The bodys muscles depend highly on potassium level to function adequately. Generally, hypokalemia is a medical, not a surgical, condition. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Diuretics. A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. 3. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed. Diarrhea. 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. 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. 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. Bradycardia can progress to cardiac fibrillation and arrest. Interprofessional patient problems focus familiarizes you with how to speak to patients. 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. Hypokalemia - Endocrine and Metabolic Disorders - MSD Manual This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. Monitor strict intake and output.Monitor urine output as well as bowel movements. 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. 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. 4. 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. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. Hyperkalemia and hypokalemia can also cause paralysis and weakness. 10. Hypokalemia nursing diagnosis Tips and Tricks From Doctors. Rectal: 30 to 50 g every 6 hours in a retention enema. Help the patient to select appropriate dietary choices to follow a high potassium diet. 1 - 3 Hyperkalemia (serum potassium level. Your body needs potassium to function correctly. This content is owned by the AAFP. (2020). All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. Nursing Diagnosis: Electrolyte Imbalance Related to: Changes in the regulation of potassium Changes in the intake of potassium Difficulty excreting potassium Conditions that affect the movement of potassium in the cellular space As evidenced by: Alterations in the electrical conductivity of the heart Ineffective respirations 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. Low potassium (hypokalemia) Causes - Mayo Clinic Nursing Diagnosis: Imbalanced Nutrition Less than Body requirements related to hypokalemia as evidenced by nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Read theprivacy policyandterms and conditions. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. 10 Electrolyte Imbalance Nursing Diagnosis & Care Plans Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. Potassium levels can fluctuate in the treatment of DKA. Studies suggest that some antibiotics can cause high potassium levels. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. (2015 Nov 22). 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. Polyuria -potassium is mainly excreted through the kidneys. 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, . Discover the causes, symptoms, and treatments for these electrolyte imbalances. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. It can result in serious injury or death if it becomes too high or too low. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. IV potassium can cause serious extravasation and vein irritation. Some medications can cause abnormal blood potassium levels. 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. Include or limit potassium in the diet.Educate the patient on their prescribed diet depending on the condition. 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. 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. Monitor respiratory rate and depth. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. Silvestri, L. A., Silvestri, A. E., & Grimm, J. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Renally mediated hyperkalemia results from derangement of one or more of the following processes: rate of flow in the distal nephron, aldosterone secretion and its effects, and functioning potassium secretory pathways. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. Potassium is an essential mineral that is responsible for fluid balance, regulating nerve signals, and muscle contraction. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. 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. Centrally potassium can be administered more quickly and in larger doses via this route. If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. Potassium is a main intracellular electrolyte. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. All rights reserved. Elsevier Health Sciences. The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. (See "Causes of hypokalemia in adults".). By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. Clinicians should review patients' medications to identify those known to cause hyperkalemia, and ask patients about the use of salt substitutes that contain potassium. Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Inhaled Beta Agonists. 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. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. 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. This may lead to serious heart problems, heart attack or death. Potassium (K) is a major cation in intracellular fluid (ICF). Potential health risks are avoidable as long as the potassium levels are kept at a normal level. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. A more recent article on potassium disorders is available. The effect can cause slow peristalsis which can lead to constipation. Hypokalemia: Practice Essentials, Pathophysiology, Etiology - Medscape Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Views on topics do not generally reflect that of the entire community. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. 4. 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. The patient is tachycardic and PVCs are noted on ECG. The patient thought apples were high in potassium. However, we aim to publish precise and current information. Elsevier/Mosby. It should ideally be done at the same time and same method (standing, bed weight, etc.) Low magnesium levels. Administer prescribed potassium with precautions.Potassium can be administered IV or PO. Hypokalemia (Low Potassium): Symptoms, Causes, Diagnosis, Treatment - WebMD 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. 4. High alcohol intake. CRITICAL CARE NURSING CARE PLANS. Potassium Disorders: Hypokalemia and Hyperkalemia | AAFP Place the patient on high potassium diet as per the physicians order. Our website services and content are for informational purposes only. 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. Wolters Kluwer India Pvt. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. Certain antibiotics. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Arrhythmias associated with hypokalemia include sinus bradycardia, ventricular tachycardia or fibrillation, and torsade de pointes.19 Although the risk of ECG changes and arrhythmias increases as serum potassium concentration decreases, these findings are not reliable because some patients with severe hypokalemia do not have ECG changes.20, The immediate goal of treatment is the prevention of potentially life-threatening cardiac conduction disturbances and neuromuscular dysfunction by raising serum potassium to a safe level. The patients lung sounds are clear. Copyright 2015 by the American Academy of Family Physicians. Identify and discontinue dietary sources of potassium, such asbeans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas.Facilitates the reduction of potassium levels and may prevent the recurrence of hyperkalemia. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. Kidney problems. 9. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. High potassium occurs due to lack of insulin. Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. 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. The diagnosis of hyperkalemia includes history taking and physical examination. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. Urine test. Hyperkalemia & Hypokalemia Nursing Diagnosis and Nursing Care Plan Potassium is mainly excreted in the kidneys. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. The IV potassium can be given in a solution with normal saline . Excessive alcohol intake is known to reduce potassium levels. 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. Potassium helps carry electrical signals to cells in your body. Risk for falls associated with potassium imbalance is caused by a disruption in the electric signals in muscles resulting in muscle weakness, cramping, hyporeflexia, and paralysis. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Here are some nursing interventions for patients with hyperkalemia: 1. 5. Electrocardiogram (ECG). Swearingen, P. (2016). The main source of potassium is from food. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . Insulin causes potassium to shift inside the cell which can lower potassium levels. See permissionsforcopyrightquestions and/or permission requests. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). 3. Including the client in the plan of care elicits participation. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. Patient information: See related handout on potassium, written by the authors of this article. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. 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). 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. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. The majority of potassium is stored in the intracellular compartment. Potassium helps in utilizing carbohydrates and protein to produce energy. Folic acid deficiency. The patient is experiencing weakness, heart palpitations, and shortness of breath. NCP (Hypokalemia) | PDF - Scribd This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. 1. What is the NANDA nursing diagnosis for pneumonia . 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. Potassium supplement. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance Beta-blockers. 2023 nurseship.com. Nursing Diagnosis (hypokalemia)-help? - allnurses Hypokalemia means low blood potassium levels. Crackles. Monitor potassium every 6 hours or as needed. 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). 4. 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 []. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Compromised regulatory mechanism. Skidmore-Roth Publications. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. The diagnosis should be confirmed with a repeat serum potassium measurement. Inform the healthcare team about the patients level of risk of falls.Effective communication among healthcare team members encourages collaboration and teamwork, which promotes the safety and prevention of fall incidents for the patient. Search dates: February, September, and December 2014. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. Occasionally, low potassium is caused by not getting enough potassium in your diet. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Determine the patients independence in performing activities.Promote and assist in patient ambulation and independence in self care. Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L). 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) Inform the patient of the need to undergo dialysis, if indicated by the physician. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L.
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