hyper/hypokalemia

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HYPOkalemia serum value

below 3.5

HYPOkalemia major complications

cardiac or respiratory arrest

How aldosterone is related to HYPOkalemia?

secretion of aldosterone leads to K+ excretion from renal tubules.

disorders leading to HYPOkalemia

adrenal adenomas, cirrhosis, nephrosis, heart failure and hypertensive crisis, Cushing syndrome, diabetes insipidus

what chemicals produce HYPOkalemia?

loop diuretics, thiazide diuretics, corticosteroids, cardiac glycosides, penicillins, amphotericin B, gentamicin, theophylline, cisplatin, tocolytic agents

Which GI issues lead to HYPOkalemia?

vomiting, diarrhea, prolong.nasogastric suctioning, newly created ileostomy, villous adenoma on intestinal tract, laxative abuse, enema adm.

How heat lead to HYPOkalemia?

heat induced diaphoresis

How renal issues lead to HYPOkalemia?

affecting reabsorption of K+, in diuretic phase of renal failure.

How dialysis leads to HYPOkalemia?

hemodialysis and peritoneal dialysis.

How diet leads to HYPOkalemia?

NPO status without sufficient IV replacement, starvation, malnutrition, alcoholism, anorexia, high glucose levels (leading to diuresis), large ingestion of black licorice (causes aldosterone effects).

Cardiovascular assessment in HYPOkalemia

variable pulse rate; weak, thready pulse; pedal pulses difficult to palpate; ECG changes (ST segm. Depression, flattened T wave, appearance of U wave, ventricular dysrhythmias and heart block); digitalis toxicity is potentiated.

Respiratory assessment on HYPOkalemia

decreased breath sounds; weak, shallow respirations; dyspnea

Renal assessment on HYPOkalemia

polyuria and nocturia, decreased specific gravity

Neuromuscular assessment on HYPOkalemia

anxiety, lethargy, depression, confusion, paresthesias, weakness, leg cramps

HYPOkalemia focus treatment

restoring normal levels, preventing complications, and treating underlying problems

HYPOkalemia, if also hypocalcemia and/or hypomagnesemia?

all electrolytes must be corrected together

if HYPOkalemia present, also check for signs of what disorder?

metabolic alkalosis (including irritability and paresthesias)

if HYPOkalemia: monitor for the following Vital signs:

Vital signs, BP(orthotastic hypot.), respiratory rate, depth and pattern.

if HYPOkalemia monitor this test:

serum electrolytes levels

if HYPOkalemia monitor heart tests:

ECG changes, heart rate and rhythm pattern

if HYPOkalemia monitor fluids:

I & O and possibly dialy weight

if taking drugs, with HYPOkalemia, monitor:

therapeutic serum levels if taking cardiac glycosides(digoxin) and serum K+ for clients taking loop and thiazide diuretics.

if HYPOkalemia occur, safety precautions:

protect from injury and maintain safety environment because weakness.

if HYPOkalemia, dietary interventions:

high-fiber diet, increase fluids to prevent constipation. And food: raisins, bananas, apricots, oranges, avocados, beans, beef, potato, tomato, cantaloupe, spinach.

When to give oral replacement if HYPOkalemia:

only if client urine output at least 0.5 mL/kg/hr

K+ dose for HYPOkalemia

usual 20mEq, higher up to 100 depending on baseline

Parenteral K+ with HYPOkalemia, verify:

additive K+ in solution

Parenteral K+ with HYPOkalemia, use always:

infusion pump, paying attention to rate, I & O.

Parenteral K+ with HYPOkalemia, monitor:

IV site closely for infiltration, phlebitis and tissue necrosis. (potassium chloride - KCl)

for HYPOkalemia never administer:

K+ by IV push or bolus or IM - lead to fatal dysrhythmias

when HYPOkalemia avoid foods:

black licorice.

HYPOkalemia teaching- report:

signs and symptoms of hypokalemia to physician

HYPOkalemia teaching - supplements:

take K+ with at least 4oz fluid or with food, never crush or break tablets or capsules. After meals to prevent GI upset.

HYPOkalemia teaching - do not use:

salt substitutes when taking K+

HYPERkalemia serum levels:

serum level K+ greater than 5.1 (in ECF)

HYPERkalemia intake etiology:

excessive intake in food or medication, use of salt substitutes, rapid infusion.

HYPERkalemia, K+ loss by:

K+ excretion by adrenal insufficiency (Addison's disease), renal failure, K+ sparing diuretics, use of ACE inhibitors.

Relative HYPERkalemia:

move from ICF to ECF, without increase K+ in body

how cellular release lead to HYPERkalemia?

massive cell damage, burns, hyperuricamia in tumor lysis syndrome, major surgeries, hypercatabolism.

pseudohyperkalemia:

hemolysis of blood sample

how transcellular shifting lead to HYPERkalemia?

metabolic acidosis, insulin deficiency, rapid increase in blood osmolality

how medications lead to HYPERkalemia?

digoxin, overdose of K+ replacement, adm. Of stored blood, K+ sparing diuretics.

how Addison's disease lead to HYPERkalemia?

decreased aldosterone occur. Leads to Na+ depletion and K+ retention.

HYPERkalemia cardiovascular ECG assessment:

ECG changes (narrow, peaked T waves, widened QRS complexes, prolonged PR intervals, flattened P waves, frequent ectopy, ventricular fibrillation, and ventricular standstill)

HYPERkalemia respiratory assessment:

unaffected until levels are very high, leading to muscle weakness and paralysis and causing resp. failure.

HYPERkalemia neuromuscular assessment:

muscle twitching (early) and cramps, irritability, anxiety; a late sign is ascending flaccid paralysis involving arms and legs.

HYPERkalemia GI assessment:

hyperactive bowel sounds, diarrhea, nausea

HYPERkalemia management, intake:

decrease K+ intake... evaluate hidden K+ intake in food, by dietitian.

HYPERkalemia management, excretion:

increase urinary output, monitor renal function

HYPERkalemia management, monitor:

serum K+ levels, report abnormals, cardiac status, signs and symptoms of hyperkalemia and metabolic acidosis

HYPERkalemiamanagement, determine:

whenever possible, the underlying cause to restore balance

HYPERkalemia possible inmediate intervention:

dialysis for intractable conditions to prevent lethal problems.

if HYPERkalemia drug to decrease K+, orally or enema:

sodium polystyrene sulfonate (Kayexalate)

K+ wasting diuretics for HYPERkalemia

loop diuretics and thiazide diuretics.

HYPERkalemia teaching:

recognize predisposing factors, avoid foods high K+, examine labels to determina K+ contents, avoid salt substitutes

HYPOkalemia signs: pulse rate?

variable

HYPOkalemia signs: what about pulse strenght?

weak, thready

HYPOkalemia signs: How appear BP?

decreased

HYPOkalemia signs: it is easy to find pedal pulse?

it is difficult to palpate

HYPOkalemia signs: what toxicity is potentiated?

Digitalis

HYPOkalemia signs: how is the abdomen?

distended

HYPOkalemia signs: are there bowel sounds?

hypoactive or absent

HYPOkalemia signs: is there changes in weight?

weight loss

HYPOkalemia signs: how is the GI feeling and working?

nausea, vomiting and/or diarrhea

HYPOkalemia signs: are there bowel movements?

constipation if decreased peristalsis; paralytic ileus

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