Hyperkalemia & Hypokalemia (Potassium Imbalances) Nursing Care Plans

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.