A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. It should be noted that the recommended dose of nebulized albuterol (10 to 20 mg) is four to eight times greater than the typical respiratory dose. Carefully check the administration rate, with 2 nurses if needed. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Pills should not be crushed but can be dissolved in 3.8 ounces of cold water or juice. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Activity intolerance related to insufficient potassium to support regular body functions as evidenced by weakness, palpitations, and shortness of breath. 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. Hypokalemia. The ECG can provide useful information for hypokalemia. As an Amazon Associate I earn from qualifying purchases. All information expressed here are courtesies of the respective authors. Other diagnostic tests that may be performed are as follows: Potassium replacement. 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. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Findings on ECG are neither sensitive nor specific for hyperkalemia. 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) The most common cause is excess loss from the kidneys or gastrointestinal tract. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Inform the patient of the need to undergo dialysis, if indicated by the physician. Deficient knowledge related to diuretic side-effects and hypokalemia as evidenced by the patient thinking apples were high in potassium. 3. St. Louis, MO: Elsevier. The patient thought his potassium might be low, so he ate 2 apples with no improvement noted. ECG should be considered if the potassium level is greater than 6 mEq per L; if there are symptoms of hyperkalemia; if there is suspicion of rapid-onset hyperkalemia; or among patients with underlying kidney disease, heart disease, or cirrhosis who have a new case of hyperkalemia. Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. Too much or too little potassium in diet. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Low potassium (hypokalemia) - Mayo Clinic Hypernatremia can cause lethargy, personality changes, and confusion. Boiling potatoes and cutting vegetable sin small pieces are also recommended. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.Evaluate therapy needs and effectiveness. St. Louis, MO: Elsevier. 2. 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. Thieme. Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. 3. 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. Gastric fluid contains little amount of potassium. Here are some nursing interventions for patients with hyperkalemia: 1. Help the patient to select appropriate dietary choices to follow a high potassium diet. 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. 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. Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Hypovolemia Nursing Diagnosis and Nursing Care Plan Concomitant hypomagnesemia should be treated concurrently. Please follow your facilities guidelines and policies and procedures. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). She has worked in Medical-Surgical, Telemetry, ICU and the ER. Dialysis should be considered in patients with kidney failure or life-threatening hyperkalemia, or when other treatment strategies fail.23,37 Other modalities are not rapid enough for urgent treatment of hyperkalemia.39, Currently available cation exchange resins, typically sodium polystyrene sulfonate (Kayexalate) in the United States, are not beneficial for the acute treatment of hyperkalemia but may be effective in lowering total body potassium in the subacute setting.25,39 Because sodium polystyrene sulfonate can be constipating, many formulations include sorbitol for its laxative effects. 5. To conclude, here we have formulated a scenario-based nursing care plan for Hypokalemia. In order to function properly, the body requires several electrolytes, one of which is potassium. 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. Hyponatremia & Hypernatremia Nursing Diagnosis & Care Plan Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic Indications for urgent treatment include severe or symptomatic hypokalemia or hyperkalemia; abrupt changes in potassium levels; electrocardiography changes; or the presence of certain comorbid conditions. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or . 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. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Place the patient on high potassium diet as per the physicians order. Your body needs potassium to function correctly. Herdman, T., Kamitsuru, S. & Lopes, C. (2021). 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. Nursing diagnoses handbook: An evidence-based guide to planning care. 2. 2. Hyperkalemia - SlideShare Educate the patient about hyperkalemia. Folic acid deficiency. Urine test. Hypokalemia. Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. Centrally potassium can be administered more quickly and in larger doses via this route. Encourage deep breathing and coughing exercise. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal. Volume depletion. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium. Compromised regulatory mechanism. Furosemide Nursing Considerations - NurseStudy.Net 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. 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 most common cause of excessive loss of Potassium is often associated with heavy fluid losses that flush Potassium out of . Distended neck and peripheral veins. 10 Electrolyte Imbalance Nursing Diagnosis & Care Plans Potassium helps in utilizing carbohydrates and protein to produce energy. To provide information on hyperkalemia and its pathophysiology in the simplest way possible. Closely monitoring intake and output can help assess the patients current fluid status and will guide treatment. Careful assessment for its early presence is needed especially for high-risk patients. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. Other causes include certain medications and some adrenal and genetic conditions. 1. Organ system dysfunction, such as life-threatening dysrhythmias, can occur when potassium is not balanced. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia. To replace potassium lost by the body. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. Polyuria -potassium is mainly excreted through the kidneys. Saunders comprehensive review for the NCLEX-RN examination. Elsevier/Mosby. 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. Insulin and Glucose. An ECG is performed to check heart rhythm. It gets potassium through the food you eat. Hyperkalemia & Hypokalemia Nursing Diagnosis and Nursing Care Plan 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. Hypokalemia Case Scenario A 57-year old male presents to the ED with complaints of nausea, weakness, heart palpitations, and mild shortness of breath. This helps the patient gain muscle strength and confidence in performing self care. Potassium levels should be closely monitored during repletion, making sure the level is rising but does not exceed 4.0 mmol/L. Skidmore-Roth Publications. The patients lung sounds are clear. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. If able to eat and drink, administer PO potassium. Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. Eh wala, yung 15, naging 7. Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder. 4. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. The majority of potassium is stored in the intracellular compartment. It is also needed in the formation of muscles in the body. 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. 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. It is advised to dilute the solution no more than 1 mEq/10 mL (1 mmol/10 mL). When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. It can quickly lead to cardiac arrest if injected too quickly (bolus) or in a large dose. Short-term goal: By the end of the shift the patient will be able to list a few foods high in potassium. F A Davis Company. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. A blood test is performed to check the levels of electrolytes in the blood including potassium. 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. Determine the patients independence in performing activities.Promote and assist in patient ambulation and independence in self care. Patient information: See related handout on potassium, written by the authors of this article. Used in the treatment of potassium deficiency when oral replacement is not feasible. 11. Monitor pulse rate and blood pressure.Hyperkalemia can cause irregular pulse rates and reduces blood artery wall tension which lowers blood pressure. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. The normal blood potassium level is 3.5 5.0 mEq/L. [Twitter moment] Retrieved from. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. It is also needed in the formation of muscles in the body. Clinical manifestations and treatment of hypokalemia in adults Inhaled Beta Agonists. High potassium occurs due to lack of insulin. NurseTogether.com does not provide medical advice, diagnosis, or treatment. and, i didn't The normal serum potassium level is between 3.5 to 5.2 mmoL/L. 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. This content is owned by the AAFP. (fatigue) NURSING DIAGNOSIS Hypokalemia RATIONALE Potassium is essential for many body functions. 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. Perform a fall risk assessment.In acute care and long-term settings, fall risk scales are commonly utilized. Some medications can cause abnormal blood potassium levels. You have entered an incorrect email address! Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. Severe hyponatremia (<115 mEq/L) can cause confusion, seizures, coma, and death. Hypokalemia - Endocrine and Metabolic Disorders - MSD Manual 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. 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. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Potassium disorders are common. 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 Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. St. Louis, MO: Elsevier. Volume depletion is typically accompanied by increased potassium excretion in the kidneys. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. (1998). 2023 nurseship.com. Treatment-related side effects such as cytotoxic drugs. 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. Muscle wasting and paralysis can result from very low potassium levels. While some can be found in the bones, liver, and red blood cells, 98% is found in the muscle cells. Biochemistry is needed to check for the level of serum potassium. Imbalanced levels can be caused by alterations in the intake and excretion of potassium. Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). Potassium pills are quite large if the patient has a difficult time swallowing, consider potassium powder or IV administration. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. The oral potassium should be used in the dose 20-40 mEq three to four times a day (the lower dose is for patients receiving IV potassium, and the higher doses for patients receiving just the oral). This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Copyright 2015 by the American Academy of Family Physicians. It can result in serious injury or death if it becomes too high or too low. Elsevier Inc. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). 3. After 1 hour of health teaching, the client will be able to: Identify measures to prevent hypokalemia. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Low magnesium levels. Continuous telemetry should be implemented when administering medications that affect cardiac status. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site. Elsevier. During the treatment, however, low potassium may result due to the administration of insulin. 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. IV potassium can cause serious extravasation and vein irritation. Hypokalemia Disease with Causes, Symptom and Nursing Intervention To accurately measure the input and output of the patient. To treat the kidney disease if this is the underlying cause of hyperkalemia. Teach the patient on how to follow a low potassium diet.
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