urine electrolyte and creatinine levels, and acid-base balance. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Bounding pulses. Silvestri, L. A., Silvestri, A. E., & Grimm, J. Diuretics. Save my name, email, and website in this browser for the next time I comment. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. Hypokalemia is treated with oral or intravenous potassium. Elsevier. 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. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Blood pressure medications. Potassium is mainly excreted in the kidneys. PO potassium can cause stomach upset so its best to administer with food or after meals. Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). Hyperkalemia and hypokalemia can also cause paralysis and weakness. 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. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. Hypokalemia nursing diagnosis Tips and Tricks From Doctors. Furosemide Nursing Considerations - NurseStudy.Net Nursing Diagnosis: Electrolyte Imbalance Related to: Changes in the regulation of potassium Changes in the intake of potassium Difficulty excreting potassium Conditions that affect the movement of potassium in the cellular space As evidenced by: Alterations in the electrical conductivity of the heart Ineffective respirations Excessive sweating. Studies suggest that some antibiotics can cause high potassium levels. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. 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. You have diarrhea. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. 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. Hypokalemia: Practice Essentials, Pathophysiology, Etiology - Medscape Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Here are some nursing interventions for patients with hyperkalemia: 1. 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. 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. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. In response to acidosis, extracellular hydrogen is exchanged for intracellular potassium, although the net result is highly variable and depends in part on the type of acidosis; metabolic acidosis produces the greatest effect.26 Because 98% of total body potassium is intracellular, any process that increases cell turnover, such as rhabdomyolysis, tumor lysis syndrome, or red blood cell transfusions, can result in hyperkalemia. Bananas, spinach, broccoli, and some fish are high in potassium. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. 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. Excessive alcohol intake is known to reduce potassium levels. Potassium (K) is a major cation in intracellular fluid (ICF). The normal blood potassium level is 3.5 5.0 mEq/L. Insulin causes potassium to shift inside the cell which can lower potassium levels. 1. 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. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Facilitates excretion of sodium and water while sparing potassium. Monitor strict intake and output.Monitor urine output as well as bowel movements. The normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. 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. This helps the patient gain muscle strength and confidence in performing self care. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations.