hypokalemia nursing diagnosis

However, we aim to publish precise and current information. Monitor respiratory rate and depth. You vomit a lot. Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a . Hyperkalemia secondary to decreased distal delivery of sodium and water occurs with congestive heart failure, cirrhosis, acute kidney injury, and advanced chronic kidney disease. In children, dosing is 0.5 to 1.0 mmol per L per kg over one hour (maximum of 40 mmol).23 Potassium should not be given in dextrose-containing solutions because dextrose-stimulated insulin secretion can exacerbate hypokalemia. Nursing Diagnosis: Risk for Decreased Cardiac Output. Common concentrations are 20 mEq/100 ml over 1 hour or 40 mEq/100 ml over 2 hours. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. 1. 3. Medical-surgical nursing: Concepts for interprofessional collaborative care. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. Hypokalemia can be life-threatening. Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L. Patients receiving digitalis should be monitored closely for signs of digitalis toxicity because hypokalemia potentiates the action of digitalis. Assess urine output and kidney function through BUN, GFR, and creatinine levels. 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. Medical-surgical nursing: Concepts & practice (3rd ed.). 1 - 3 Hyperkalemia (serum potassium level. Hypokalemia and Hyperkalemia Nursing Care Plan 2 Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. Carefully check the administration rate, with 2 nurses if needed. For more information, check out our privacy policy. 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. Figure 3 is an algorithm for the management of hyperkalemia, and Table 322,30,36 summarizes medications used in the treatment of the condition. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Encourage deep breathing and coughing exercise. Additional potassium will be required if losses are ongoing. Breathing requires many muscles, particularly the diaphragm, which require potassium in order to work properly. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Kidney problems. 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. The most accurate method for evaluating urinary potassium excretion is a 24-hour timed urine potassium collection; normal kidneys excrete no more than 15 to 30 mEq per L (15 to 30 mmol per L) of potassium per day in response to hypokalemia. Elsevier. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). Continuous telemetry should be implemented when administering medications that affect cardiac status. We use cookies to ensure that we give you the best experience on our website. (See "Causes of hypokalemia in adults".). Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. 3. Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L). 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. nursing diagnosis provided by NANDA nursing care plans for various nursing mental health and psychiatric nursing. (2022). and, i didn't To replace potassium lost by the body. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. There are subsets of patients that are susceptible to the development of hypokalemia. Depletion of potassium occurs and then leads to altered electrolyte balance in the body. Copyright 2015 by the American Academy of Family Physicians. Nurses must closely monitor patients lab results and correct imbalances to prevent complications. 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. Monitor blood potassium levels.Serum potassium levels should be monitored closely and redrawn as ordered to monitor for hypo/hyperkalemia. During the treatment, however, low potassium may result due to the administration of insulin. Gastric fluid contains little amount of potassium. 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. The most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . The diagnosis of hyperkalemia includes history taking and physical examination. 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. Hyperkalemia and hypokalemia can also cause paralysis and weakness. Please follow your facilities guidelines and policies and procedures. CRITICAL CARE NURSING CARE PLANS. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. Potassium supplement. A slow intravenous potassium solution is given to raise the potassium level in the blood stream. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. Occasionally, low potassium is caused by not getting enough potassium in your 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. 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. 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. Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans: Hyperkalemia, an elevated level of potassium in the blood, can occur in patients with renal disease due to the kidneys reduced ability to excrete potassium, and in patients who have received massive blood transfusions due to the release of potassium from stored blood cells. Severe or symptomatic hypokalemia can be treated promptly with oral and IV potassium. All the contents on this site are for entertainment, informational, educational, and example purposes ONLY. A risk for diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and nursing interventions are aimed at prevention. Hypokalemia means low blood potassium levels. Discover the causes, symptoms, and treatments for these electrolyte imbalances. Buy on Amazon, Silvestri, L. A. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Potential health risks are avoidable as long as the potassium levels are kept at a normal level. Muscular weakness can affect respiratory muscles and lead to respiratory complications. All information expressed here are courtesies of the respective authors. PO potassium can cause stomach upset so its best to administer with food or after meals. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations. Hypernatremia can cause lethargy, personality changes, and confusion. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. 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. The nerve impulses are created by the movement of sodium and potassium in and out the cells. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Further replenishment can proceed more slowly, and attention can turn to the diagnosis and management of the underlying disorder.15 Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L), based on expert opinion.15. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. IV potassium can cause serious extravasation and vein irritation. Hypokalemia is serum potassium concentration < 3.5 mEq/L (< 3.5 mmol/L) caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Hypokalemia nursing diagnosis Tips and Tricks From Doctors. Studies suggest that some antibiotics can cause high potassium levels. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. Here are some nursing interventions for patients with hyperkalemia: 1. 5. The rapidity and method of potassium repletion depends on the: (2015 Nov 22). Elsevier. Renally mediated hyperkalemia results from derangement of one or more of the following processes: rate of flow in the distal nephron, aldosterone secretion and its effects, and functioning potassium secretory pathways. 9. However, potassium will need to be given intravenously in the following conditions: Treating of underlying disease. It also decreases the risk of falls and fall related injuries. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Nursing diagnoses handbook: An evidence-based guide to planning care. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. Hypokalaemia ECG Changes. 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. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. Priority nursing diagnoses allnurses. Nursing care plans: Diagnoses, interventions, & outcomes. 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. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. 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. Consider switching to a potassium-sparing diuretic. St. Louis, MO: Elsevier. To give the patient enough information on hypernatremia and its effects to the body. 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. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day. Potassium can be obtained as a dietary supplement but is naturally available in many foods. Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. 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.

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