Swearingen, P. (2016). 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. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Silvestri, L. A., Silvestri, A. E., & Grimm, J. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Recommended nursing diagnosis and nursing care plan books and resources. Hypokalemia is treated with oral or intravenous potassium. About 98% of the bodys potassium is found inside the cells and the rest is found extracellularly. 4. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Potassium regulates fluid and facilitates muscular contraction and nerve activity. Patient information: See related handout on potassium, written by the authors of this article. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. 4. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. (See "Causes of hypokalemia in adults".). Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). 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 main source of potassium is from food. each day. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Determine cardiovascular status.Heart dysrhythmias can result from an excess or deficit of potassium that disrupts the normal electric transmission of signals responsible for heart (myocardium) contraction. Obtain daily blood sample from the patient. 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. 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. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. Author disclosure: No relevant financial affiliations. 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. However, a 2014 study suggests that severe hypokalemia is rare. Short-term goal: By the end of the shift the patient will experience a resolution of heart palpitations and shortness of breath, with no further PVCs seen on ECG.Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-leader-2','ezslot_8',642,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-leader-2-0'); Long-term goal: The patient will maintain a normal potassium level, monitoring for recurrent signs and symptoms of hypokalemia. 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. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Continuous telemetry should be implemented when administering medications that affect cardiac status. Elsevier Health Sciences. 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. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. 2. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. Bradycardia can progress to cardiac fibrillation and arrest. She found a passion in the ER and has stayed in this department for 30 years. After 48 hours of nursing intervention, the client will be able to maintain serum potassium levels within the normal range. If able to eat and drink, administer PO potassium. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Potassium is contraindicated if oliguria or anuria is present. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. 2023 nurseship.com. Data Sources: An Essential Evidence search was conducted. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). 4. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). 4. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. 1. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. 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. The patient is experiencing weakness, heart palpitations, and shortness of breath. Including the client in the plan of care elicits participation. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Blood pressure medications. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. Hypokalemia. If you continue to use this site we will assume that you are happy with it. 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. 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, . However, we aim to publish precise and current information. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Avoid using medical jargons and explain in laymans terms. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild 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. Boiling potatoes and cutting vegetable sin small pieces are also recommended. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. Potassium helps in utilizing carbohydrates and protein to produce energy. We and our partners share information on your use of this website to help improve your experience. Potassium helps carry electrical signals to cells in your body. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. 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. Please read our disclaimer. 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. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Comer, S. and Sagel, B. Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. 1. Elsevier. Assess urine output and kidney function through BUN, GFR, and creatinine levels. 2. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. High alcohol intake. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude. Potassium movement from extracellular to intracellular fluid due to: IV therapy with potassium-deficient solutions, Rapid infusion of potassium-containing IV solutions, Adrenal insufficiency (such as in Addisons disease), Potassium movement from intracellular to the extracellular fluid, Muscle weakness, leg cramps, deep tendon hyporeflexia, and paresthesias, ECG changes: ST depression, inverted T waves, and prominent U waves, Increased motility, hyperactive bowel sounds, and diarrhea, Ascending flaccid paralysis until the respiratory muscles become affected as a toxic level of serum potassium is reached, ECG changes: Tall peaked T waves, widened QRS complexes, and prolonged PR intervals, Conditions that affect the movement of potassium in the cellular space, Alterations in the electrical conductivity of the heart, Patient will demonstrate serum potassium levels within normal limits, Patient will verbalize the absence of muscle pain or cramping, Disruption in the electric functioning of the heart, Patient will display pulse and blood pressure within acceptable limits, Patient will verbalize the absence of angina or palpitations, Patient will demonstrate ECG results of normal sinus rhythm, Patient will be able to verbalize understanding of decreased cardiac output in relation to hypo/hyperkalemia, Patient will participate in physical therapy sessions, Patient will be able to maintain or regain muscle strength. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. 11. Elsevier Inc. Hyperkalemia and hypokalemia can also cause paralysis and weakness. 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. Potassium supplementation is the main treatment for hypokalemia. Inform the patient of the need to undergo dialysis, if indicated by the physician. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. 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. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. 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. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. Hyperkalemia-induced ventricular fibrillation is treated with calcium. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Copyright 2023 American Academy of Family Physicians. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! Encourage the patient to stand up and reposition slowly to prevent faintness and falls. 4. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. Biochemistry is needed to check for the level of serum potassium. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. Anna Curran. 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. Elsevier. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. 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. Encourage intake of carbohydrates and fats and low potassium food such as pineapple, plums, strawberries, carrots, cauliflower, corn, and whole grains.Reduces exogenous sources of potassium and prevents metabolic tissue breakdown with the release of cellular potassium. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. It is also needed in the formation of muscles in the body. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). (2015 Nov 22). 1. 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.
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