The normal serum potassium level is between 3.5 to 5.2 mmoL/L. Hypernatremia can cause lethargy, personality changes, and confusion. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. To replace potassium lost by the body. Upon assessment, the patient is alert and oriented and follows commands appropriately. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. Copyright 2023 American Academy of Family Physicians. 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. Search dates: February, September, and December 2014. St. Louis, MO: Elsevier. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia, an elevated level of potassium in the blood, can occur in patients with renal disease due to the kidneys reduced ability to excrete potassium, and in patients who have received massive blood transfusions due to the release of potassium from stored blood cells. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. INTRODUCTION. 2. A risk for diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and nursing interventions are aimed at prevention. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Inhaled Beta Agonists. High alcohol intake. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Psychiatric Nursing . 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. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). 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. 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. 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. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. Indications for urgent treatment include severe or symptomatic hypokalemia or hyperkalemia; abrupt changes in potassium levels; electrocardiography changes; or the presence of certain comorbid conditions. 5. Potassium regulates fluid and facilitates muscular contraction and nerve activity. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Findings on ECG are neither sensitive nor specific for hyperkalemia. Other causes include certain medications and some adrenal and genetic conditions. Hypokalemia can be life-threatening. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. 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. (See "Causes of hypokalemia in adults".). To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Oral potassium does not correct the problem, If hypokalemia is causing abnormal heart rhythms, Switching to potassium-sparing diuretics if needed, Treatment of kidney disease, which includes dialysis, Elimination disorders related to increase in urine volume (polyuria). NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. 1. Blood pressure medications. 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. 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. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). 4. 5. 1386-1388). Potassium helps carry electrical signals to cells in your body. Hypokalemia is serum potassium concentration < 3.5 mEq/L (< 3.5 mmol/L) caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). You vomit a lot. Gitelman Syndrome UK [gitelmansuk]. 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. 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. Centrally potassium can be administered more quickly and in larger doses via this route. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. 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. A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. The patient says: Ive been on Lasix for years now so I know what to expect, but I still think Ive been urinating more than usual. He also reports thirst and constipation, but he was careful not to drink excess water because of his heart failure. Potassium helps in utilizing carbohydrates and protein to produce energy. Diuretics (water retention relievers) Excessive laxative use. Common acute manifestations are muscle weakness and ECG changes. 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). if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[468,60],'nurseship_com-large-mobile-banner-1','ezslot_4',646,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-1-0'); The patient is admitted to the hospital for Hypokalemia. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Interprofessional patient problems focus familiarizes you with how to speak to patients. Nursing diagnoses handbook: An evidence-based guide to planning care. The physical examination should focus on identifying cardiac arrhythmias and neurologic manifestations, which range from generalized weakness to ascending paralysis. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Elsevier/Mosby. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. Strategies to prevent chronic hyperkalemia include instructing patients to eat a low-potassium diet, discontinuing or adjusting medications, avoiding nonsteroidal anti-inflammatory drugs, and adding a diuretic if the patient has sufficient renal function. Some medications can cause abnormal blood potassium levels. Intravenous Calcium. 3. Priority nursing diagnoses allnurses. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. St. Louis, MO: Elsevier. Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. Beta-blockers. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. Anna Curran. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. What is the NANDA nursing diagnosis for pneumonia . This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Excessive sweating. St. Louis, MO: Elsevier. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. If you continue to use this site we will assume that you are happy with it. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Facilitates excretion of sodium and water while sparing potassium. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. 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.
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