hypokalemia nursing diagnosis

Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Nursing Diagnosis (hypokalemia)-help? - allnurses Obtain daily blood sample from the patient. When defined as a value of less than 3.6 mmol of potassium per . 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. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction Please read our disclaimer. Rectal: 30 to 50 g every 6 hours in a retention enema. 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. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. Save my name, email, and website in this browser for the next time I comment. A blood test is performed to check the levels of electrolytes in the blood including potassium. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. 9. 4. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. High potassium occurs due to lack of insulin. Urine test. The effect can cause slow peristalsis which can lead to constipation. Elsevier Health Sciences. The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. 5. Buy on Amazon. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-large-mobile-banner-2','ezslot_6',662,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-2-0');Risk for decreased cardiac tissue perfusion related to severe potassium deficiency as evidenced by heart palpitations, tachycardia, and presence of PVCs. 3. Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. Educate the patient about the symptoms of hypokalemia. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. Hypokalemia Disease with Causes, Symptom and Nursing Intervention To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. Generally, hypokalemia is a medical, not a surgical, condition. A more recent article on potassium disorders is available. 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. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. Some types of diuretics increase potassium excretion through the kidneys. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. 2. Upon assessment, the patient is alert and oriented and follows commands appropriately. Used in the treatment of potassium deficiency when oral replacement is not feasible. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. 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. The main source of potassium is from food. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. Excessive sweating. Boiling potatoes and cutting vegetable sin small pieces are also recommended. Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. 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. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Including the client in the plan of care elicits participation. Copyright 2015 by the American Academy of Family Physicians. [] Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. 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. (2020). Your kidneys control your body's potassium levels, allowing for excess . Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting; sodium polystyrene sulfonate is reserved for subacute treatment. 5. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. 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. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. 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. It can result in serious injury or death if it becomes too high or too low. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. Inform him/her the target range for serum potassium levels. Renal function should be monitored for patients receiving potassium replacement. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). 4. Other causes include certain medications and some adrenal and genetic conditions. 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. 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. PO potassium can cause stomach upset so its best to administer with food or after meals. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Create a daily weight chart and a food and fluid chart. Potassium supplementation is the main treatment for hypokalemia. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Low magnesium levels. The combination of furosemide and beta-blocker may reduce blood pressure and decrease heart rate. 2. Educate the patient about high-potassium foods. 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. Nursing care plans: Diagnoses, interventions, & outcomes. The oral potassium should be used in the dose 20-40 mEq three to four times a day (the lower dose is for patients receiving IV potassium, and the higher doses for patients receiving just the oral). Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively sample clinical applications, prioritized action/interventions with rationales a documentation section, and much more! You have diarrhea. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Too much or too little potassium in diet. We and our partners share information on your use of this website to help improve your experience. 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. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. To give the patient enough information on hypernatremia and its effects to the body. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. Furosemide Nursing Considerations - NurseStudy.Net Diabetic ketoacidosis. Hypokalemia | Definition & Patient Education - Healthline Mosby. 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. This content is owned by the AAFP. Hyponatremia & Hypernatremia Nursing Diagnosis & Care Plan Bradycardia can progress to cardiac fibrillation and arrest. 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. About 98% of the bodys potassium is found inside the cells and the rest is found extracellularly. Therefore, potassium helps control the fluid inside the cell, while sodium . Now, my body feels very weak., Vomitus of yellowish fluid approximately 70 cc times three episodes for two days, Diarrhea; Watery stools times 4 episodes for two days, Presence of an elevated U wave on ECG result, Altered electrolyte balance related to active fluid loss secondary to vomiting and diarrhea. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Author disclosure: No relevant financial affiliations. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Hypokalaemia ECG Changes. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. Articles submitted here are original but are checked for minor typographical errors, and are formatted for site compatibility.This is a site that continuously improves and broadcasts healthcare information relevant to today's ever-changing world. Other medical causes. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. 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. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Anna Curran. Common acute manifestations are muscle weakness and ECG changes. 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. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. The patient says: Ive been on Lasix for years now so I know what to expect, but I still think Ive been urinating more than usual. He also reports thirst and constipation, but he was careful not to drink excess water because of his heart failure. Too much potassium supplementation can cause hyperkalemia. 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. 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. It is also needed in the formation of muscles in the body. 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. Patient information: See related handout on potassium, written by the authors of this article. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Centrally potassium can be administered more quickly and in larger doses via this route. Muscle wasting and paralysis can result from very low potassium levels. See permissionsforcopyrightquestions and/or permission requests. 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. Elsevier. NCP (Hypokalemia) | PDF - Scribd 1. 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. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. You have entered an incorrect email address! Hyperaldosteronism Nursing Diagnosis and Nursing Care Plan Hypokalemia results from abnormal losses, transcellular shifts, or insufficient intake (Table 1).68 Abnormal losses are most common.9 Because the kidney can significantly lower potassium excretion in response to decreased intake, insufficient intake is rarely the sole cause of hypokalemia, but it often contributes to hypokalemia in hospitalized patients.9, Diuretic use is a common cause of renally mediated hypokalemia.10 When given in the same dosage, chlorthalidone is more likely to induce hypokalemia than hydrochlorothiazide, which is more often implicated because of its widespread use.11,12 Diuretic-induced hypokalemia is dose-dependent and tends to be mild (3 to 3.5 mEq per L [3 to 3.5 mmol per L]), although it can be more severe when accompanied by other causes (e.g., gastrointestinal [GI] losses).13, GI losses are another common cause of hypokalemia, particularly among hospitalized patients.9 The mechanism by which upper GI losses induce hypokalemia is indirect and stems from the kidney's response to the associated alkalosis. The patients lung sounds are clear. (1998). Elsevier. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. 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. It is also needed in the formation of muscles in the body. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . Consider switching to a potassium-sparing diuretic. There are subsets of patients that are susceptible to the development of hypokalemia. Clinical manifestations and treatment of hypokalemia in adults Bounding pulses. 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. However, we aim to publish precise and current information. Here are some nursing interventions for patients with hyperkalemia: 1. 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. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. 10. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. Aphasia, muscle twitching, tremors, seizures. Potassium can be obtained as a dietary supplement but is naturally available in many foods. While others spare potassium from being excreted through the kidneys. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Potassium levels can fluctuate in the treatment of DKA. The patient is experiencing weakness, heart palpitations, and shortness of breath. Ignatavicius, MS, RN, CNE, ANEF, D. D., Workman, PhD, RN, FAAN, M. L., Rebar, PhD, MBA, RN, COI, C. R., & Heimgartner, MSN, RN, COI, N. M. (2018). Concomitant hypomagnesemia should be treated concurrently. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. The patient thought apples were high in potassium. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. Folic acid deficiency. The diagnosis should be confirmed with a repeat serum potassium measurement. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. This is commonly done through the administration of oral potassium supplement and high potassium diet. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Medical-surgical nursing: Concepts & practice (3rd ed.). (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. 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. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy []. Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs IV potassium can cause serious extravasation and vein irritation. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). In order to function properly, the body requires several electrolytes, one of which is 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.

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