The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. 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. Insulin and glucose . 1. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu Hypokalemia: Symptoms, causes, and diagnosis - Medical News Today 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. Recommended nursing diagnosis and nursing care plan books and resources. 5. Magnesium helps the movement potassium in and out the cells. 1386-1388). 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. Data Sources: An Essential Evidence search was conducted. Elsevier Inc. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. 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. 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. 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. Hypotension Extreme thirst Elevated heart rate Weakness Cramps in the legs Reduced urine production Dry mucosal membranes Decreased skin elasticity Accelerated respiration Hypovolemia that leads to hypovolemic shock is a potentially fatal condition. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Hypokalemia NCLEX Review Notes - Registered Nurse RN Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. Include or limit potassium in the diet.Educate the patient on their prescribed diet depending on the condition. 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. Please read our disclaimer. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). Potassium Disorders: Hypokalemia and Hyperkalemia | AAFP 2. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. Nursing care plans: Diagnoses, interventions, & outcomes. 1 - 3 Hyperkalemia (serum potassium level. 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). 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. 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. 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. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. 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. (See "Causes of hypokalemia in adults".). While others spare potassium from being excreted through the kidneys. To replace potassium lost by the body. 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. 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. 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. Elsevier. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. If able to eat and drink, administer PO potassium. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Potassium supplements are used to treat severe hypokalemia. Medication intake. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Hypokalemia | NEJM - New England Journal of Medicine Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. 2. Potassium is a main intracellular electrolyte. 4. 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. Boiling potatoes and cutting vegetable sin small pieces are also recommended. Urine test. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). Centrally potassium can be administered more quickly and in larger doses via this route. Hyperkalemia - SlideShare With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Diuretics (water retention relievers) Excessive laxative use. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. You have entered an incorrect email address! Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Monitor heart rate and rhythm. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Weight should be performed every day to help assess fluid volume status. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. The combination of furosemide and beta-blocker may reduce blood pressure and decrease heart rate. 3. 5. The patient needs to avoid foods high in potassium such as bananas. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. Potassium disorders are common. do you see all the information i began to generate from those two pieces of information? Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. Beta-blockers. Wolters Kluwer India Pvt. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. It may have a role as adjuvant therapy, particularly among patients with concurrent metabolic acidosis.24,39,40, Potassium can be removed via the GI tract or the kidneys, or directly from the blood with dialysis. In response to acidosis, extracellular hydrogen is exchanged for intracellular potassium, although the net result is highly variable and depends in part on the type of acidosis; metabolic acidosis produces the greatest effect.26 Because 98% of total body potassium is intracellular, any process that increases cell turnover, such as rhabdomyolysis, tumor lysis syndrome, or red blood cell transfusions, can result in hyperkalemia. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. 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. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Hypokalemia is treated with oral or intravenous potassium. 2. Create a daily weight chart and a food and fluid chart. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Aphasia, muscle twitching, tremors, seizures. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. Diarrhea. IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low potassium. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Monitor respiratory rate and depth. A more recent article on potassium disorders is available. 1. Elsevier Health Sciences. Other causes include certain medications and some adrenal and genetic conditions. Search dates: February, September, and December 2014. This is commonly done through the administration of oral potassium supplement and high potassium diet. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Hyponatremia & Hypernatremia Nursing Diagnosis & Care Plan Medical-surgical nursing: Concepts & practice (3rd ed.). Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. [Twitter moment] Retrieved from. Start a strict input and output monitoring. She found a passion in the ER and has stayed in this department for 30 years. Views on topics do not generally reflect that of the entire community. Gastric fluid contains little amount of potassium. Hypokalemia nursing diagnosis Tips and Tricks From Doctors. Potassium regulates fluid and facilitates muscular contraction and nerve activity. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. St. Louis, MO: Elsevier. Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Facilitates excretion of sodium and water while sparing potassium. 1. Potassium supplement. Rapid correction is possible with oral potassium; the fastest results are likely best achieved by combining oral (e.g., 20 to 40 mmol) and intravenous administration.22. Further evaluation may include measurement of serum glucose to evaluate for hyperglycemia, and measurement of serum renin, aldosterone, and cortisol to further investigate kidney and adrenal function. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting.
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