Albuterol, a beta2 agonist, is an underutilized adjuvant for shifting potassium intracellularly.24,37 All forms of administration (i.e., inhaled, nebulized, and intravenous where available) are effective. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. It is also needed in the formation of muscles in the body. Hypokalemia and Hyperkalemia Nursing Care Plan 2 Centrally potassium can be administered more quickly and in larger doses via this route. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. 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. Your body needs potassium to function correctly. Potassium levels can fluctuate in the treatment of DKA. 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. Encourage deep breathing and coughing exercise. 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. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Patient information: See related handout on potassium, written by the authors of this article. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. 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. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. 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. Potassium supplement. Hyperkalemia-induced ventricular fibrillation is treated with calcium. The patient needs to avoid foods high in potassium such as bananas. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). Occasionally, low potassium is caused by not getting enough potassium in your diet. 2. To conclude, here we have formulated a scenario-based nursing care plan for Hypokalemia. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. It is also needed in the formation of muscles in the body. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. 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. Upon assessment, the patient is alert and oriented and follows commands appropriately. Learn how your comment data is processed. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Diabetic ketoacidosis. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. 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. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance Treatment of hyperkalemia. Medication intake. Potassium is a main intracellular electrolyte. 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. 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. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. If experiencing hyperkalemia, limit these foods in the diet. A more recent article on potassium disorders is available. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Bradycardia can progress to cardiac fibrillation and arrest. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. All rights reserved. Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. Some of the potassium ions are lost when vomiting occurs. 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. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. You vomit a lot. Intravenous calcium should be administered if hyperkalemic ECG changes are present. Here are some nursing interventions for patients with hyperkalemia: 1. Mosby. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. Additional potassium will be required if losses are ongoing. [Twitter moment] Retrieved from. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. 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 normal blood potassium level is 3.5 5.0 mEq/L. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. Please read our disclaimer. Continuous telemetry should be implemented when administering medications that affect cardiac status. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. 1. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. Avoid using medical jargons and explain in laymans terms. 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. Low magnesium levels. High potassium occurs due to lack of insulin. 4. (2022). Compromised regulatory mechanism. Kidney problems. 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. 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. and, i didn't Create a daily weight chart and a food and fluid chart. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. Elsevier. Elsevier. 1. In order to function properly, the body requires several electrolytes, one of which is potassium. 1386-1388). nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. The patient is experiencing weakness, heart palpitations, and shortness of breath. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. 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. Magnesium helps the movement potassium in and out the cells. Findings on ECG are neither sensitive nor specific for hyperkalemia. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). A 12-lead ECG is performed and shows sinus tachycardia with PVCs. Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. Correction typically should not exceed 20 mmol per hour, although higher rates using central venous catheters have been successful in emergency situations.22 Continuous cardiac monitoring is indicated if the rate exceeds 10 mmol per hour. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). Careful assessment for its early presence is needed especially for high-risk patients. All Rights Reserved. She has worked in Medical-Surgical, Telemetry, ICU and the ER. 5. Diabetic ketoacidosis. Beta-blockers. Gitelman Syndrome UK [gitelmansuk]. The rapidity and method of potassium repletion depends on the: More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. The most common cause is excess loss from the kidneys or gastrointestinal tract. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Although sodium bicarbonate is often used to treat hyperkalemia, the evidence to support this use is equivocal, showing minimal to no benefit.39 Therefore, sodium bicarbonate should not be used as monotherapy. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . An ECG is performed to check heart rhythm. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. Institute fall and safety measures.Institute fall and safety measures due to the neuromuscular effect (muscle weakness) caused by the changes in potassium. Although redistributive hyperkalemia is uncommon, a cautious approach is warranted because treatment may not involve attempts to eliminate potassium, and correction of the underlying problem can provoke rebound hypokalemia. 5. Insulin and Glucose. Potassium (K) is a major cation in intracellular fluid (ICF). If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. 4. Assess the level of consciousness and neuromuscular function, including sensation, strength, and movement.The client is usually conscious and alert; however, muscular paresthesia, weakness, and flaccid paralysis may occur. Recommended nursing diagnosis and nursing care plan books and resources. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). 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. Strategies to prevent chronic hyperkalemia include instructing patients to eat a low-potassium diet, discontinuing or adjusting medications, avoiding nonsteroidal anti-inflammatory drugs, and adding a diuretic if the patient has sufficient renal function. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Start a strict input and output monitoring. For the past few nights, he has had severe leg cramps that have woken him up. 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. https://twitter.com/gitelmansuk/status/668416488211136512, Urinary Tract Infection Nursing Care Plan, Impaired concentrating ability Dizziness and fainting, Increased ammonia production Increased frequency in urination, Increased bicarbonate reabsorption extreme thirst, Altered sodium reabsorption seizure and coma, Hypokalemic nephropathy Unable to hold urine, Serum potassium levels less than 3.5 mEq/L, ECG changes- flat/inverted T waves, depressed ST segment, elevated U wave, Urinary potassium excretion test exceeding 20 mEq/day. do you see all the information i began to generate from those two pieces of information? Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. 5. Aphasia, muscle twitching, tremors, seizures. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction Saunders comprehensive review for the NCLEX-RN examination (9th ed.). See permissionsforcopyrightquestions and/or permission requests. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. To accurately measure the input and output of the patient. 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. The patient is tachycardic and PVCs are noted on ECG. 2. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Search dates: February, September, and December 2014. Further evaluation may include measurement of serum glucose to evaluate for hyperglycemia, and measurement of serum renin, aldosterone, and cortisol to further investigate kidney and adrenal function. 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. Oral potassium does not correct the problem, If hypokalemia is causing abnormal heart rhythms, Switching to potassium-sparing diuretics if needed, Treatment of kidney disease, which includes dialysis, Elimination disorders related to increase in urine volume (polyuria). To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Potassium helps in utilizing carbohydrates and protein to produce energy. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. Other causes include certain medications and some adrenal and genetic conditions. 3. While others spare potassium from being excreted through the kidneys. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia).
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