hypokalemia nursing diagnosis

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Please follow your facilities guidelines and policies and procedures. All-in-One Nursing Care Planning Resource E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental HealthIncludes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Urine test. Insulin causes potassium to shift inside the cell which can lower potassium levels. Other laboratory tests include serum glucose and magnesium levels, urine electrolyte and creatinine levels, and acid-base balance. 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. The nerve impulses are created by the movement of sodium and potassium in and out the cells. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Gitelman Syndrome UK [gitelmansuk]. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. 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. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. A detailed medication list is vital as abnormal potassium levels can be caused by certain medications. 5. The diagnosis should be confirmed with a repeat serum potassium measurement. 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. There are subsets of patients that are susceptible to the development of hypokalemia. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. 1. Place the patient on high potassium diet as per the physicians order. Distended neck and peripheral veins. If able to eat and drink, administer PO potassium. The patient thought apples were high in potassium. Psychiatric Nursing . Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. The patient is experiencing weakness, heart palpitations, and shortness of breath. Nursing Diagnosis: Electrolyte Imbalance Related to: Changes in the regulation of potassium Changes in the intake of potassium Difficulty excreting potassium Conditions that affect the movement of potassium in the cellular space As evidenced by: Alterations in the electrical conductivity of the heart Ineffective respirations 1. Because potassium can only be administered slowly and in small doses via a peripheral IV, a central line is recommended to correct hypokalemia more quickly. It gets potassium through the food you eat. Elsevier. Nursing assessment for hyperkalemia patients focuses on monitoring for signs and symptoms of life-threatening cardiac dysrhythmias, as well as identifying and addressing the underlying cause of hyperkalemia. 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. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . 4. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Intravenous calcium should be administered if hyperkalemic ECG changes are present. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. Wolters Kluwer India Pvt. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. A standing weight is the most accurate. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. The most common cause is excess loss from the kidneys or gastrointestinal tract. Low potassium (hypokalemia) - Mayo Clinic Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. (2022). It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. 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. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). During the treatment, however, low potassium may result due to the administration of insulin. Potassium movement from extracellular to intracellular fluid due to: IV therapy with potassium-deficient solutions, Rapid infusion of potassium-containing IV solutions, Adrenal insufficiency (such as in Addisons disease), Potassium movement from intracellular to the extracellular fluid, Muscle weakness, leg cramps, deep tendon hyporeflexia, and paresthesias, ECG changes: ST depression, inverted T waves, and prominent U waves, Increased motility, hyperactive bowel sounds, and diarrhea, Ascending flaccid paralysis until the respiratory muscles become affected as a toxic level of serum potassium is reached, ECG changes: Tall peaked T waves, widened QRS complexes, and prolonged PR intervals, Conditions that affect the movement of potassium in the cellular space, Alterations in the electrical conductivity of the heart, Patient will demonstrate serum potassium levels within normal limits, Patient will verbalize the absence of muscle pain or cramping, Disruption in the electric functioning of the heart, Patient will display pulse and blood pressure within acceptable limits, Patient will verbalize the absence of angina or palpitations, Patient will demonstrate ECG results of normal sinus rhythm, Patient will be able to verbalize understanding of decreased cardiac output in relation to hypo/hyperkalemia, Patient will participate in physical therapy sessions, Patient will be able to maintain or regain muscle strength. The rapidity and method of potassium repletion depends on the: Encourage the patient to stand up and reposition slowly to prevent faintness and falls. Centrally potassium can be administered more quickly and in larger doses via this route. Used in the treatment of potassium deficiency when oral replacement is not feasible. St. Louis, MO: Elsevier. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). 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. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Now, my body feels very weak., Vomitus of yellowish fluid approximately 70 cc times three episodes for two days, Diarrhea; Watery stools times 4 episodes for two days, Presence of an elevated U wave on ECG result, Altered electrolyte balance related to active fluid loss secondary to vomiting and diarrhea. Insulin and Glucose. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. 2697-2729). The normal blood potassium level is 3.5 5.0 mEq/L. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Findings on ECG are neither sensitive nor specific for hyperkalemia. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. 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. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. nursing care plan for HYPOKALEMIA plsss. - allnurses Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. Comer, S. and Sagel, B. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. 1. Stress the importance of the clients notifying future caregivers when a chronic condition potentiates the development of hyperkalemia, such as oliguric renal failure.May help prevent hyperkalemia recurrences. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Insulin and glucose . Urinalysis can also show the presence of potassium in the urine. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. (1998). 2. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Potassium helps carry electrical signals to cells in your body. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. It also decreases the risk of falls and fall related injuries. ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. 2. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. 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). This may lead to serious heart problems, heart attack or death. 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 & Hyperkalemia Nursing Diagnosis & Care Plan Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. IV potassium can cause serious extravasation and vein irritation. Hypokalemia (Low Potassium): Symptoms, Causes, Diagnosis, Treatment - WebMD Beta-blockers. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. 1386-1388). It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Continuous telemetry should be implemented when administering medications that affect cardiac status. We use cookies to ensure that we give you the best experience on our website. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. each day. knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. Upon assessment, the patient is alert and oriented and follows commands appropriately. Search dates: February, September, and December 2014. This helps the patient gain muscle strength and confidence in performing self care. 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. Educate the patient about the symptoms of hypokalemia. 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 goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. Hypokalemia | NEJM - New England Journal of Medicine Potassium helps in utilizing carbohydrates and protein to produce energy. 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. 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. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans Other diagnostic tests that may be performed are as follows: Potassium replacement. Potassium is contraindicated if oliguria or anuria is present. Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic High potassium levels can be treated through: Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue. Hypokalemia Article - StatPearls (2020). All information expressed here are courtesies of the respective authors. Buy on Amazon. Hypernatremia can cause lethargy, personality changes, and confusion. 4. Your kidneys control your body's potassium levels, allowing for excess . Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. 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. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . Carefully check the administration rate, with 2 nurses if needed. Some types of diuretics increase potassium excretion through the kidneys. 5. 1. Assess the level of consciousness and neuromuscular function, including sensation, strength, and movement.The client is usually conscious and alert; however, muscular paresthesia, weakness, and flaccid paralysis may occur. Encourage deep breathing and coughing exercise. A slow intravenous potassium solution is given to raise the potassium level in the blood stream. 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. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy []. 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. Skidmore-Roth Publications. Hyperaldosteronism Nursing Diagnosis and Nursing Care Plan Potassium (K) is a major cation in intracellular fluid (ICF). Excessive alcohol intake is known to reduce potassium levels. Hyperkalemia-induced ventricular fibrillation is treated with calcium. (See "Causes of hypokalemia in adults".). She received her RN license in 1997. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. St. Louis, MO: Elsevier. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Saunders comprehensive review for the NCLEX-RN examination. Clinical manifestations and treatment of hypokalemia in adults The most accurate method for evaluating urinary potassium excretion is a 24-hour timed urine potassium collection; normal kidneys excrete no more than 15 to 30 mEq per L (15 to 30 mmol per L) of potassium per day in response to hypokalemia. Electrocardiogram (ECG). If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. PO potassium can cause stomach upset so its best to administer with food or after meals. 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. 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. 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. IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low potassium. Including the client in the plan of care elicits participation. Muscle wasting and paralysis can result from very low potassium levels. Nursing Diagnosis (hypokalemia)-help? - allnurses Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Patients with a serum glucose level of more than 250 mg per dL (13.9 mmol per L) typically do not require coadministration of glucose. 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 Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. 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. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. Your kidneys or adrenal glands don't work well. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Swearingen, P. (2016). Possibly evidenced by Ascites. Inhaled Beta Agonists. Studies suggest that some antibiotics can cause high potassium levels. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs. Hypokalaemia ECG Changes. Hypokalemia and Hyperkalemia Nursing Care Plan 2 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. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site.
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