Increased plasma osmolality, such as with uncontrolled diabetes mellitus, establishes a concentration gradient wherein potassium follows water out of cells. Abnormal heart rhythm and palpitation- the brain sends nerve signals to the heart muscles to make them contract and beat. 1. Imbalances in blood potassium levels are referred to as hypokalemia and hyperkalemia. High potassium occurs due to lack of insulin. CRITICAL CARE NURSING CARE PLANS. 3. Start a strict input and output monitoring. Ackley and Ladwigs Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing interventions. Assess the patients readiness to learn, misconceptions, and blocks to learning (e.g. Insulin and glucose . 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. Hypokalemia can cause muscle weakness, paralysis, breathing and swallowing problems (because of muscle paralysis), and irregular heart rate in serious conditions. You vomit a lot. Dilute potassium when given IV.For patients who cannot take PO medications, IV potassium will be administered. Consider IV maintenance fluids with potassium added. Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Hinkle, J. L., & Cheever, K. H. (2018). Inhaled Beta Agonists. The patient thought apples were high in potassium. Patients with heart failure may experience hyperkalemia due to their medications (ACE inhibitors and beta blockers). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). To conclude, here we have formulated a scenario-based nursing care plan for Hypokalemia. Check renal function.Excess potassium can build up in the body if damaged kidneys are unable to eliminate it. 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. a nursing problem (nursing diagnosis) is based upon the symptoms the patient is having and not solely on lab data. Administer a slow intravenous potassium solution as prescribed. Monitor respiratory rate and depth. Hypothermia and increased blood cell production (for example, leukemia) are additional risk factors for developing hypokalemia. ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. Diuretics (water retention relievers) Excessive laxative use. Hypokalemia means low blood potassium levels. Elsevier/Mosby. The normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L. Symptoms include fatigue, weakness, nausea, heart palpitations, shortness of breath, leg cramps, polyuria, polydipsia, and constipation. 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. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. Additionally, this sampleHypokalemianursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales. 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. Excessive sweating. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells. 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. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude. Risk for decreased cardiac output associated with potassium imbalance is caused by a disruption in the electric signals in the myocardium resulting in dysrhythmias. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. 1386-1388). You have diarrhea. This content is owned by the AAFP. To give the patient enough information on hypernatremia and its effects to the body. Search dates: February, September, and December 2014. High potassium levels can be treated through: Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue. 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). Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Encourage the patient to stand up and reposition slowly to prevent faintness and falls. His temperature is 37.4 C, heart rate is 122 beats per minute, blood pressure is 142/84 mmHg, respirations are 20 breaths per minute, and oxygen saturation is 98% on room air. Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management. Nursing Diagnosis: Acute Confusion Related to: Dehydration Electrolyte imbalance Impaired metabolism Urinary retention As evidenced by: Cognitive dysfunction Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-banner-1','ezslot_12',640,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-banner-1-0'); Long-term goal: At home, the patient will take a daily potassium supplement in addition to his regular diuretic. Chronic kidney disease, diabetes, heart failure, and liver disease all increase the risk of hyperkalemia. Apply visible fall prevention signage.Informing the patient and the caregiver about fall prevention measures will promote participation and lower the risk for falls. To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. 2. 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. These contents are not intended to be used as a substitute for professional medical advice or practice guidelines. 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. Hypokalemia refers to a condition in which the concentration of Potassium in the blood is low. These assessments allow the nurse to determine patients at the highest risk for falls to implement precautions. Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia. Potassium supplements are used to treat severe hypokalemia. Treating these conditions involves monitoring and preventing hypo/hyperkalemia. 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. Low potassium diet include eating apples, berries, pineapple, breads, and cereals. Interprofessional patient problems focus familiarizes you with how to speak to patients. IV potassium can cause serious extravasation and vein irritation. Be aware that cardiac arrest can occur.Potassium excess depresses myocardial conduction. Encourage deep breathing and coughing exercise. 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. Wound Care & Infection Nursing Diagnosis & Care Plan, Parkinsons Disease Nursing Diagnosis & Care Plan, Hypokalemia serum potassium level < 3.5 mEq/L (3.5 mmol/L), Hyperkalemia serum potassium level > 5.0 mEq/L (5.0 mmol/L), Excessive use of potassium-wasting diuretics, Increased production of aldosterone (water and salt regulating hormone) (such as in Cushings syndrome), Kidney disease impairing the reabsorption of potassium, Poor potassium intake such as through eating disorders. Consider switching to a potassium-sparing diuretic. 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. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care. Carefully check the administration rate, with 2 nurses if needed. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. After 48 hours of nursing intervention, the client will be able to maintain serum potassium levels within the normal range. Folic acid deficiency. Prevent sudden hypotension.Changes in blood potassium levels can cause hypotension due to decreased levels of aldosterone, vasopressin, and responsiveness to the effects of angiotensin II. Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Diabetic ketoacidosis. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump. Hypokalemia. You take medication that makes you pee ( water pills or diuretics) It's possible, but rare, to get . This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Elevate the head of the bed.Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis.