hypokalemia nursing diagnosis

knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. Insulin and Glucose. 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. Gastric fluid contains little amount of potassium. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. (2020). Here are some nursing interventions for patients with hyperkalemia: 1. 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. You vomit a lot. Your kidneys control your body's potassium levels, allowing for excess . Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. 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. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Urinalysis can also show the presence of potassium in the urine. Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs 3. Hypokalemia Disease with Causes, Symptom and Nursing Intervention Hypovolemia Nursing Diagnosis and Nursing Care Plan Therefore, potassium helps control the fluid inside the cell, while sodium . Herdman, T., Kamitsuru, S. & Lopes, C. (2021). Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. 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. Buy on Amazon. Wound Care & Infection Nursing Diagnosis & Care Plan, Parkinsons Disease Nursing Diagnosis & Care Plan, Hypokalemia serum potassium level < 3.5 mEq/L (3.5 mmol/L), Hyperkalemia serum potassium level > 5.0 mEq/L (5.0 mmol/L), Excessive use of potassium-wasting diuretics, Increased production of aldosterone (water and salt regulating hormone) (such as in Cushings syndrome), Kidney disease impairing the reabsorption of potassium, Poor potassium intake such as through eating disorders. Thieme. Assess urine output and kidney function through BUN, GFR, and creatinine levels. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Hypokalemia | Definition & Patient Education - Healthline Magnesium helps the movement potassium in and out the cells. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. Hypokalemia. Hinkle, J. L., & Cheever, K. H. (2018). 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. Implement safety measures when administering IV potassium.Because IV potassium infusion can cause phlebitis as a complication, the nurse should regularly check the IV site for indications of phlebitis or infiltration. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. 2. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. Bounding pulses. 2697-2729). Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. 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. Non-steroidal anti-inflammatory medications (NSAIDs). Urine test. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. Hypokalaemia ECG Changes. 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. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Data Sources: An Essential Evidence search was conducted. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. Please follow your facilities guidelines and policies and procedures. 2. Blood test. 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. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. She found a passion in the ER and has stayed in this department for 30 years. 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. All rights reserved. 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. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Views on topics do not generally reflect that of the entire community. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. When defined as a value of less than 3.6 mmol of potassium per . Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Some medications can cause abnormal blood potassium levels. How to Diagnose Fluid Volume Deficit: Signs and Care Plan - PrepScholar Hyperkalemia can result from taking potassium chloride or salt substitutes. For both disorders, it is important to consider potential causes of transcellular shifts because patients are at increased risk of rebound potassium disturbances. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Monitor for signs and symptoms of hypokalemia: Assist client in selecting foods rich in potassium as such as banana, fruit juices, melon, citrus fruits,and fresh vegetables. 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. Other causes include certain medications and some adrenal and genetic conditions. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Educate the patient about hyperkalemia. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. Muscle wasting and paralysis can result from very low potassium levels. 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. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. Obtain daily blood sample from the patient. IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low potassium. 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. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. Hypokalemia is treated with oral or intravenous potassium. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Inform the patient of the need to undergo dialysis, if indicated by the physician. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. 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. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). See permissionsforcopyrightquestions and/or permission requests. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. Diuretics (water retention relievers) Excessive laxative use. NCP (Hypokalemia) | PDF - Scribd 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. 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. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. Other diagnostic tests that may be performed are as follows: Potassium replacement. Short-term goal: By the end of the shift the patients potassium will normalize and the patient will experience a resolution of symptoms. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Include or limit potassium in the diet.Educate the patient on their prescribed diet depending on the condition. Hypokalemia & Hyperkalemia Nursing Diagnosis & Care Plan 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. 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. Occasionally, low potassium is caused by not getting enough potassium in your diet. During the treatment, however, low potassium may result due to the administration of insulin. Diabetic ketoacidosis. Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. 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. 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. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. 3. Low magnesium levels. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in 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. 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. Potassium helps carry electrical signals to cells in your body. PO potassium can cause stomach upset so its best to administer with food or after meals. It also decreases the risk of falls and fall related injuries. 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. This content is owned by the AAFP. Priority nursing diagnoses allnurses. Medication intake. 5. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). 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. Aphasia, muscle twitching, tremors, seizures. Hypokalemia: Symptoms, causes, and diagnosis - Medical News Today 7. Review drug regimen for medications containing potassium or affecting potassium excretion such as spironolactone (Aldactone), hydrochlorothiazide (Maxzide), amiloride (Midamor), and penicillin G.Requires regular monitoring of potassium levels and may require alternate drug choices or changes in the dosage or frequency. Educate the patient about the symptoms of hypokalemia. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . Distended neck and peripheral veins. The ECG can provide useful information for hypokalemia. 4. Mosby. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans 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. 2. Compromised regulatory mechanism. [Twitter moment] Retrieved from. To accurately measure the input and output of the patient. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. A blood test is performed to check the levels of electrolytes in the blood including potassium. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. Weight should be performed every day to help assess fluid volume status. 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. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Elsevier. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. 1 - 3 Hyperkalemia (serum potassium level. Elsevier. Your body needs potassium to function correctly. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. 1. St. Louis, MO: Elsevier. Biochemistry is needed to check for the level of serum potassium. 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, . The normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L. 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. Elsevier Inc. ECG should be considered if the potassium level is greater than 6 mEq per L; if there are symptoms of hyperkalemia; if there is suspicion of rapid-onset hyperkalemia; or among patients with underlying kidney disease, heart disease, or cirrhosis who have a new case of hyperkalemia. 3. Potassium (K) is a major cation in intracellular fluid (ICF). Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. 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. While others spare potassium from being excreted through the kidneys.

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