hypokalemia nursing diagnosis

To accurately measure the input and output of the patient. 4. Kathleen Salvador is a registered nurse and a nurse educator holding a Masters degree. Concomitant hypomagnesemia should be treated concurrently. Assess urine output and kidney function through BUN, GFR, and creatinine levels. Wolters Kluwer India Pvt. Furosemide is a potassium wasting diuretic but diuretics such as Spironolactone (Aldactone) or Amiloride (Midamor) are potassium-sparing diuretics. Other medical causes. Conditions that cause hypoaldosteronism, such as adrenal insufficiency and hyporeninemic hypoaldosteronism (a common complication of diabetic nephropathy and tubulointerstitial diseases), can lead to hyperkalemia. Monitor strict intake and output.Monitor urine output as well as bowel movements. 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. Aphasia, muscle twitching, tremors, seizures. Compromised regulatory mechanism. Conditions such as alcoholism, eating disorders, and renal disorders can cause a severe case of hypokalemia. Lewiss medical-surgical nursing 2-Volume set: Assessment and management of clinical problems (11th ed., pp. Generally, hypokalemia is a medical, not a surgical, condition. Distended neck and peripheral veins. Encourage frequent rest periods; assist with daily activities, as indicated.General muscle weakness decreases activity tolerance. Potassium regulates fluid and facilitates muscular contraction and nerve activity. Elsevier/Mosby. For example, a decline in serum potassium from 3.8 to 2.9 mEq per L (3.8 to 2.9 mmol per L) roughly corresponds to a 300-mEq (300-mmol) reduction in total body potassium. Common concentrations are 10 mEq/100 ml over 1 hour or 40 mEq/250 ml over 4 hours. 1. Oral potassium does not correct the problem, If hypokalemia is causing abnormal heart rhythms, Switching to potassium-sparing diuretics if needed, Treatment of kidney disease, which includes dialysis, Elimination disorders related to increase in urine volume (polyuria). Recommended nursing diagnosis and nursing care plan books and resources. 4. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Hypovolemia Nursing Diagnosis and Nursing Care Plan 4. Short-term goal: By the end of the shift the patient will experience a resolution of heart palpitations and shortness of breath, with no further PVCs seen on ECG.Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-leader-2','ezslot_8',642,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-leader-2-0'); Long-term goal: The patient will maintain a normal potassium level, monitoring for recurrent signs and symptoms of hypokalemia. Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices. 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. She has worked in Medical-Surgical, Telemetry, ICU and the ER. 1. The most reliable method for shifting potassium intracellularly is administration of glucose and insulin. Normal Potassium Level 3.5-5.1 ( 2.5 or less is very dangerous) Most of the body's potassium is found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. Blood test. Inform him/her the target range for serum potassium levels. 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. See permissionsforcopyrightquestions and/or permission requests. A more practical approach is calculation of the urine potassium-to-creatinine ratio from a spot urine specimen; a ratio greater than 1.5 mEq per mmol (13 mEq per g) is indicative of renal potassium wasting.18 If no cause is identified with the initial workup, assessment of thyroid and adrenal function should be considered. A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. 3. 5. Administer medications as ordered.Aldosterone receptor antagonists (such as spironolactone or eplerenone) can be used to treat mild hypokalemia. Potassium (K) is a major cation in intracellular fluid (ICF). Neurologic signs of hypokalemia include generalized weakness and decreased deep tendon reflexes.11. 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. No edema is noted, and in fact, mild tenting is noted on the back of the patients hand. Rapid administration of IV potassium can cause cardiac arrest so an IV pump should always be used. Hinkle, J. L., & Cheever, K. H. (2018). Strategies to prevent chronic hyperkalemia include instructing patients to eat a low-potassium diet, discontinuing or adjusting medications, avoiding nonsteroidal anti-inflammatory drugs, and adding a diuretic if the patient has sufficient renal function. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. 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. Hypokalemia | Definition & Patient Education - Healthline Inform the patient of the need to undergo dialysis, if indicated by the physician. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). 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. The patient complains of weakness, nausea, heart palpitations, and shortness of breath. Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine. It should ideally be done at the same time and same method (standing, bed weight, etc.) Educate the patient about high-potassium foods. The patient should be able to monitor for hypokalemia, which is common with diuretic administration. Some types of diuretics increase potassium excretion through the kidneys. Possibly evidenced by Ascites. 7. Review drug regimen for medications containing potassium or affecting potassium excretion such as spironolactone (Aldactone), hydrochlorothiazide (Maxzide), amiloride (Midamor), and penicillin G.Requires regular monitoring of potassium levels and may require alternate drug choices or changes in the dosage or frequency. 1 - 3 Hyperkalemia (serum potassium level. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Assess the patients neuromuscular status.Potassium is utilized by muscles to transmit electrical signals to the brain leading to muscle contraction. For the past few nights, he has had severe leg cramps that have woken him up. Monitor urine output.In kidney failure, potassium is retained because of improper excretion. This indicates depletion in the normal potassium levels in the body, a potential life-threatening emergency and can be fatal. Also, large amounts of potassium found in the intestinal fluids are excreted during episodes of diarrhea. Bounding pulses. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. Hypokalemia. Potassium is mainly excreted in the kidneys. Hypokalemia is a side effect of diuretic administration and the patient is showing signs of dehydration. The patient has a past medical history of heart failure and takes furosemide (Lasix) daily. In order to function properly, the body requires several electrolytes, one of which is potassium. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Low Potassium Level Causes (Hypokalemia) - Cleveland Clinic Comer, S. and Sagel, B. Educate the patient about hyperkalemia. It is also needed in the formation of muscles in the body. 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. (2020). Avoid using medical jargons and explain in laymans terms. Elsevier. Consider switching to a potassium-sparing diuretic. Potassium movement from extracellular to intracellular fluid due to: IV therapy with potassium-deficient solutions, Rapid infusion of potassium-containing IV solutions, Adrenal insufficiency (such as in Addisons disease), Potassium movement from intracellular to the extracellular fluid, Muscle weakness, leg cramps, deep tendon hyporeflexia, and paresthesias, ECG changes: ST depression, inverted T waves, and prominent U waves, Increased motility, hyperactive bowel sounds, and diarrhea, Ascending flaccid paralysis until the respiratory muscles become affected as a toxic level of serum potassium is reached, ECG changes: Tall peaked T waves, widened QRS complexes, and prolonged PR intervals, Conditions that affect the movement of potassium in the cellular space, Alterations in the electrical conductivity of the heart, Patient will demonstrate serum potassium levels within normal limits, Patient will verbalize the absence of muscle pain or cramping, Disruption in the electric functioning of the heart, Patient will display pulse and blood pressure within acceptable limits, Patient will verbalize the absence of angina or palpitations, Patient will demonstrate ECG results of normal sinus rhythm, Patient will be able to verbalize understanding of decreased cardiac output in relation to hypo/hyperkalemia, Patient will participate in physical therapy sessions, Patient will be able to maintain or regain muscle strength. 1386-1388). 4. Ignatavicius, MS, RN, CNE, ANEF, D. D., Workman, PhD, RN, FAAN, M. L., Rebar, PhD, MBA, RN, COI, C. R., & Heimgartner, MSN, RN, COI, N. M. (2018). The ECG can provide useful information for hypokalemia. 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. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Nursing Diagnosis (hypokalemia)-help? - allnurses

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