Teach the patient on how to follow a low potassium diet. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Concomitant hypomagnesemia should be treated concurrently. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L. Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. Typically, 10 units of insulin are administered, followed by 25 g of glucose to prevent hypoglycemia.37 Because hypoglycemia is a common adverse effect even with the provision of glucose, serum glucose levels should be monitored regularly. The normal blood potassium level is 3.5 5.0 mEq/L. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. You have diarrhea. 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! Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . 5. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. Some types of diuretics increase potassium excretion through the kidneys. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction Determine cardiovascular status.Heart dysrhythmias can result from an excess or deficit of potassium that disrupts the normal electric transmission of signals responsible for heart (myocardium) contraction. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. 3. Symptoms include fatigue, weakness, nausea, heart palpitations, shortness of breath, leg cramps, polyuria, polydipsia, and constipation. The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. 1. Thieme. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . Dialysis should be considered in patients with kidney failure or life-threatening hyperkalemia, or when other treatment strategies fail.23,37 Other modalities are not rapid enough for urgent treatment of hyperkalemia.39, Currently available cation exchange resins, typically sodium polystyrene sulfonate (Kayexalate) in the United States, are not beneficial for the acute treatment of hyperkalemia but may be effective in lowering total body potassium in the subacute setting.25,39 Because sodium polystyrene sulfonate can be constipating, many formulations include sorbitol for its laxative effects. Potassium can be obtained as a dietary supplement but is naturally available in many foods. Urinalysis can also show the presence of potassium in the urine. Potassium regulates fluid and facilitates muscular contraction and nerve activity. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). High potassium occurs due to lack of insulin. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. Common acute manifestations are muscle weakness and ECG changes. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. 1. 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. Volume depletion. Nursing diagnoses handbook: An evidence-based guide to planning care. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Clinical manifestations of hypokalemia are typically seen only if the serum potassium is <3.0 mEq/L. What is the NANDA nursing diagnosis for pneumonia . Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance St. Louis, MO: Elsevier. 7. Review drug regimen for medications containing potassium or affecting potassium excretion such as spironolactone (Aldactone), hydrochlorothiazide (Maxzide), amiloride (Midamor), and penicillin G.Requires regular monitoring of potassium levels and may require alternate drug choices or changes in the dosage or frequency. 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. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium. Gastric fluid contains little amount of potassium. Inhaled Beta Agonists. Skidmore-Roth Publications. Polyuria -potassium is mainly excreted through the kidneys. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. The nerve impulses are created by the movement of sodium and potassium in and out the cells. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Some medications can cause abnormal blood potassium levels. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. However, we aim to publish precise and current information. Diuretics. CRITICAL CARE NURSING CARE PLANS. 2. Data Sources: An Essential Evidence search was conducted. Muscle wasting and paralysis can result from very low potassium levels. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. 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. Elsevier Inc. 2. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Monitor urine output.In kidney failure, potassium is retained because of improper excretion. do you see all the information i began to generate from those two pieces of information? St. Louis, MO: Elsevier. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. 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). The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. 4. 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 Copyright 2023 American Academy of Family Physicians. High alcohol intake. Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. Hypokalemia is treated with oral or intravenous potassium. https://twitter.com/gitelmansuk/status/668416488211136512, Urinary Tract Infection Nursing Care Plan, Impaired concentrating ability Dizziness and fainting, Increased ammonia production Increased frequency in urination, Increased bicarbonate reabsorption extreme thirst, Altered sodium reabsorption seizure and coma, Hypokalemic nephropathy Unable to hold urine, Serum potassium levels less than 3.5 mEq/L, ECG changes- flat/inverted T waves, depressed ST segment, elevated U wave, Urinary potassium excretion test exceeding 20 mEq/day. Too much potassium supplementation can cause hyperkalemia. Distended neck and peripheral veins. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. Some of the potassium ions are lost when vomiting occurs. Read theprivacy policyandterms and conditions. The IV potassium can be given in a solution with normal saline . Repeat measurement of serum potassium can help identify pseudohyperkalemia, which is common and typically results from potassium moving out of cells during or after sample collection.31 Other laboratory studies include measurement of serum blood urea nitrogen and creatinine, measurement of urine electrolytes and creatinine, and assessment of acid-base status. This is commonly done through the administration of oral potassium supplement and high potassium diet. Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. Copyright 2015 by the American Academy of Family Physicians. Biochemistry is needed to check for the level of serum potassium. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. Gitelman Syndrome UK [gitelmansuk]. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Kidney problems. Diabetic ketoacidosis. Place the patient on high potassium diet as per the physicians order. Abnormal heart rhythm and palpitation- the brain sends nerve signals to the heart muscles to make them contract and beat. Educate the patient about the role of potassium in the body. Because of their increased risk of developing hyperkalemia, patients with underlying renal dysfunction merit special attention.22, Severe hyperkalemia (more than 6.5 mEq per L [6.5 mmol per L]) can cause muscle weakness, ascending paralysis, heart palpitations, and paresthesias. The effect can cause slow peristalsis which can lead to constipation. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. 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. 6. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. 1 - 3 Hyperkalemia (serum potassium level. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. Hypokalemia. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. Hinkle, J. L., & Cheever, K. H. (2018). Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Compromised regulatory mechanism. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. Studies suggest that some antibiotics can cause high potassium levels. For more information, check out our privacy policy. A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Aphasia, muscle twitching, tremors, seizures. This may lead to serious heart problems, heart attack or death. 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. It gets potassium through the food you eat. 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. Renal function should be monitored for patients receiving potassium replacement. 1. An ECG is performed to check heart rhythm. The bodys muscles depend highly on potassium level to function adequately. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. We and our partners share information on your use of this website to help improve your experience. 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. Hypokalemia is often caused by an excessive loss of potassium in your digestive tract due to vomiting, diarrhea or laxative use. However, case reports linking the concomitant use of sodium polystyrene sulfonate and sorbitol to GI injury prompted a U.S. Food and Drug Administration boxed warning.41,42 More recent reports implicate sodium polystyrene sulfonate alone.43 Therefore, use of the drug with or without sorbitol should be avoided in patients with or at risk of abnormal bowel function, such as postoperative patients and those with constipation or inflammatory bowel disease.42, There is no evidence supporting the use of diuretics for the acute treatment of hyperkalemia. Potassium helps in utilizing carbohydrates and protein to produce energy. 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. Anna Curran. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. Diarrhea. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. Nursing Diagnosis: Risk for Decreased Cardiac Output. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. (1998). Inform him/her the target range for serum potassium levels. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. When defined as a value of less than 3.6 mmol of potassium per . 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). St. Louis, MO: Elsevier. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. INTRODUCTION. Other ECG changes include P-wave flattening, PR-interval prolongation, widening of the QRS complex, and sine waves.19 Hyperkalemia-induced arrhythmias include sinus bradycardia, sinus arrest, ventricular tachycardia, ventricular fibrillation, and asystole.19. Other medical causes. 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. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. Mosby. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. 3. 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.