Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. 1. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). Potential health risks are avoidable as long as the potassium levels are kept at a normal level. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. 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. Potassium supplement. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. Gitelman Syndrome UK [gitelmansuk]. You have entered an incorrect email address! Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. Educate the patient about high-potassium foods. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Excessive alcohol intake is known to reduce potassium levels. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). All Rights Reserved. The normal blood potassium level is 3.5 5.0 mEq/L. Excessive sweating. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. Interprofessional patient problems focus familiarizes you with how to speak to patients. Renal function should be monitored for patients receiving potassium replacement. 3. 3. 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. do you see all the information i began to generate from those two pieces of information? Peripherally potassium should be administered no faster than 10 mEq per hour. Potassium helps carry electrical signals to cells in your body. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Findings on ECG are neither sensitive nor specific for hyperkalemia. The bodys muscles depend highly on potassium level to function adequately. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. 2. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Hypokalemia can be life-threatening. Intravenous calcium, which helps prevent life-threatening conduction disturbances by stabilizing the cardiac muscle cell membrane, should be administered if ECG changes are present.24,25,35 Intravenous calcium has no effect on plasma potassium concentration. Medical-surgical nursing: Concepts & practice (3rd ed.). Copyright 2023 American Academy of Family Physicians. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. For hypokalemia associated with diuretic use, stopping the diuretic or reducing its dosage may be effective.15 Another strategy, if otherwise indicated to treat a comorbid condition, is use of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), beta blocker, or potassium-sparing diuretic because each of these drugs is associated with an elevation in serum potassium. It is also needed in the formation of muscles in the body. High potassium occurs due to lack of insulin. Distended neck and peripheral veins. The ECG can provide useful information for hypokalemia. To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. Potassium disorders are common. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. To give the patient enough information on hypernatremia and its effects to the body. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . Potassium can be obtained as a dietary supplement but is naturally available in many foods. PO potassium can cause stomach upset so its best to administer with food or after meals. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Place the patient on high potassium diet as per the physicians order. Treatment-related side effects such as cytotoxic drugs. Silvestri, L. A., Silvestri, A. E., & Grimm, J. Clinical manifestations of hypokalemia are typically seen only if the serum potassium is <3.0 mEq/L. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. Hypokalemia is treated with oral or intravenous potassium. 2. Elsevier. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. Monitor strict intake and output.Monitor urine output as well as bowel movements. 2023 nurseship.com. See permissionsforcopyrightquestions and/or permission requests. 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. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! Concomitant hypomagnesemia should be treated concurrently. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Medication intake. Psychiatric Nursing . In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. Please read our disclaimer. Read theprivacy policyandterms and conditions. If you continue to use this site we will assume that you are happy with it. Data Sources: An Essential Evidence search was conducted. 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. If experiencing hyperkalemia, limit these foods in the diet. 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. All information expressed here are courtesies of the respective authors. Certain antibiotics. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Potassium supplements are used to treat severe hypokalemia. 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. The combination of furosemide and beta-blocker may reduce blood pressure and decrease heart rate. Beta-blockers. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. 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. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. 5. 1. 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. 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. Bounding pulses. Your kidneys control your body's potassium levels, allowing for excess . Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Potassium (K) is a major cation in intracellular fluid (ICF). Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. Other diagnostic tests that may be performed are as follows: Potassium replacement. A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. It is also needed in the formation of muscles in the body. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. 1 - 3 Hyperkalemia (serum potassium level. Insulin and glucose . Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. 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. The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. Occasionally, low potassium is caused by not getting enough potassium in your diet. 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. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. CRITICAL CARE NURSING CARE PLANS. 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. What is the NANDA nursing diagnosis for pneumonia . Hypokalemia and Hyperkalemia Nursing Care Plan 2 It also decreases the risk of falls and fall related injuries. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. 2. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. Urine test. Urinalysis can also show the presence of potassium in the urine. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. Kidney problems. Potassium regulates fluid and facilitates muscular contraction and nerve activity. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. All rights reserved. Search dates: February, September, and December 2014. 6. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. However, diuretics, particularly loop diuretics, may play a role in the treatment of some forms of chronic hyperkalemia, such as that caused by hyporeninemic hypoaldosteronism.39,44 Fludrocortisone is an option for hyperkalemia associated with mineralocorticoid deficiency, including hyporeninemic hypoaldosteronism.29. Hypokalemia. The patient thought apples were high in potassium. Hypotension Extreme thirst Elevated heart rate Weakness Cramps in the legs Reduced urine production Dry mucosal membranes Decreased skin elasticity Accelerated respiration Hypovolemia that leads to hypovolemic shock is a potentially fatal condition. Additional potassium will be required if losses are ongoing. 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. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Elsevier/Mosby. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. Diabetic ketoacidosis. 2697-2729). St. Louis, MO: Elsevier. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Imbalanced levels can be caused by alterations in the intake and excretion of potassium. 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. The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. Nursing diagnoses handbook: An evidence-based guide to planning care. Possible causes of hypokalemia include the following: Possible causes of hyperkalemia include the following: Signs and symptoms of potassium imbalance include: To ensure proper functioning and homeostasis the body must maintain a dynamic equilibrium of fluids and electrolytes. (2020). A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. She found a passion in the ER and has stayed in this department for 30 years. About 98% of the bodys potassium is found inside the cells and the rest is found extracellularly. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. Our website services and content are for informational purposes only. Careful assessment for its early presence is needed especially for high-risk patients. 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. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively sample clinical applications, prioritized action/interventions with rationales a documentation section, and much more! Eh wala, yung 15, naging 7. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Elsevier Health Sciences. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Biochemistry is needed to check for the level of serum potassium. Non-steroidal anti-inflammatory medications (NSAIDs). Inform the patient of the need to undergo dialysis, if indicated by the physician. 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. Crackles. 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. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. 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. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Obtain ECG and observe signs of dysrhythmias.A potassium imbalance may result in alterations in ECG findings since potassium is essential for both depolarization (contraction) and repolarization (relaxation) of the heart. 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. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . 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. Centrally potassium can be administered more quickly and in larger doses via this route.
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