hypokalemia nursing diagnosis

Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. 4. Copyright 2015 by the American Academy of Family Physicians. Psychiatric Nursing . The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. Low magnesium levels. 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. 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. It is also needed in the formation of muscles in the body. 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. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Elsevier/Mosby. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Patient information: See related handout on potassium, written by the authors of this article. The diagnosis should be confirmed with a repeat serum potassium measurement. Author disclosure: No relevant financial affiliations. The majority of potassium is stored in the intracellular compartment. Educate the patient about hyperkalemia. Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Additional potassium will be required if losses are ongoing. Swearingen, P. (2016). Muscle wasting and paralysis can result from very low potassium levels. Interprofessional patient problems focus familiarizes you with how to speak to patients. This content is owned by the AAFP. Electrocardiogram (ECG). Consider switching to a potassium-sparing diuretic. To give the patient enough information on hypernatremia and its effects to the body. Implement safety measures when administering IV potassium.Because IV potassium infusion can cause phlebitis as a complication, the nurse should regularly check the IV site for indications of phlebitis or infiltration. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. A history of paralysis, hyperthyroidism, or use of insulin or beta agonists suggests possible transcellular shifts leading to redistributive hypokalemia. 1. Hyperkalemia-induced ventricular fibrillation is treated with calcium. For both disorders, it is important to consider potential causes of transcellular shifts because patients are at increased risk of rebound potassium disturbances. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. Inform the patient of the need to undergo dialysis, if indicated by the physician. CRITICAL CARE NURSING CARE PLANS. Potassium is mainly excreted in the kidneys. St. Louis, MO: Elsevier. Inform him/her the target range for serum potassium levels. More prolonged and profound hypokalemia may cause rhabdomyolysis, renal abnormalities, and cardiac arrhythmias. Views on topics do not generally reflect that of the entire community. 2. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Diabetic ketoacidosis. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. 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. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. When defined as a value of less than 3.6 mmol of potassium per . Prevent sudden hypotension.Changes in blood potassium levels can cause hypotension due to decreased levels of aldosterone, vasopressin, and responsiveness to the effects of angiotensin II. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Institute fall and safety measures.Institute fall and safety measures due to the neuromuscular effect (muscle weakness) caused by the changes in potassium. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). The ECG can provide useful information for hypokalemia. Skidmore-Roth Publications. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). The patient should be able to monitor for hypokalemia, which is common with diuretic administration. However, a 2014 study suggests that severe hypokalemia is rare. Potassium can be obtained as a dietary supplement but is naturally available in many foods. Hypokalemia is often caused by an excessive loss of potassium in your digestive tract due to vomiting, diarrhea or laxative use. (See "Causes of hypokalemia in adults".). Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). Discover the causes, symptoms, and treatments for these electrolyte imbalances. This includes the heart muscle wherein when the potassium level is depleted abnormal heart waves are formed. 2. 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. Studies suggest that some antibiotics can cause high potassium levels. (2020). Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. 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. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Insulin and Glucose. Pills should not be crushed but can be dissolved in 3.8 ounces of cold water or juice. 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! Elsevier. Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium. Hypokalemia. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. 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. Potassium is a main intracellular electrolyte. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Volume depletion is typically accompanied by increased potassium excretion in the kidneys. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Diarrhea. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity. The patient is experiencing weakness, heart palpitations, and shortness of breath. The physical examination should include assessment of blood pressure and intravascular volume status to identify potential causes of kidney hypoperfusion, which can lead to hyperkalemia. 5. Other diagnostic tests that may be performed are as follows: Potassium replacement. When intravenous potassium is used, standard administration is 20 to 40 mmol of potassium in 1 L of normal saline. Nurses must closely monitor patients lab results and correct imbalances to prevent complications. Other medical causes. Start a strict input and output monitoring. Encourage deep breathing and coughing exercise. Medical-surgical nursing: Concepts & practice (3rd ed.). The patient thought apples were high in potassium. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. It is also responsible for keeping the heartbeat regular and promotes the movement of nutrients into and waste out of the cells. 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. 2023 nurseship.com. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). Teach the patient on how to follow a low potassium diet. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Further progression can lead to ST-interval depression, T-wave inversions, PR-interval prolongation, and U waves. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. The main source of potassium is from food. 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. For hypokalemia associated with diuretic use, stopping the diuretic or reducing its dosage may be effective.15 Another strategy, if otherwise indicated to treat a comorbid condition, is use of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), beta blocker, or potassium-sparing diuretic because each of these drugs is associated with an elevation in serum potassium. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). Herdman, T., Kamitsuru, S. & Lopes, C. (2021). 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. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. 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. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. 9. Including the client in the plan of care elicits participation. 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. Monitor strict intake and output.Monitor urine output as well as bowel movements. To conclude, here we have formulated a scenario-based nursing care plan for Hypokalemia. Administer the following drugs, as prescribed: Also, potassium-rich foods in the diet help maintain potassium balance. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. Administer prescribed potassium with precautions.Potassium can be administered IV or PO. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Please read our disclaimer. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. 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. Folic acid deficiency. The infusion should be discontinued immediately if this occurs. The normal blood potassium level is 3.5 5.0 mEq/L. 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. INTRODUCTION. Excessive alcohol intake is known to reduce potassium levels. Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. It can result in serious injury or death if it becomes too high or too low. Mosby. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. 1. 3. It should ideally be done at the same time and same method (standing, bed weight, etc.) Copyright 2023 American Academy of Family Physicians. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Some medications can cause abnormal blood potassium levels. To accurately measure the input and output of the patient. 2. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance Some of the potassium ions are lost when vomiting occurs. This may lead to serious heart problems, heart attack or death. Crackles. 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. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. 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. Normal Potassium Level 3.5-5.1 ( 2.5 or less is very dangerous) Most of the body's potassium is found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. Symptoms include fatigue, weakness, nausea, heart palpitations, shortness of breath, leg cramps, polyuria, polydipsia, and constipation. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. Identification and treatment of concurrent hypomagnesemia are also important because magnesium depletion impedes potassium repletion and can exacerbate hypokalemia-induced rhythm disturbances.16,17. A slow intravenous potassium solution is given to raise the potassium level in the blood stream. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! The nerve impulses are created by the movement of sodium and potassium in and out the cells. 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. All Rights Reserved. Polyuria -potassium is mainly excreted through the kidneys. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Kidney problems. Hypokalemia means low blood potassium levels. As a portion of daily potassium is excreted in the colon, lower GI losses in the form of persistent diarrhea can also result in hypokalemia and may be accompanied by hyperchloremic acidosis.6, Hypokalemia is often asymptomatic. With a critically low potassium level, the patient is at risk for ventricular arrhythmias. Administer a slow intravenous potassium solution as prescribed. Here are some nursing interventions for patients with hyperkalemia: 1. She has worked in Medical-Surgical, Telemetry, ICU and the ER. There is an additive effect when albuterol is combined with insulin.38 Albuterol's potassium-lowering effect is mitigated in some patients, particularly those with end-stage kidney disease; therefore, albuterol should not be used as monotherapy.30, Sodium Bicarbonate. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. 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. She found a passion in the ER and has stayed in this department for 30 years. Treatment-related side effects such as cytotoxic drugs. A more recent article on potassium disorders is available. Our website services and content are for informational purposes only. 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. 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. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. 4. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Avoid using medical jargons and explain in laymans terms. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. If experiencing hyperkalemia, limit these foods in the diet. Potassium is contraindicated if oliguria or anuria is present. Fluid loss from the body such as vomiting and diarrhea causes depletion of the electrolyte potassium partly because potassium is actually lost with gastric fluid. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. The rapidity and method of potassium repletion depends on the: To treat the kidney disease if this is the underlying cause of hyperkalemia. All rights reserved. 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. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. F A Davis Company. Obtain daily blood sample from the patient. (1998). 6. Consider IV maintenance fluids with potassium added. 1386-1388). Include or limit potassium in the diet.Educate the patient on their prescribed diet depending on the condition. She has more than 10 years of clinical and teaching experience and worked as a licensed Nursing Specialist in JCI-accredited hospitals in the Middle East. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. 4. Bananas, spinach, broccoli, and some fish are high in potassium. Non-steroidal anti-inflammatory medications (NSAIDs). Oral potassium does not correct the problem, If hypokalemia is causing abnormal heart rhythms, Switching to potassium-sparing diuretics if needed, Treatment of kidney disease, which includes dialysis, Elimination disorders related to increase in urine volume (polyuria).

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