Hyperkalemia & Hypokalemia (Potassium Imbalances) Nursing Care Plans

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.

Electrolyte Imbalances

Electrolytes regulate nerve and muscle function, hydrate the body, balance blood acidity and pressure, and further rebuild damaged tissue. Sodium, calcium, potassium, chloride, phosphate, and magnesium are all electrolytes. When these substances become imbalanced, it can lead to either muscle weakness or excessive contraction.

Electrolyte imbalance can occur due to several factors. Various disorders and their corresponding treatments may put the patient at risk for imbalances in serum electrolyte concentrations. Patients experiencing congestive heart failure frequently end up with rebound hospitalizations due to irregular sodium and potassium levels. Diabetes and hypertension may eventually place a patient in a calcium or magnesium imbalance. Electrolyte losses may occur from draining wounds and fistulas, particularly gastrointestinal fistulas. Irregularities in sodium and chloride concentrations happen frequently in situations associated with fluid imbalances, primarily gastrointestinal fluid losses such as vomiting, diarrhea, or suctioning.

Changes in the secretion of antidiuretic hormone and aldosterone can contribute to sodium imbalances. Patients receiving diuretics may be at risk for potassium imbalances. Thyroid and parathyroid problems place the patient at risk for calcium imbalances. Magnesium imbalances often occur in the same situations as calcium and potassium imbalances.

Electrolytes are vital for the normal functioning of the human body. A proper understanding of these imbalances is essential for current management and future prevention. This care plan and nurse study guide focus on sodium, potassium, calcium, and magnesium 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:

  1. Hyperkalemia: Risk for Electrolyte Imbalance
  2. Hypokalemia: Risk for Electrolyte Imbalance

Hypokalemia: Risk For Electrolyte Imbalance

Hypokalemia, a low level of potassium in the blood, can occur in patients due to various reasons such as diarrhea and vomiting, diabetic acidosis, renal failure, high sodium diet, and treatment-related side effects. These conditions can lead to a loss of potassium from the body, reduced potassium intake or absorption, or shifts of potassium from the extracellular fluid into the cells, leading to a risk of electrolyte imbalance.

Nursing Diagnosis

  • Risk for Electrolyte Imbalance

May be related to

  • Diarrhea, vomiting.
  • Diabetic acidosis, renal failure.
  • High-sodium diet, starvation.
  • Profuse sweating.
  • Treatment-related side effects such as diuretics, TPN, and some antibiotics.

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 rhythm and laboratory results within the normal limit for the client and the absence of paresthesias, muscle weakness, and cognitive impairment.

Nursing Assessment and Rationales

Nursing assessment plays a pivotal role in identifying patients with hypokalemia, an electrolyte disturbance that can result in critical complications. A thorough nursing assessment of risk factors, clinical presentation, and diagnostic tests is necessary to determine appropriate interventions for managing hypokalemia.

1. Monitor respiratory rate, depth, and effort. Encourage deep breathing and coughing exercise. Encouraged frequent re-positions.
Respiratory muscle weakness may progress to paralysis leading to respiratory arrest.

2. Monitor heart rate and rhythm.
Abnormalities in heart conduction and contractility are associated with hypokalemia. Tachycardia may develop as well as potentially life-threatening atrial and ventricular dysrhythmias–AV blocks, AV dissociation, ventricular tachycardia, and PVCs.

3. Note for signs of metabolic alkalosis such as tachycardia, dysrhythmias, hypoventilation, tetany, and changes in mentation.
These are usually associated with hypokalemia.

4. Monitor the level of consciousness and neuromuscular function, noting movement, strength, and sensation.
Tetany, paresthesia, apathy, drowsiness, irritability, and coma may occur.

5. Monitor gastric, urinary, and wound losses accurately.
Guide for calculating fluid and potassium replacement needs. Potassium should only be administered to patients with good urinary flow as it is primarily eliminated from the body through the kidneys; if a patient has decreased kidney function or impaired urinary flow, administering potassium can lead to a buildup of potassium in the bloodstream, which can result in life-threatening complications such as cardiac arrhythmias, muscle weakness, and paralysis. Therefore, it is important to assess the patient’s urinary output before administering potassium and to monitor their potassium levels closely during and after administration to prevent these adverse events.

6. Observe for absence or changes in bowel sounds.
Paralytic ileus commonly follows gastric losses through vomiting, gastric suction, or protracted diarrhea.

7. Observe for signs of digoxin toxicity when used: reports of blurred vision, vomiting, nausea, increasing atrial dysrhythmias, and heart block.
Hypokalemia enhances the effect of digoxin, slowing cardiac conduction.

8. Monitor laboratory results as indicated.

  • 8.1. Arterial blood gasses (ABGs)
    Correction of metabolic alkalosis raises serum potassium levels and decreased replacement needs. Correction of acidosis drives potassium back into the cells, resulting in reduced serum levels and increased replacement needs.
  • 8.2. Serum potassium
    Frequent regular checking of serum potassium should be done during replacement therapy, especially in the presence of insufficient renal function.

Nursing Interventions and Rationales

Hypokalemia, characterized by serum potassium level less than 3.5 mEq/L, can lead to significant complications if not appropriately managed. Effective nursing interventions are crucial for the prompt identification, treatment, and prevention of this electrolyte imbalance.

1. Discuss preventable causes of the condition such as nutritional choices and the proper use of laxatives.
Provides an opportunity for the client to prevent a recurrence. In addition, dietary control is more palatable than oral replacement medications.

2. Encourage high potassium diets such as oranges, bananas, tomatoes, coffee, red meat, and dried fruits. Discuss the use of potassium chloride salt substitutes for a client receiving long-term diuretics.
Potassium may be replaced and level maintained through the diet when the client is allowed oral food and fluids. Dietary replacement of 40 to 60 mEq/L/day is usually sufficient if no abnormal losses are happening.

3. Monitor the rate of IV potassium administration using a micro drop set or infusion pump. Observe for side effects, and provide an ice pack, as indicated.
Ensures controlled delivery of medication to prevent bolus effect and reduce associated discomfort such as burning sensation at the IV site. When a solution cannot be administered via the central vein and slowing of rate is not possible or effective, applying an ice pack to the infusion site may help relieve discomfort.

4. Review medication regimen for potassium-wasting drugs such as amphotericin B (Fungizone), catecholamines IV, carbenicillin (Geocillin), furosemide (Lasix), gentamicin (Garamycin), and hydrochlorothiazide (Diamox)
If alternative drugs such as potassium-sparing diuretics (e.g., Aldactone, Midamor) cannot be administered or when high-dose sodium drugs are administered (e.g., carbenicillin), close monitoring and replacement of potassium are important.

5. Administer potassium orally or intravenously.
May be required to correct deficiencies when changes in medication, therapy, and dietary intake are inadequate. IV (intravenous) potassium can be a lifesaving treatment for patients with low potassium levels; however, if administered incorrectly or in excessive doses, it can lead to serious complications such as cardiac arrest, arrhythmias, and tissue damage. Therefore, it is important to closely monitor potassium levels and administer IV potassium according to established guidelines and under the supervision of a healthcare professional.

Recommended nursing diagnosis and nursing care plan books and resources.

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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.

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 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.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:

Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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