To effectively monitory the patients daily nutritional intake and progress in weight loss goals. 2. Assess urine output and kidney function through BUN, GFR, and creatinine levels. 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. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. Excessive sweating. Encourage physical therapy.Encourage participation in physical and occupational therapy sessions as ordered to regain strength and adapt to changes. Please read our disclaimer. Silvestri, L. A., Silvestri, A. E., & Grimm, J. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. Aphasia, muscle twitching, tremors, seizures. However, diuretics, particularly loop diuretics, may play a role in the treatment of some forms of chronic hyperkalemia, such as that caused by hyporeninemic hypoaldosteronism.39,44 Fludrocortisone is an option for hyperkalemia associated with mineralocorticoid deficiency, including hyporeninemic hypoaldosteronism.29. Encourage deep breathing and coughing exercise. We use cookies to ensure that we give you the best experience on our website. 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. 1. Imbalanced Nutrition Less than Body requirements, BPH Nursing Diagnosis and Nursing Care Plan, Legionnaires Disease Nursing Diagnosis and Nursing Care Plan. Nursing care plans: Diagnoses, interventions, & outcomes. Monitor respiratory rate and depth. 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. Place the patient on high potassium diet as per the physicians order. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. 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. Psychiatric Nursing . Inform the patient of the need to undergo dialysis, if indicated by the physician. In order to function properly, the body requires several electrolytes, one of which is potassium. 4. Potassium is mainly excreted in the kidneys. Diuretics may be temporarily paused until potassium level increases and fluid status is normalized. Hyperaldosteronism Nursing Diagnosis and Nursing Care Plan This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. 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. 2. P. otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. It should ideally be done at the same time and same method (standing, bed weight, etc.) Hyperkalemia & Hypokalemia Nursing Care Plans - Nurseslabs 2. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. Crackles. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. 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. 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. 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. Hypokalemia | Definition & Patient Education - Healthline Patient information: See related handout on potassium, written by the authors of this article. Monitor strict intake and output.Monitor urine output as well as bowel movements. Start a strict input and output monitoring. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Nurses pocket guide: Diagnoses, interventions, and rationales (15th ed.). All rights reserved. Educate the patient about hyperkalemia. 5. 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. Copyright 2015 by the American Academy of Family Physicians. 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. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Careful assessment for its early presence is needed especially for high-risk patients. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels. The diagnosis should be confirmed with a repeat serum potassium measurement. (See "Causes of hypokalemia in adults".). Potassium can be obtained as a dietary supplement but is naturally available in many foods. 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. Determine the patients independence in performing activities.Promote and assist in patient ambulation and independence in self care. Carefully check the administration rate, with 2 nurses if needed. Relative insulin deficiency or insulin resistance, which also occurs in persons with diabetes, prevents potassium from entering cells. Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This is a community of professional nurses gifted with literary skills who share theoretical and clinical knowledge, nursing tidbits, facts, statistics, healthcare information, news, disease data, care plans, drugs and anything under the umbrella of nursing. Inhibits renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. 11. Potassium supplements are used to treat severe hypokalemia. Intravenous Calcium. each day. It also decreases the risk of falls and fall related injuries. Rectal: 30 to 50 g every 6 hours in a retention enema. St. Louis, MO: Elsevier. Hypokalemia (Low Potassium): Symptoms, Causes, Diagnosis, Treatment - WebMD 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. Treat underlying conditions.Potassium imbalances can be caused by kidney disease, diabetes, alcoholism, Addisons disease, and more. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Monitor heart rate and rhythm. 1. Medication intake. Potassium is an electrolyte needed primarily for muscle and nerve tissue function. Elsevier. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Potential health risks are avoidable as long as the potassium levels are kept at a normal level. Below is a list of other common causes of hypokalemia: I have been vomiting and experiencing diarrhea for the past few days. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. Hinkle, J. L., & Cheever, K. H. (2018). This is commonly done through the administration of oral potassium supplement and high potassium diet. St. Louis, MO: Elsevier. To accurately measure the input and output of the patient. 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. 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. Hyponatremia & Hypernatremia Nursing Diagnosis & Care Plan NurseTogether.com does not provide medical advice, diagnosis, or 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). Insulin and glucose . Urinalysis can also show the presence of potassium in the urine. Position the patient therapeutically.Elevate the legs when hypotension occurs in hyperkalemia. Cardiac enzymes are normal but his potassium level is 2.8 mmol/L. When he started to feel heart palpitations and shortness of breath, he decided to come to the hospital. Thieme. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. Constipation low potassium levels (hypokalemia) can affect the intestinal muscles. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. (2020). ANTHONY J. VIERA, MD, MPH, AND NOAH WOUK, MD. (1998). 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. Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. 1. 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. 2023 nurseship.com. 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. Beta-blockers. An ECG is performed to check heart rhythm. 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. Concomitant hypomagnesemia should be treated concurrently. 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. All Rights Reserved. Create a daily weight chart and a food and fluid chart. Help the patient to select appropriate dietary choices to follow a high potassium diet. 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