Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. F A Davis Company. Additional potassium will be required if losses are ongoing. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Your kidneys or adrenal glands don't work well. Teach the patient on how to follow a low potassium diet. Data Sources: An Essential Evidence search was conducted. She received her RN license in 1997. 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. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Provide fresh blood or washed red blood cells (RBCs), if transfusion is indicated.Fresh blood has less potassium than banked blood because the breakdown of older RBCs releases potassium. 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. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. An ECG is performed to check heart rhythm. Discover the causes, symptoms, and treatments for these electrolyte imbalances. The effect can cause slow peristalsis which can lead to constipation. Common acute manifestations are muscle weakness and ECG changes. [] Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. (1998). Buy on Amazon, Silvestri, L. A. 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. All Rights Reserved. 5. Copyright 2023 American Academy of Family Physicians. 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. 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. 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. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Insulin causes potassium to shift inside the cell which can lower potassium levels. Folic acid deficiency. 2. Biochemistry is needed to check for the level of serum potassium. Intravenous Calcium. Therefore, potassium helps control the fluid inside the cell, while sodium . Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). 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. St. Louis, MO: Elsevier. Diabetic ketoacidosis. As a portion of daily potassium is excreted in the colon, lower GI losses in the form of persistent diarrhea can also result in hypokalemia and may be accompanied by hyperchloremic acidosis.6, Hypokalemia is often asymptomatic. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Urine test. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. Certain antibiotics. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. 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). Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. Buy on Amazon. Copyright 2015 by the American Academy of Family Physicians. Elsevier Health Sciences. 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. Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Nursing interventions for hyperkalemia patients aim to prevent life-threatening cardiac dysrhythmias by reducing serum potassium levels through a combination of medication administration, dietary management, and monitoring. Weight should be performed every day to help assess fluid volume status. The main source of potassium is from food. 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. There are subsets of patients that are susceptible to the development of hypokalemia. Insulin and Glucose. Some of the potassium ions are lost when vomiting occurs. 5. Our website services and content are for informational purposes only. Hypokalemia and Hyperkalemia Nursing Care Plan 2 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Concomitant hypomagnesemia should be treated concurrently. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . 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. 2. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Educate the patient about the role of potassium in the body. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. The patient is experiencing weakness, heart palpitations, and shortness of breath. Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Wolters Kluwer India Pvt. each day. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. To conclude, here we have formulated a scenario-based nursing care plan for Hypokalemia. 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. 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 diagnosis of hyperkalemia includes history taking and physical examination. Diuretics (water retention relievers) Excessive laxative use. The goals of acute treatment are to prevent potentially life-threatening cardiac conduction and neuromuscular disturbances, shift potassium into cells, eliminate excess potassium, and resolve the underlying disturbance. 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. Search dates: February, September, and December 2014. 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. Learn how your comment data is processed. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. The nerve impulses are created by the movement of sodium and potassium in and out the cells. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Institute fall and safety measures.Institute fall and safety measures due to the neuromuscular effect (muscle weakness) caused by the changes in potassium. When defined as a value of less than 3.6 mmol of potassium per . For more information, check out our privacy policy. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Diuretics. 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. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. Your body needs potassium to function correctly. 1. Place the patient on high potassium diet as per the physicians order. 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. Bounding pulses. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. Crackles. Bradycardia can progress to cardiac fibrillation and arrest. We use cookies to ensure that we give you the best experience on our website. [Twitter moment] Retrieved from. 11. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. 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. Studies suggest that some antibiotics can cause high potassium levels. Planning:- The nurse will monitor for dysrrythmias, assess electrocargraphic Recordings and report changes that are related to cardiopulmonary resuscitation may be required but is seldom successful with severe hypokalemia because the heart muscle wil, respond. Other causes include certain medications and some adrenal and genetic conditions. Inform the patient of the need to undergo dialysis, if indicated by the physician. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Risk for falls associated with potassium imbalance is caused by a disruption in the electric signals in muscles resulting in muscle weakness, cramping, hyporeflexia, and paralysis. 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. (2015 Nov 22). Elsevier Inc. It also decreases the risk of falls and fall related injuries. 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. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. 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. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[468,60],'nurseship_com-large-mobile-banner-1','ezslot_4',646,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-1-0'); The patient is admitted to the hospital for Hypokalemia. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Aphasia, muscle twitching, tremors, seizures. Hyperkalemia-induced ventricular fibrillation is treated with calcium. If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed. 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. The bodys muscles depend highly on potassium level to function adequately. 3. 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. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Diabetic ketoacidosis. and, i didn't Potassium disorders are common. 4. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Potassium supplementation is the main treatment for hypokalemia. She has worked in Medical-Surgical, Telemetry, ICU and the ER. This helps the patient gain muscle strength and confidence in performing self care. Help the patient to select appropriate dietary choices to follow a high potassium diet. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. Saunders comprehensive review for the NCLEX-RN examination. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. It is also needed in the formation of muscles in the body. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. 1. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. Beta-blockers. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. Comer, S. and Sagel, B. 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. There is an additive effect when albuterol is combined with insulin.38 Albuterol's potassium-lowering effect is mitigated in some patients, particularly those with end-stage kidney disease; therefore, albuterol should not be used as monotherapy.30, Sodium Bicarbonate. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. 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. Peripherally potassium should be administered no faster than 10 mEq per hour. Hypokalemia. The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. 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. 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. Electrocardiogram (ECG). Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Hypokalemia can be life-threatening. The patients lung sounds are clear. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Intravenous calcium should be administered if hyperkalemic ECG changes are present. St. Louis, MO: Elsevier. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. 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. The infusion should be discontinued immediately if this occurs. CRITICAL CARE NURSING CARE PLANS. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. 3. Treatment-related side effects such as cytotoxic drugs. This is commonly done through the administration of oral potassium supplement and high potassium diet. Potassium helps in utilizing carbohydrates and protein to produce energy. 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. Careful assessment for its early presence is needed especially for high-risk patients. Hypokalaemia ECG Changes. 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. However, we aim to publish precise and current information. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. 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. 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. Medical-surgical nursing: Concepts & practice (3rd ed.). Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Rectal: 30 to 50 g every 6 hours in a retention enema. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. 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. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Volume depletion. Hypokalemia means low blood potassium levels. If able to eat and drink, administer PO potassium. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. 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. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. It can result in serious injury or death if it becomes too high or too low. Polyuria -potassium is mainly excreted through the kidneys. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Some medications can cause abnormal blood potassium levels. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. 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. Centrally potassium can be administered more quickly and in larger doses via this route. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. 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. For the past few nights, he has had severe leg cramps that have woken him up. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. If after five minutes, follow-up ECG continues to show signs of hyperkalemia, the dose should be repeated.37 Clinicians should be aware that intravenous calcium has a short duration, ranging from 30 to 60 minutes.

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