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. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude. Electrocardiogram (ECG). 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. (2020). Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. 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). Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. St. Louis, MO: Elsevier. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. 4. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. It is also needed in the formation of muscles in the body. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. Hyperkalemia-induced ventricular fibrillation is treated with calcium. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. Urinalysis can also show the presence of potassium in the urine. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. 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. The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. 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). Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. 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. Data Sources: An Essential Evidence search was conducted. Inform the patient of the need to undergo dialysis, if indicated by the physician. 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. Intravenous Calcium. Obtain ECG and observe signs of dysrhythmias.A potassium imbalance may result in alterations in ECG findings since potassium is essential for both depolarization (contraction) and repolarization (relaxation) of the heart. 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. 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. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Copyright 2023 American Academy of Family Physicians. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. 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. 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). There are subsets of patients that are susceptible to the development of hypokalemia. Your body needs potassium to function correctly. Nursing interventions for hyperkalemia patients aim to prevent life-threatening cardiac dysrhythmias by reducing serum potassium levels through a combination of medication administration, dietary management, and monitoring. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . 1. 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. 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. Encourage deep breathing and coughing exercise. Fluid loss from the body such as vomiting and diarrhea causes depletion of the electrolyte potassium partly because potassium is actually lost with gastric fluid. Nursing Diagnosis: Risk for Hypernatremia Potentially Related To Dehydration Severe diarrhea Fever Vomiting Poorly controlled diabetes Certain medications Kidney disease Diabetes insipidus Extensive burns Evidenced By Extreme thirst Fatigue Headache Nausea Lethargy Confusion Muscle twitching or spasms Seizures Coma Desired Outcomes Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. Potential health risks are avoidable as long as the potassium levels are kept at a normal level. 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. Occasionally, low potassium is caused by not getting enough potassium in your diet. Potassium supplementation is the main treatment for hypokalemia. Boiling potatoes and cutting vegetable sin small pieces are also recommended. Used in the treatment of potassium deficiency when oral replacement is not feasible. (2022). Elsevier. 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. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. However, we aim to publish precise and current information. Gastric fluid contains little amount of potassium. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. An ECG is performed to check heart rhythm. To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Beta-blockers. You vomit a lot. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. The infusion should be discontinued immediately if this occurs. This content is owned by the AAFP. The IV potassium can be given in a solution with normal saline . IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low 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. Diabetic ketoacidosis. During the treatment, however, low potassium may result due to the administration of insulin. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . You have diarrhea. 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. Medication intake. 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. Therefore, although ECG changes should trigger urgent treatment, treatment decisions should not be based solely on the presence or absence of ECG changes.32, Peaked T waves are the prototypical, and generally the earliest, ECG sign of hyperkalemia. Clinical manifestations of hypokalemia are typically seen only if the serum potassium is <3.0 mEq/L. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). Place the patient on high potassium diet as per the physicians order. Psychiatric Nursing . Diarrhea. 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. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. Excessive alcohol intake is known to reduce potassium levels.
