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 renal issues lead to HYPOkalemia?
affecting reabsorption of K+, in diuretic phase of renal failure.
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.
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 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.
Parenteral K+ with HYPOkalemia, monitor:
IV site closely for infiltration, phlebitis and tissue necrosis. (potassium chloride - KCl)
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.
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.
how cellular release lead to HYPERkalemia?
massive cell damage, burns, hyperuricamia in tumor lysis syndrome, major surgeries, hypercatabolism.
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 management, intake:
decrease K+ intake... evaluate hidden K+ intake in food, by dietitian.
HYPERkalemia management, monitor:
serum K+ levels, report abnormals, cardiac status, signs and symptoms of hyperkalemia and metabolic acidosis
HYPERkalemia possible inmediate intervention:
dialysis for intractable conditions to prevent lethal problems.
recognize predisposing factors, avoid foods high K+, examine labels to determina K+ contents, avoid salt substitutes