Learn about the essential nursing care plans and nursing diagnosis for the nursing management of potassium (K) imbalances: hypokalemia and hyperkalemia. Discover the causes, symptoms, and treatments for these electrolyte imbalances.
Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
Potassium (K) is a major cation in intracellular fluid (ICF). Potassium is important in regulating the osmolarity of ECF by exchanging it with sodium. It also maintains the transmembrane electrical potential that exists between the ICF and ECF. Potassium also maintains normal neuromuscular contraction by participation in the sodium-potassium pump.
The normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L.
- Hyperkalemia is defined as a serum potassium level above 5.0 mEq/L.
- Hypokalemia is defined as a serum potassium level below 3.5 mEq/L.
Nursing Care Plans
The goal of nursing care is to restore and maintain normal potassium levels through monitoring and appropriate interventions.
Here are two nursing diagnosis for hyperkalemia and hypokalemia nursing care plans:
Hyperkalemia: Risk For Electrolyte Imbalance
Hyperkalemia, an elevated level of potassium in the blood, can occur in patients with renal disease due to the kidneys’ reduced ability to excrete potassium, and in patients who have received massive blood transfusions due to the release of potassium from stored blood cells. Treatment-related side effects, such as certain medications or chemotherapy, can also contribute to hyperkalemia by altering potassium levels in the body, leading to a risk for electrolyte imbalance.
- Risk for Electrolyte Imbalance
May be related to
- Renal disease.
- Treatment-related side effects such as cytotoxic drugs, NSAIDs, diuretics, potassium-containing medications, and massive transfusion with banked blood.
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- The client will display heart rate, blood pressure, and laboratory results within the normal limit and absence of paresthesia, muscle weakness, and cognitive impairment.
Nursing Assessment and Rationales
Nursing assessment for hyperkalemia patients focuses on monitoring for signs and symptoms of life-threatening cardiac dysrhythmias, as well as identifying and addressing the underlying cause of hyperkalemia.
1. Monitor heart rate and rhythm. Be aware that cardiac arrest can occur.
Potassium excess depresses myocardial conduction. Bradycardia can progress to cardiac fibrillation and arrest.
2. Monitor respiratory rate and depth. Encourage deep breathing and coughing exercise. Elevate the head of the bed.
Clients may hypoventilate and retain carbon dioxide resulting in respiratory acidosis. Muscular weakness can affect respiratory muscles and lead to respiratory complications.
3. Assess the level of consciousness and neuromuscular function, including sensation, strength, and movement.
The client is usually conscious and alert; however, muscular paresthesia, weakness, and flaccid paralysis may occur.
4. Monitor urine output.
In kidney failure, potassium is retained because of improper excretion. Potassium is contraindicated if oliguria or anuria is present.
5. Identify the client at risk or the cause of the hyperkalemia such as excessive intake of potassium or decreased excretion.
Early identification and intervention can avoid complications.
6. Monitor laboratory results, such as serum potassium and arterial blood gases, as indicated.
Evaluate therapy needs and effectiveness.
Nursing Interventions and Rationales
Nursing interventions for hyperkalemia patients aim to prevent life-threatening cardiac dysrhythmias by reducing serum potassium levels through a combination of medication administration, dietary management, and monitoring. Here are some nursing interventions for patients with hyperkalemia:
1. Encourage frequent rest periods; assist with daily activities, as indicated.
General muscle weakness decreases activity tolerance.
2. Stress the importance of the client’s notifying future caregivers when a chronic condition potentiates the development of hyperkalemia, such as oliguric renal failure.
May help prevent hyperkalemia recurrences.
3. Teach and assist the client with range-of-motion (ROM) exercises, as tolerated.
Improves muscle tone and reduces muscle cramps and pain.
4. Encourage intake of carbohydrates and fats and low potassium food such as pineapple, plums, strawberries, carrots, cauliflower, corn, and whole grains.
Reduces exogenous sources of potassium and prevents metabolic tissue breakdown with the release of cellular potassium.
5. Instruct the client in the use of potassium-containing salts or salt substitutes, and taking potassium supplements safely.
Prevention of hyperkalemia can be managed with diet, supplements, and other medications.
6. Identify and discontinue dietary sources of potassium, such as beans, dark leafy greens, potatoes, squash, yogurt, fish, avocados, mushrooms, and bananas.
Facilitates the reduction of potassium levels and may prevent the recurrence of hyperkalemia.
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.
8. Administer medications, as indicated:
- 8.1. Loop diuretics such as furosemide (Lasix)
Promotes renal clearance and potassium excretion.
- 8.2. Beta-adrenergic agonist such as albuterol (Proventil)
The administration of nebulization has been helpful in clients receiving hemodialysis and may also attenuate the hypoglycemic effect of insulin administration.
- 8.3. Calcium gluconate or calcium chloride
A temporary stopgap measure that antagonizes toxic potassium depressant effects on the heart and stimulates cardiac contractility.
- 8.4. IV glucose with insulin and sodium bicarbonate
Short-term emergency measures to move potassium into the cell, thus reducing toxic serum levels.
- 8.5. Sodium polystyrene sulfonate (Kayexalate, SPS suspension), given per NGT, orally, or rectally
Resin removes potassium by exchanging potassium for sodium or calcium in the GI tract. Sorbitol enhances evacuation.
9. Provide fresh blood or washed red blood cells (RBCs), if transfusion is indicated.
Fresh blood has less potassium than banked blood because the breakdown of older RBCs releases potassium.
10. Infuse potassium-based medication or solutions slowly.
Prevents administration of concentrated bolus, allows time for kidneys to clear excess free potassium.
11. Prepare for and assist with dialysis.
May be required when more conservative methods fail or are contraindicated such as severe heart failure.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
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