Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. Some medications can cause abnormal blood potassium levels. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. 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. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. 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 4. Some types of diuretics increase potassium excretion through the kidneys. (See "Causes of hypokalemia in adults".). It also maintains the transmembrane electrical potential that exists between the ICF and ECF. 1 - 3 Hyperkalemia (serum potassium level. Educate the patient about the symptoms of hypokalemia. Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. Consider IV maintenance fluids with potassium added. Possibly evidenced by Ascites. For the prevention of hypokalemia in patients with persistent losses, as with ongoing diuretic therapy or hyperaldosteronism, 20 mmol per day is usually sufficient.15, Hyperkalemia is caused by excess potassium intake, impaired potassium excretion, or transcellular shifts (Table 2).8,24 The etiology of hyperkalemia is often multifactorial, with impaired renal function, medication use, and hyperglycemia as the most common contributors.25 Because healthy individuals can adapt to excess potassium consumption by increasing excretion, increased potassium intake is rarely the sole cause of hyperkalemia, and underlying renal dysfunction is common.24. The IV potassium can be given in a solution with normal saline . This content is owned by the AAFP. Potassium is a main intracellular electrolyte. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Used in the treatment of potassium deficiency when oral replacement is not feasible. 3. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. Administer a slow intravenous potassium solution as prescribed. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. There are different types of test and diagnosis for hypokalemia disease, those are given in the below: S. Electrolytes / Potassium, Magnesium, Calcium, Phosphorous, TSH, Aldosterone, ECG, . Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. Hyperkalemia is defined as a serum or plasma potassium level above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. Potassium helps carry electrical signals to cells in your body. Here we will formulate sample Hypokalemia nursing care plans based on a hypothetical case scenario. [] Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. 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. 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. Place the patient on high potassium diet as per the physicians order. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. and, i didn't Kidney problems. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Data Sources: An Essential Evidence search was conducted. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Nursing Diagnosis: Risk for Decreased Cardiac Output. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Blood test. 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. 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. Facilitates excretion of sodium and water while sparing potassium. 1. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . 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. 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. High alcohol intake. Elsevier. Hypokalemia means low blood potassium levels. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. Bananas, spinach, broccoli, and some fish are high in potassium. 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. 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. When defined as a value of less than 3.6 mmol of potassium per . Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. If experiencing hyperkalemia, limit these foods in the diet. Careful monitoring during treatment is essential because supplemental potassium is a common cause of hyperkalemia in hospitalized patients.21 The risk of rebound hyperkalemia is higher when treating redistributive hypokalemia. Copyright 2015 by the American Academy of Family Physicians. Short-term goal: By the end of the shift the patient will experience a resolution of heart palpitations and shortness of breath, with no further PVCs seen on ECG.Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-leader-2','ezslot_8',642,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-leader-2-0'); Long-term goal: The patient will maintain a normal potassium level, monitoring for recurrent signs and symptoms of hypokalemia. Prioritized nursing diagnosis includes risk for decreased cardiac tissue perfusion, activity intolerance, and deficient knowledge. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. 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). Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. Inform the healthcare team about the patients level of risk of falls.Effective communication among healthcare team members encourages collaboration and teamwork, which promotes the safety and prevention of fall incidents for the patient. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia secondary to hyperaldosteronism as evidenced by serum potassium level of 2.9 mmol/L, high aldosterone levels, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. 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. Author disclosure: No relevant financial affiliations. Additional potassium will be required if losses are ongoing. Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. While others spare potassium from being excreted through the kidneys. Swearingen, P. (2016). It is also needed in the formation of muscles in the body. 2. 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. See permissionsforcopyrightquestions and/or permission requests. 5. Discover the causes, symptoms, and treatments for these electrolyte imbalances. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. 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. 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 the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed. List of NANDA Approved Nursing Diagnoses Nurse Hussein. Monitor respiratory rate and depth. Hypokalemia. Hypokalaemia ECG Changes. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. Anna Curran. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. Searches of PubMed, the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse were completed using the key terms hypokalemia and hyperkalemia. 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. Medical-surgical nursing: Concepts & practice (3rd ed.). Insulin causes potassium to shift inside the cell which can lower potassium levels. The rapidity and method of potassium repletion depends on the: Gastric fluid contains little amount of 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 Diuretics (water retention relievers) Excessive laxative use. Avoid using medical jargons and explain in laymans terms. Indications for prompt intervention are symptoms of hyperkalemia, changes on ECG, severe hyperkalemia (greater than 6.5 mEq per L), rapid-onset hyperkalemia, or underlying heart disease, cirrhosis, or kidney disease.24,30,3335 Potassium should be monitored often because patients are at risk of redeveloping hyperkalemia until the underlying disorder is corrected and excess potassium is eliminated. A more recent article on potassium disorders is available. 9. Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost. In order to function properly, the body requires several electrolytes, one of which is potassium. Educate the patient about high-potassium foods. Medication intake. Patient information: See related handout on potassium, written by the authors of this article. Potassium disorders are common. PO potassium can cause stomach upset so its best to administer with food or after meals. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Muscle wasting and paralysis can result from very low potassium levels. 2. 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. IV fluids with added potassium would be appropriate for dehydrated and hypokalemic patients, or if the patient required ongoing diuretic administration despite low potassium. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. (2015 Nov 22). 2697-2729). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Potassium is mainly excreted in the kidneys. Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium. F A Davis Company. The goals of acute treatment are to prevent potentially life-threatening cardiac conduction and neuromuscular disturbances, shift potassium into cells, eliminate excess potassium, and resolve the underlying disturbance. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. Potassium regulates fluid and facilitates muscular contraction and nerve activity. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. The infusion should be discontinued immediately if this occurs. Save my name, email, and website in this browser for the next time I comment. Create a daily weight chart and a food and fluid chart. A blood test is performed to check the levels of electrolytes in the blood including potassium. Therefore, potassium helps control the fluid inside the cell, while sodium . 2. 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. Intravenous Calcium. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. Nursing Care Plans The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. Search dates: February, September, and December 2014. 1. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. 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. We may earn a small commission from your purchase. Start a strict input and output monitoring. CRITICAL CARE NURSING CARE PLANS. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). 3. Monitor potassium every 6 hours or as needed. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. 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. 2. do you see all the information i began to generate from those two pieces of information? Aphasia, muscle twitching, tremors, seizures. Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. St. Louis, MO: Elsevier. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. 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. Saunders comprehensive review for the NCLEX-RN examination. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Intravenous calcium should be administered if hyperkalemic ECG changes are present. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. In general, hypokalemia is associated with diagnoses of cardiac disease, renal failure, malnutrition, and shock. Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. 10. 11. Educate the patient about hyperkalemia. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. 2. This is commonly done through the administration of oral potassium supplement and high potassium diet. 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. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Causes of potassium loss include: Alcohol use (excessive) Chronic kidney disease. It is also needed in the formation of muscles in the body. Renal function should be monitored for patients receiving potassium replacement. If hypokalemia becomes a recurrent issue, the patient may be switched to a diuretic that conserves potassium. Polyuria -potassium is mainly excreted through the kidneys. To treat the kidney disease if this is the underlying cause of hyperkalemia. Clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. 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. Identify and discontinue dietary sources of potassium, such asbeans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas.Facilitates the reduction of potassium levels and may prevent the recurrence of hyperkalemia. The effect can cause slow peristalsis which can lead to constipation. If able to eat and drink, administer PO potassium. Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Hypokalemia and Hyperkalemia Nursing Care Plan 2 Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. 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. 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. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). Because serum potassium concentration drops approximately 0.3 mEq per L (0.3 mmol per L) for every 100-mEq (100-mmol) reduction in total body potassium, the approximate potassium deficit can be estimated in patients with abnormal losses and decreased intake. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Hypokalemia. The ECG can provide useful information for hypokalemia. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. 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. Elsevier. Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Nurses must closely monitor patients lab results and correct imbalances to prevent complications. 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. 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. You have entered an incorrect email address! Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias.
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