Hyperkalemia & Hypokalemia (Potassium Imbalances) 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.

Nursing Diagnosis

• 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.

Desired Outcomes

• 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.