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. Weight should be performed every day to help assess fluid volume status. Ackley and Ladwigs Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing 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. Saunders comprehensive review for the NCLEX-RN examination. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. 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. 4. 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. Buy on Amazon. Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. Hypokalemia | NEJM - New England Journal of Medicine When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. Nurses must closely monitor patients lab results and correct imbalances to prevent complications. Used in the treatment of potassium deficiency when oral replacement is not feasible. 2. 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 Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Elsevier. Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. 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. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. 3. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Hyperkalemia-induced ventricular fibrillation is treated with calcium. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Potassium regulates fluid and facilitates muscular contraction and nerve activity. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu 3. She received her RN license in 1997. Potassium is a main intracellular electrolyte. 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. Hyperkalemia and hypokalemia can also cause paralysis and weakness. 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. While others spare potassium from being excreted through the kidneys. All Rights Reserved. NCP (Hypokalemia) | PDF - Scribd Bounding pulses. Patient information: See related handout on potassium, written by the authors of this article. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. Copyright 2023 American Academy of Family Physicians. Low magnesium levels. Rectal: 30 to 50 g every 6 hours in a retention enema. 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. 2. Save my name, email, and website in this browser for the next time I comment. Potassium is an electrolyte needed primarily for muscle and nerve tissue 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. Potassium is contraindicated if oliguria or anuria is present. 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. The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. For both disorders, it is important to consider potential causes of transcellular shifts because patients are at increased risk of rebound potassium disturbances. 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. (2015 Nov 22). Other recommended site resources for this nursing care plan: Other nursing care plans related to endocrine system and metabolism disorders: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers. Hypokalaemia ECG Changes. 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. 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. We and our partners share information on your use of this website to help improve your experience. As an Amazon Associate I earn from qualifying purchases. 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. Obtain daily blood sample from the patient. Potassium can be obtained as a dietary supplement but is naturally available in many foods. Folic acid deficiency. 4. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. 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. Potassium (K) is a major cation in intracellular fluid (ICF). Hypokalemia (Low Potassium): Symptoms, Causes, Diagnosis, Treatment - WebMD Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). Polyuria -potassium is mainly excreted through the kidneys. This helps the patient gain muscle strength and confidence in performing self care. 2. For the past few nights, he has had severe leg cramps that have woken him up. The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. 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.

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