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You have diarrhea. 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. Treatment of hyperkalemia. Rectal: 30 to 50 g every 6 hours in a retention enema. Infuse potassium-based medication or solutions slowly.Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Crackles. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Hypokalemia is treated with oral or intravenous potassium. Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting. 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. 2023 nurseship.com. Continuous telemetry should be implemented when administering medications that affect cardiac status. A standing weight is the most accurate. 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). It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Consider switching to a potassium-sparing diuretic. 3. 3. 3. 2. Hypokalemia. Diarrhea. 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. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. Insulin and glucose . Bradycardia can progress to cardiac fibrillation and arrest. NCP (Hypokalemia) | PDF - Scribd Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. While others spare potassium from being excreted through the kidneys. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. Therefore, potassium helps control the fluid inside the cell, while sodium . Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. Concomitant hypomagnesemia should be treated concurrently. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . Renal function should be monitored for patients receiving potassium replacement. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. 3. Bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms are all high in potassium. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. 3. Review the patients current medications.Imbalanced potassium levels can be caused by drugs including diuretics, beta-blockers, and aminoglycosides. 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. Potassium helps in utilizing carbohydrates and protein to produce energy. Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2020). 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. Administer a slow intravenous potassium solution as prescribed. Clinical manifestations and treatment of hypokalemia in adults List of NANDA Approved Nursing Diagnoses Nurse Hussein. 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. 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. Articles submitted here are original but are checked for minor typographical errors, and are formatted for site compatibility.This is a site that continuously improves and broadcasts healthcare information relevant to today's ever-changing world. Nurses Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. 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. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Wolters Kluwer India Pvt. Some types of diuretics increase potassium excretion through the kidneys. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. To replace potassium lost by the body. Bananas, spinach, broccoli, and some fish are high in potassium. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. To effectively monitory the patients daily nutritional intake and progress in weight loss goals. 1. 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. Electrocardiogram (ECG). Elsevier/Mosby. Hypovolemia Nursing Diagnosis and Nursing Care Plan Administer prescribed potassium with precautions.Potassium can be administered IV or PO. Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. Here are some nursing interventions for patients with hyperkalemia: 1. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Additional potassium will be required if losses are ongoing. A blood test is performed to check the levels of electrolytes in the blood including potassium. Hypokalemia and Hyperkalemia Nursing Care Plan 2 Please read our disclaimer. 2. Weight should be performed every day to help assess fluid volume status. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). What is the NANDA nursing diagnosis for pneumonia . The diagnosis of hyperkalemia includes history taking and physical examination. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. CRITICAL CARE NURSING CARE PLANS. 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. Educate the patient about the role of potassium in the body. 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. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Priority nursing diagnoses allnurses. 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 physical examination should include assessment of blood pressure and intravascular volume status to identify potential causes of kidney hypoperfusion, which can lead to hyperkalemia. 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. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. The nerve impulses are created by the movement of sodium and potassium in and out the cells. Compromised regulatory mechanism. 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. Hyperkalemia - SlideShare Hypokalemia Nursing Care Plan - RN speak The patient thought apples were high in potassium. A 12-lead ECG is performed and shows sinus tachycardia with PVCs. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. (1998). Recommended nursing diagnosis and nursing care plan books and resources. The diagnosis should be confirmed with a repeat serum potassium measurement. Views on topics do not generally reflect that of the entire community. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important . There are subsets of patients that are susceptible to the development of hypokalemia. The normal blood potassium level is 3.5 5.0 mEq/L. Monitor heart rate and rhythm. Hypokalemia | Definition & Patient Education - Healthline Hyperaldosteronism Nursing Diagnosis and Nursing Care Plan If experiencing hyperkalemia, limit these foods in the diet. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. Administered when potassium levels need to be replenished, as well as, in patients with ongoing potassium loss when it must be maintained. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. 2. Volume depletion. Too much potassium supplementation can cause hyperkalemia. Nursing Intervention for Hypokalemia Disease: There are different types of nursing interventions for hypokalemia, . Short-term goal: By the end of the shift the patients potassium will normalize and the patient will experience a resolution of symptoms. Diabetic ketoacidosis. 4. Review the patients diet.Potassium levels can be influenced by the amount of potassium that is being consumed. Biochemistry is needed to check for the level of serum potassium. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Diuretics. St. Louis, MO: Elsevier. Medical-surgical nursing: Concepts & practice (3rd ed.). 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. It also decreases the risk of falls and fall related injuries. However, a 2014 study suggests that severe hypokalemia is rare. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). A focused history includes evaluation for possible GI losses, review of medications, and assessment for underlying cardiac comorbidities. Although redistributive hyperkalemia is uncommon, a cautious approach is warranted because treatment may not involve attempts to eliminate potassium, and correction of the underlying problem can provoke rebound hypokalemia. St. Louis, MO: Elsevier. 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. Thieme. Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). 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, . For the past few nights, he has had severe leg cramps that have woken him up. 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. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. 1 - 3 Hyperkalemia (serum potassium level. 10. All rights reserved. Hypokalemia Treatment & Management - Medscape 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 Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Intravenous Calcium. Buy on Amazon, Silvestri, L. A. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). 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. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Hinkle, J. L., & Cheever, K. H. (2018). The IV potassium can be given in a solution with normal saline . 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. The bodys muscles depend highly on potassium level to function adequately. Common acute manifestations are muscle weakness and ECG changes. Insulin and Glucose. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. Search dates: February, September, and December 2014. Inhaled Beta Agonists. Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. Consider IV maintenance fluids with potassium added. Obtain daily blood sample from the patient. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.Improves muscle tone and reduces muscle cramps and pain. 7. Review drug regimen for medications containing potassium or affecting potassium excretion such as spironolactone (Aldactone), hydrochlorothiazide (Maxzide), amiloride (Midamor), and penicillin G.Requires regular monitoring of potassium levels and may require alternate drug choices or changes in the dosage or frequency. Your kidneys or adrenal glands don't work well. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . 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. Read theprivacy policyandterms and conditions. To treat the kidney disease if this is the underlying cause of hyperkalemia. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia: Risk for Electrolyte Imbalance To give the patient enough information on hypernatremia and its effects to the body. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Our website services and content are for informational purposes only. PO potassium can cause stomach upset so its best to administer with food or after meals. Nanda Nursing Diagnosis List Mental Health Hyperkalemia - forums.usc.edu Gastric fluid contains little amount of potassium. Hypokalemia can become life threatening if it affects the heart muscle, causes paralysis, or impairs the functioning of the lungs.
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