Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Skidmore-Roth Publications. 3. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. 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. Nursing Diagnosis: Deficient Knowledge related to new diagnosis of hyperkalemia as evidenced by patients verbalization of I want to know more about my new diagnosis and care. Also, the administration of potassium to treat or prevent hypokalemia can inadvertently cause hyperkalemia.19, ACE inhibitors contributed to one-half of all cases of drug-induced hyperkalemia in one sample, and approximately 10% of outpatients who start an ACE inhibitor or an ARB will develop hyperkalemia within one year.23,28 The incidence of hyperkalemia associated with use of potassium-sparing diuretics has risen since adding spironolactone to standard therapy was shown to reduce morbidity and mortality in patients with congestive heart failure.29 Dual treatment with an ACE inhibitor and an ARB increases the risk of harmful adverse effects, including hyperkalemia, and should be avoided.11 Other commonly used medications known to cause hyperkalemia include trimethoprim, heparin, beta blockers, digoxin, and nonsteroidal anti-inflammatory drugs.3, As with hypokalemia, the immediate danger of hyperkalemia is its effect on cardiac conduction and muscle strength, and initial efforts should focus on determining the need for urgent intervention (Figure 2).14,30 The absence of symptoms does not exclude severe hyperkalemia, because hyperkalemia is often asymptomatic. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). This is commonly done through the administration of oral potassium supplement and high potassium diet. Hinkle, J. L., & Cheever, K. H. (2018). Potassium is contraindicated if oliguria or anuria is present. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. (2015 Nov 22). Place the patient on high potassium diet as per the physicians order. 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. 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. Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. 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. For the prevention of hypokalemia in patients with persistent losses, as with ongoing diuretic therapy or hyperaldosteronism, 20 mmol per day is usually sufficient.15, Hyperkalemia is caused by excess potassium intake, impaired potassium excretion, or transcellular shifts (Table 2).8,24 The etiology of hyperkalemia is often multifactorial, with impaired renal function, medication use, and hyperglycemia as the most common contributors.25 Because healthy individuals can adapt to excess potassium consumption by increasing excretion, increased potassium intake is rarely the sole cause of hyperkalemia, and underlying renal dysfunction is common.24. Consider IV maintenance fluids with potassium added. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. The patient is experiencing weakness, heart palpitations, and shortness of breath. To give the patient enough information on hypernatremia and its effects to the body. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Distended neck and peripheral veins. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. These can include assistive devices, braces, and adaptive equipment. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Careful monitoring during treatment is essential because supplemental potassium is a common cause of hyperkalemia in hospitalized patients.21 The risk of rebound hyperkalemia is higher when treating redistributive hypokalemia. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. 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. 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. Excessive sweating. 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. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. 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. She found a passion in the ER and has stayed in this department for 30 years. Intravenous Calcium. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. 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. The majority of potassium is stored in the intracellular compartment. The ECG can provide useful information for hypokalemia. 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. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. (See "Causes of hypokalemia in adults".). Diarrhea. nursing care plan for HYPOKALEMIA plsss. - allnurses 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. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. 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. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. Bounding pulses. The rapidity and method of potassium repletion depends on the: However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. The diagnosis should be confirmed with a repeat serum potassium measurement. Boiling potatoes and cutting vegetable sin small pieces are also recommended. 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. Potassium supplementation is the main treatment for hypokalemia. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). 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. Eh wala, yung 15, naging 7. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. 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. 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. Careful assessment for its early presence is needed especially for high-risk patients. Consider switching to a potassium-sparing diuretic. Potassium levels can fluctuate in the treatment of DKA. You vomit a lot. How to Diagnose Fluid Volume Deficit: Signs and Care Plan - PrepScholar 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, . Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Monitor potassium every 6 hours or as needed. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. 1. During the treatment, however, low potassium may result due to the administration of insulin. 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. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. St. Louis, MO: Elsevier. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Insulin and glucose . 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. before you can make any diagnosis you must consider many factors: a health history (review of systems) performing a physical exam assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. 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). Search dates: February, September, and December 2014. She received her RN license in 1997. Your body needs potassium to function correctly. A blood test is performed to check the levels of electrolytes in the blood including potassium. 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. 2. Elsevier Health Sciences. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. Bradycardia can progress to cardiac fibrillation and arrest. Treatment-related side effects such as cytotoxic drugs. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. 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. Here are some nursing interventions for patients with hyperkalemia: 1. 1. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. Other causes include certain medications and some adrenal and genetic conditions. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. 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. Magnesium helps the movement potassium in and out the cells. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Insulin causes potassium to shift inside the cell which can lower potassium levels. The patient needs to avoid foods high in potassium such as bananas. Hypokalemia - Endocrine and Metabolic Disorders - MSD Manual While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. In children, dosing is 0.5 to 1.0 mmol per L per kg over one hour (maximum of 40 mmol).23 Potassium should not be given in dextrose-containing solutions because dextrose-stimulated insulin secretion can exacerbate hypokalemia. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia secondary to hyperaldosteronism as evidenced by serum potassium level of 2.9 mmol/L, high aldosterone levels, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. The infusion should be discontinued immediately if this occurs. Patient information: See related handout on potassium, written by the authors of this article. To treat the kidney disease if this is the underlying cause of hyperkalemia. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. It also decreases the risk of falls and fall related injuries. Anna Curran. 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. 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. 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. Electrocardiogram (ECG). 3. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. do you see all the information i began to generate from those two pieces of information? Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Author disclosure: No relevant financial affiliations. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. Medical-surgical nursing: Concepts & practice (3rd ed.). Obtain daily blood sample from the patient. Start a strict input and output monitoring. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. In order to function properly, the body requires several electrolytes, one of which is potassium. 3. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. Treatment-related side effects, such as certain medications or chemotherapy, can also contribute to hyperkalemia by altering potassium levels in the body, leading to a risk for electrolyte imbalance. 11. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. Hyperkalemia (Nursing) - StatPearls - NCBI Bookshelf Educate the patient about the symptoms of hypokalemia. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This is a community of professional nurses gifted with literary skills who share theoretical and clinical knowledge, nursing tidbits, facts, statistics, healthcare information, news, disease data, care plans, drugs and anything under the umbrella of nursing. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice.