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The diagnosis of hyperkalemia includes history taking and physical examination. Eating disorders such as bulimia nervosa and anorexia nervosa can lead to deficits in potassium. The majority of potassium is stored in the intracellular compartment. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). If you continue to use this site we will assume that you are happy with it. Hypokalemia Treatment & Management - Medscape Educate the patient about the symptoms of hypokalemia. Determine the patients independence in performing activities.Promote and assist in patient ambulation and independence in self care. During the treatment, however, low potassium may result due to the administration of insulin. Hypokalemia is a serum potassium level less than 3.5 mEq/L or 3.5 mmol/L. 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. Wolters Kluwer India Pvt. Hypokalemia nursing diagnosis Tips and Tricks From Doctors. It is appropriate to increase dietary potassium in patients with low-normal and mild hypokalemia, particularly in those with a history of hypertension or heart disease.15 The effectiveness of increased dietary potassium is limited, however, because most of the potassium contained in foods is coupled with phosphate, whereas most cases of hypokalemia involve chloride depletion and respond best to supplemental potassium chloride.6,15, Because use of intravenous potassium increases the risk of hyperkalemia and can cause pain and phlebitis, intravenous potassium should be reserved for patients with severe hypokalemia, hypokalemic ECG changes, or physical signs or symptoms of hypokalemia, or for those unable to tolerate the oral form. Compromised regulatory mechanism. Institute fall and safety measures.Institute fall and safety measures due to the neuromuscular effect (muscle weakness) caused by the changes in potassium. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. There are subsets of patients that are susceptible to the development of hypokalemia. Prepare for and assist with dialysis.May be required when more conservative methods fail or are contraindicated such as severe heart failure. 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. 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. This helps the patient gain muscle strength and confidence in performing self care. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia. All information expressed here are courtesies of the respective authors. To give the patient enough information on hypernatremia and its effects to the body. Common acute manifestations are muscle weakness and ECG changes. Psychiatric Nursing . 3. 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. Insulin and Glucose. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Avoid using medical jargons and explain in laymans terms. 4. To replace potassium lost by the body. 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. 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. High alcohol intake. 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. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. Volume depletion. Diabetic ketoacidosis. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. It can result in serious injury or death if it becomes too high or too low. Potassium disorders are common. Occasionally, low potassium is caused by not getting enough potassium in your diet. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Various mechanisms promote the exit of potassium from cells or impede its entrance, thereby raising the plasma potassium concentration (redistributive hyperkalemia). Aphasia, muscle twitching, tremors, seizures. 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. Changes in the level of consciousness (lethargy, disorientation, confusion to coma). Inform him/her the target range for serum potassium levels. Teach the patient on how to follow a low potassium diet. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Medical-surgical nursing: Concepts for interprofessional collaborative care. 4. Too much potassium supplementation can cause hyperkalemia. Potassium supplementation is the main treatment for hypokalemia. The nerve impulses are created by the movement of sodium and potassium in and out the cells. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). Blood test. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Too much or too little potassium in diet. A standing weight is the most accurate. Saunders comprehensive review for the NCLEX-RN examination (9th ed.). She has worked in Medical-Surgical, Telemetry, ICU and the ER. Nursing Diagnosis Excess Fluid Volume May be related to Excess fluid or sodium intake. Swearingen, P. (2016). Risk for falls associated with potassium imbalance is caused by a disruption in the electric signals in muscles resulting in muscle weakness, cramping, hyporeflexia, and paralysis. 2. 3. 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. Buy on Amazon. A more recent article on potassium disorders is available. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Rectal: 30 to 50 g every 6 hours in a retention enema. However, we aim to publish precise and current information. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. 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). To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). 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. 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. Muscle wasting and paralysis can result from very low potassium levels. It will include three Hypokalemia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales. 2. Anna Curran. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. To treat the kidney disease if this is the underlying cause of hyperkalemia. Nursing diagnoses handbook: An evidence-based guide to planning care. All rights reserved. If administering IV, infuse secondarily to a compatible IV solution such as 0.9% normal saline to minimize burning at the IV site.