hypokalemia nursing diagnosis

4. 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. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. 1. 2. Elsevier Inc. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. 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. 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. Wound Care & Infection Nursing Diagnosis & Care Plan, Parkinsons Disease Nursing Diagnosis & Care Plan, Hypokalemia serum potassium level < 3.5 mEq/L (3.5 mmol/L), Hyperkalemia serum potassium level > 5.0 mEq/L (5.0 mmol/L), Excessive use of potassium-wasting diuretics, Increased production of aldosterone (water and salt regulating hormone) (such as in Cushings syndrome), Kidney disease impairing the reabsorption of potassium, Poor potassium intake such as through eating disorders. Upon assessment, the patient is alert and oriented and follows commands appropriately. Hypokalemia and Hyperkalemia Nursing Care Plan 2 However, a 2014 study suggests that severe hypokalemia is rare. Centrally potassium can be administered more quickly and in larger doses via this route. 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. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. 3. (2022). Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Biochemistry is needed to check for the level of serum potassium. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. 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. 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. The rapidity and method of potassium repletion depends on the: Other recommended site resources for this nursing care plan: Other nursing care plans related to endocrine system and metabolism disorders: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. Gitelman Syndrome UK [gitelmansuk]. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. Dewit, S. C., Stromberg, H., & Dallred, C. (2017). It can result in serious injury or death if it becomes too high or too low. A blood test is performed to check the levels of electrolytes in the blood including potassium. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Blood test. The normal blood potassium level is 3.5 5.0 mEq/L. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 1. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Data Sources: An Essential Evidence search was conducted. 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. Your kidneys or adrenal glands don't work well. 2. Search dates: February, September, and December 2014. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. The diagnosis of hyperkalemia includes history taking and physical examination. Hypokalemia or potassium levels can impair the kidneys function to concentrate urine, which may result to polyuria. Our website services and content are for informational purposes only. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. 6. 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, . Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Occasionally, low potassium is caused by not getting enough potassium in your diet. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. CRITICAL CARE NURSING CARE PLANS. 5. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site. Patient information: See related handout on potassium, written by the authors of this article. Check for safety hazards in the patients environment.Assess the following environmental factors: 5. Review the patients current medications.Imbalanced potassium and the use of cardiac medications (used to treat dysrhythmias) greatly increase the risk for muscle weakness and potential falls. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Buy on Amazon, Silvestri, L. A. The effect can cause slow peristalsis which can lead to constipation. 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. Elsevier. Pills should not be crushed but can be dissolved in 3.8 ounces of cold water or juice. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. 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. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Electrolyte imbalance associated with potassium imbalance (hypokalemia/hyperkalemia) can be caused by conditions affecting the regulation, intake and excretion, and movement of potassium in the cellular space. Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the bodys way of using nutrients, leading to weakness and fatigue. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Beta-blockers. A potassium deficiency can result in shortness of breath, and in severe cases, can stop the lungs from working completely. 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) Therefore, although ECG changes should trigger urgent treatment, treatment decisions should not be based solely on the presence or absence of ECG changes.32, Peaked T waves are the prototypical, and generally the earliest, ECG sign of hyperkalemia. What is the NANDA nursing diagnosis for pneumonia . 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). 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. Magnesium helps the movement potassium in and out the cells. 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. Arrhythmias associated with hypokalemia include sinus bradycardia, ventricular tachycardia or fibrillation, and torsade de pointes.19 Although the risk of ECG changes and arrhythmias increases as serum potassium concentration decreases, these findings are not reliable because some patients with severe hypokalemia do not have ECG changes.20, The immediate goal of treatment is the prevention of potentially life-threatening cardiac conduction disturbances and neuromuscular dysfunction by raising serum potassium to a safe level. It is also needed in the formation of muscles in the body. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance 10. 11. Nonurgent hypokalemia is treated with 40 to 100 mmol of oral potassium per day over days to weeks. Save my name, email, and website in this browser for the next time I comment. All Rights Reserved. To give the patient enough information on hypernatremia and its effects to the body. 1386-1388). Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. Albuterol, a beta2 agonist, is an underutilized adjuvant for shifting potassium intracellularly.24,37 All forms of administration (i.e., inhaled, nebulized, and intravenous where available) are effective. Prompt intervention and possible ECG monitoring are indicated for patients with severe hypokalemia (serum potassium < 2.5 mEq per L) or severe hyperkalemia (serum potassium > 6.5 mEq per L [6.5 mmol per L]); ECG changes; physical signs or symptoms; possible rapid-onset hyperkalemia; or underlying kidney disease, heart disease, or cirrhosis. 3. Monitor potassium every 6 hours or as needed. 1. Carefully check the administration rate, with 2 nurses if needed. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. 2. 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. Hypokalemia results from abnormal losses, transcellular shifts, or insufficient intake (Table 1).68 Abnormal losses are most common.9 Because the kidney can significantly lower potassium excretion in response to decreased intake, insufficient intake is rarely the sole cause of hypokalemia, but it often contributes to hypokalemia in hospitalized patients.9, Diuretic use is a common cause of renally mediated hypokalemia.10 When given in the same dosage, chlorthalidone is more likely to induce hypokalemia than hydrochlorothiazide, which is more often implicated because of its widespread use.11,12 Diuretic-induced hypokalemia is dose-dependent and tends to be mild (3 to 3.5 mEq per L [3 to 3.5 mmol per L]), although it can be more severe when accompanied by other causes (e.g., gastrointestinal [GI] losses).13, GI losses are another common cause of hypokalemia, particularly among hospitalized patients.9 The mechanism by which upper GI losses induce hypokalemia is indirect and stems from the kidney's response to the associated alkalosis. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. She received her RN license in 1997. 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. as you can see, what you do during your assessment activity is extremely important to what goes into your care planning. Compromised regulatory mechanism. Priority nursing diagnoses allnurses. In response to acidosis, extracellular hydrogen is exchanged for intracellular potassium, although the net result is highly variable and depends in part on the type of acidosis; metabolic acidosis produces the greatest effect.26 Because 98% of total body potassium is intracellular, any process that increases cell turnover, such as rhabdomyolysis, tumor lysis syndrome, or red blood cell transfusions, can result in hyperkalemia. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. 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. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed., pp. Urine test. Possibly evidenced by Ascites. (See "Causes of hypokalemia in adults".). 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. Too much or too little potassium in diet. The nerve impulses are created by the movement of sodium and potassium in and out the cells. However, we aim to publish precise and current information. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. Diabetic ketoacidosis. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Nursing diagnoses handbook: An evidence-based guide to planning care. 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. Excessive sweating. Encourage intake of carbohydrates and fats and low potassium food such as pineapple, plums, strawberries, carrots, cauliflower, corn, and whole grains.Reduces exogenous sources of potassium and prevents metabolic tissue breakdown with the release of cellular potassium. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Hypernatremia can cause lethargy, personality changes, and confusion. 3. Surgical intervention is required only with certain etiologies, such as the following: Renal artery stenosis Adrenal adenoma. 2. Start a strict input and output monitoring. You vomit a lot. 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. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. 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. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-banner-1','ezslot_12',640,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-banner-1-0'); Long-term goal: At home, the patient will take a daily potassium supplement in addition to his regular diuretic. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. 2. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. The infusion should be discontinued immediately if this occurs. We use cookies to ensure that we give you the best experience on our website. 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. Volume depletion. Brunner and Suddarths textbook of medical-surgical nursing (13th ed.). All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. Therefore, potassium helps control the fluid inside the cell, while sodium . During the treatment, however, low potassium may result due to the administration of insulin. Potential health risks are avoidable as long as the potassium levels are kept at a normal level. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Elsevier. To accurately measure the input and output of the patient. 5. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions. This content is owned by the AAFP. 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. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Monitor respiratory rate and depth. Comer, S. and Sagel, B. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. Diuretics. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. 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. Electrocardiogram (ECG). 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. The majority of potassium is stored in the intracellular compartment. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. Saunders comprehensive review for the NCLEX-RN examination. 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. Rectal: 30 to 50 g every 6 hours in a retention enema. 3. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. 3. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. We may earn a small commission from your purchase. For example, a decline in serum potassium from 3.8 to 2.9 mEq per L (3.8 to 2.9 mmol per L) roughly corresponds to a 300-mEq (300-mmol) reduction in total body potassium. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause.

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