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. Consider switching to a potassium-sparing diuretic. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Potassium supplement. Carefully check the administration rate, with 2 nurses if needed. 4. (See "Causes of hypokalemia in adults".). She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. A more recent article on potassium disorders is available. Comer, S. and Sagel, B. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. 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. What is the NANDA nursing diagnosis for pneumonia . 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. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). The normal blood potassium level is 3.5 5.0 mEq/L. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. IV potassium can cause serious extravasation and vein irritation. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. 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. Inform the patient of the need to undergo dialysis, if indicated by the physician. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . This helps the patient gain muscle strength and confidence in performing self care. Educate the patient about high-potassium foods. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. (2022). 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. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. Treatment of hyperkalemia. Further replenishment can proceed more slowly, and attention can turn to the diagnosis and management of the underlying disorder.15 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), based on expert opinion.15. Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. 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. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Read theprivacy policyandterms and conditions. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Hypokalemia and Hyperkalemia NCLEX Review and Nursing Care Plans. 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. 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. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Planning:- The nurse will monitor for dysrrythmias, assess electrocargraphic Recordings and report changes that are related to cardiopulmonary resuscitation may be required but is seldom successful with severe hypokalemia because the heart muscle wil, respond. Copyright 2023 American Academy of Family Physicians. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Excessive alcohol intake is known to reduce potassium levels. 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. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Hypokalemia nursing diagnosis Tips and Tricks From Doctors. Educate the patient about the symptoms of hypokalemia. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. 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. Intravenous Calcium. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. Skidmore-Roth Publications. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). 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. 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. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. 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! Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). It is appropriate to increase dietary potassium in patients with low-normal and mild hypokalemia, particularly in those with a history of hypertension or heart disease.15 The effectiveness of increased dietary potassium is limited, however, because most of the potassium contained in foods is coupled with phosphate, whereas most cases of hypokalemia involve chloride depletion and respond best to supplemental potassium chloride.6,15, Because use of intravenous potassium increases the risk of hyperkalemia and can cause pain and phlebitis, intravenous potassium should be reserved for patients with severe hypokalemia, hypokalemic ECG changes, or physical signs or symptoms of hypokalemia, or for those unable to tolerate the oral form. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Here are some nursing interventions for patients with hyperkalemia: 1. 2. Certain antibiotics. 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. Insulin and Glucose. To replace potassium lost by the body. Potassium supplementation is the main treatment for hypokalemia. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. 1386-1388). 4. In children, dosing is 0.5 to 1.0 mmol per L per kg over one hour (maximum of 40 mmol).23 Potassium should not be given in dextrose-containing solutions because dextrose-stimulated insulin secretion can exacerbate hypokalemia. Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. 4. The patient needs to avoid foods high in potassium such as bananas. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. INTRODUCTION. 1. Potassium helps carry electrical signals to cells in your body. 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. Electrocardiogram (ECG). This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Volume depletion. Long-term goal: The patient will eat a broad variety of fruits and vegetables, with knowledge of a few high-potassium foods to eat in case of suspected hypokalemia. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). St. Louis, MO: Elsevier. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Your kidneys or adrenal glands don't work well. 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. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Possibly evidenced by Ascites. Interprofessional patient problems focus familiarizes you with how to speak to patients. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Other diagnostic tests that may be performed are as follows: Potassium replacement. Including the client in the plan of care elicits participation. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. Priority nursing diagnoses allnurses. 4. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. 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. In order to function properly, the body requires several electrolytes, one of which is potassium. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). For more information, check out our privacy policy. Normal Potassium Level 3.5-5.1 ( 2.5 or less is very dangerous) Most of the body's potassium is found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. As an Amazon Associate I earn from qualifying purchases. Potassium helps in utilizing carbohydrates and protein to produce energy. 3. 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. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. If able to eat and drink, administer PO potassium. 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. Studies suggest that some antibiotics can cause high potassium levels. CRITICAL CARE NURSING CARE PLANS. 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. Muscular weakness can affect respiratory muscles and lead to respiratory complications. 2. However, we aim to publish precise and current information. Nursing diagnosis:- Potential for dysrrythmia r/t 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 the patient to stand up and reposition slowly to prevent faintness and falls. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. You have entered an incorrect email address! 1 - 3 Hyperkalemia (serum potassium level. 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. Potassium is a main intracellular electrolyte. 6. 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. Recommended nursing diagnosis and nursing care plan books and resources. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. 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. Evaluation begins with a search for warning signs or symptoms warranting urgent treatment (Figure 1).7,14 These include weakness or palpitations, changes on electrocardiography (ECG), severe hypokalemia (less than 2.5 mEq per L [2.5 mmol per L]), rapid-onset hypokalemia, or underlying heart disease or cirrhosis.7,15 Most cases of hypokalemia-induced rhythm disturbances occur in individuals with underlying heart disease.10 Early identification of transcellular shifts is important because management may differ. 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) See permissionsforcopyrightquestions and/or permission requests. 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. Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. 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 Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. Assess urine output and kidney function through BUN, GFR, and creatinine levels. Bounding pulses. 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. Possible causes of hypokalemia include the following: Possible causes of hyperkalemia include the following: Signs and symptoms of potassium imbalance include: To ensure proper functioning and homeostasis the body must maintain a dynamic equilibrium of fluids and electrolytes. A more practical approach is calculation of the urine potassium-to-creatinine ratio from a spot urine specimen; a ratio greater than 1.5 mEq per mmol (13 mEq per g) is indicative of renal potassium wasting.18 If no cause is identified with the initial workup, assessment of thyroid and adrenal function should be considered. Wolters Kluwer India Pvt. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Sample Osteoporosis Nursing Care Plans |NANDA Nursing Diagnosis |Interventions with Rationales, Clopidogrel Bisulfate (Plavix) Nursing Implications |Patient Teachings, 19 NANDA Nursing Diagnosis for Fracture |Nursing Priorities & Management, 25 NANDA Nursing Diagnosis for Breast Cancer, 5 Stages of Bone Healing Process |Fracture classification |5 Ps, 9 NANDA nursing diagnosis for Cellulitis |Management |Patho |Pt education, 20 NANDA nursing diagnosis for Chronic Kidney Disease (CKD). Nursing diagnoses handbook: An evidence-based guide to planning care. Educate the patient about hyperkalemia. 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. 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. A standing weight is the most accurate. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. However, diuretics, particularly loop diuretics, may play a role in the treatment of some forms of chronic hyperkalemia, such as that caused by hyporeninemic hypoaldosteronism.39,44 Fludrocortisone is an option for hyperkalemia associated with mineralocorticoid deficiency, including hyporeninemic hypoaldosteronism.29. The diagnosis of hyperkalemia includes history taking and physical examination. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized.
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