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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). Volume depletion. 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. Recommended nursing diagnosis and nursing care plan books and resources. 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. 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. Help the patient to select appropriate dietary choices to follow a high potassium diet. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction 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. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. What is the NANDA nursing diagnosis for pneumonia . Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. The main source of potassium is from food. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Hyperkalemia can result from taking potassium chloride or salt substitutes. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. Potential health risks are avoidable as long as the potassium levels are kept at a normal level. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Hypokalemia (Low Potassium): Symptoms, Causes, Diagnosis, Treatment - WebMD Educate the patient about the role of potassium in the body. Inform the patient of the need to undergo dialysis, if indicated by the physician. Hypokalemia Disease with Causes, Symptom and Nursing Intervention To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. 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. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Other medical causes. 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. 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. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. 3. 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. 2. Evaluation of hypokalemia - Differential diagnosis of symptoms | BMJ Hyperkalemia-induced ventricular fibrillation is treated with calcium. 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. 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. Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. Your kidneys or adrenal glands don't work well. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Anna Curran. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. Encourage deep breathing and coughing exercise. Possibly evidenced by Ascites. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. PO potassium can cause stomach upset so its best to administer with food or after meals. 4. Interprofessional patient problems focus familiarizes you with how to speak to patients. Hypokalemia can be life-threatening. 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. Polyuria -potassium is mainly excreted through the kidneys. 5. 2697-2729). St. Louis, MO: Elsevier. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). Blood test. Carefully check the administration rate, with 2 nurses if needed. Low potassium (hypokalemia) Causes - Mayo Clinic Clinical manifestations and treatment of hypokalemia in adults Therefore, potassium helps control the fluid inside the cell, while sodium . Your body needs potassium to function correctly. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Potassium is a main intracellular electrolyte. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium. Potassium helps in utilizing carbohydrates and protein to produce energy. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. Nursing Diagnosis: Risk for Decreased Cardiac Output. Obtain daily blood sample from the patient. Elsevier/Mosby. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. 4. 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. Too much potassium supplementation can cause hyperkalemia. do you see all the information i began to generate from those two pieces of information? Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. To conclude, here we have formulated a scenario-based nursing care plan for 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. It may have a role as adjuvant therapy, particularly among patients with concurrent metabolic acidosis.24,39,40, Potassium can be removed via the GI tract or the kidneys, or directly from the blood with dialysis. 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. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Patients with a serum glucose level of more than 250 mg per dL (13.9 mmol per L) typically do not require coadministration of glucose. Wolters Kluwer India Pvt. (1998). 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. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). 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. 10 Electrolyte Imbalance Nursing Diagnosis & Care Plans It is also needed in the formation of muscles in the body. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Including the client in the plan of care elicits participation. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Gitelman Syndrome UK [gitelmansuk]. We and our partners share information on your use of this website to help improve your experience. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. 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. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. Potassium is an essential mineral that is responsible for fluid balance, regulating nerve signals, and muscle contraction. Rapid correction is possible with oral potassium; the fastest results are likely best achieved by combining oral (e.g., 20 to 40 mmol) and intravenous administration.22. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. 2023 nurseship.com. Patient information: See related handout on potassium, written by the authors of this article. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. 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. If able to eat and drink, administer PO potassium. Renal function should be monitored for patients receiving potassium replacement. Eh wala, yung 15, naging 7. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. 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. 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. Hypernatremia can cause lethargy, personality changes, and confusion. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. Here are some nursing interventions for patients with hyperkalemia: 1. Urinalysis can also show the presence of potassium in the urine. Findings on ECG are neither sensitive nor specific for hyperkalemia. 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. When defined as a value of less than 3.6 mmol of potassium per . 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. [] Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. 3. and, i didn't The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. Hypokalemia. (2022). NCP (Hypokalemia) | PDF - Scribd This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Treatment of hyperkalemia. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. You vomit a lot. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. 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. Insulin causes potassium to shift inside the cell which can lower potassium levels. 1. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. 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. Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic Urine test. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. Hypokalemia. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. If experiencing hyperkalemia, limit these foods in the diet. She received her RN license in 1997. The patients lung sounds are clear. Hypokalemia is treated with oral or intravenous potassium. 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. These can include assistive devices, braces, and adaptive equipment. You have diarrhea. This may lead to serious heart problems, heart attack or death. Generally, hypokalemia is a medical, not a surgical, condition. Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. The patient is experiencing weakness, heart palpitations, and shortness of breath. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. Potassium (K) is a major cation in intracellular fluid (ICF). Copyright 2015 by the American Academy of Family Physicians. Educate the patient about hyperkalemia. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. The patient thought apples were high in potassium. 1. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. Potassium regulates fluid and facilitates muscular contraction and nerve activity. 2. Medication intake. Clinical manifestations of hypokalemia are typically seen only if the serum potassium is <3.0 mEq/L. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Inform him/her the target range for serum potassium levels. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). The rapidity and method of potassium repletion depends on the: Potassium levels can fluctuate in the treatment of DKA. Excessive alcohol intake is known to reduce potassium levels. The most common cause is excess loss from the kidneys or gastrointestinal tract. St. Louis, MO: Elsevier. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Low magnesium levels. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. IV potassium can cause serious extravasation and vein irritation. This is commonly done through the administration of oral potassium supplement and high potassium diet. Bradycardia can progress to cardiac fibrillation and arrest. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Nursing care plans: Diagnoses, interventions, & outcomes. To replace potassium lost by the body. 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.