Hyperkalemia & Hypokalemia NCLEX Review Care Plans
Nursing Study Guide on Hypokalemia and Hyperkalemia
Hypokalemia and Hyperkalemia are conditions that refer to abnormal levels of potassium in the blood.
Hypokalemia occurs when potassium falls below 3.6mmol/L and hyperkalemia occurs when potassium level in the blood is greater than 5.2mmol/L.
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Both conditions can be fatal and life-threatening; hence the need for prompt medical management depending on the severity.
Potassium is a main intracellular electrolyte. About 98% of the body’s potassium is found inside the cells and the rest is found extracellularly. P
otassium functions to maintain fluid balance, to regulate nerve signals, and to help with muscle contractions.
Symptoms of Hypokalemia and Hyperkalemia
The signs and symptoms of hypokalemia and hyperkalemia depend on how critical the potassium level is and how rapid the rise and fall in potassium levels happens:
- Weakness, nausea, and fatigue- hypokalemia causes weak muscle contractions and affects the body’s way of using nutrients, leading to weakness and fatigue
- Constipation – low potassium levels (hypokalemia) can affect the intestinal muscles. The effect can cause slow peristalsis which can lead to constipation.
- Polyuria -potassium is mainly excreted through the kidneys. Hypokalemia or potassium levels can impair the kidneys’ function to concentrate urine, which may result to polyuria.
- Increased thirst -as a result of polyuria, the body will try to compensate to avoid dehydration by increasing the thirst signal
- Nausea and vomiting
- Nausea – common in hyperkalemia
- Muscular cramps or twitching – hyperkalemia or high potassium levels in the blood can cause alteration in the voltage of the nerve cells causing unregulated muscle contractions.
- Abnormal heart rhythm and palpitation- the brain sends nerve signals to the heart muscles to make them contract and beat. The nerve impulses are created by the movement of sodium and potassium in and out the cells. Hyperkalemia affects this process therefore causing inadequate nerve impulses to signal the heart muscles to contract properly causing arrhythmia and palpitations.
Causes of Hypokalemia and Hyperkalemia
Hypokalemia and hyperkalemia typically happen as a result of another problem. Abnormal potassium levels commonly occur due to the following:
- Volume depletion. Volume depletion from vomiting, diarrhea, increased sweating, and excessive laxative use can all lead to hypokalemia. Gastric fluid contains little amount of potassium. Some of the potassium ions are lost when vomiting occurs. Volume depletion is typically accompanied by increased potassium excretion in the kidneys.
- Kidney problems. Potassium is mainly excreted in the kidneys. Impaired kidney functions prevent the kidneys from properly filtering potassium from the blood to excrete it causing either hypokalemia or hyperkalemia.
- Adrenal glands problem. Addison’s disease and Hyperaldosteronism can cause abnormal potassium levels. High levels of aldosterone in cases of hyperaldosteronism can cause low blood potassium levels by signaling the kidneys to excrete more potassium through the urine. On the other hand, Addison’s disease involves low levels of aldosterone which results to reduced excretion of potassium through the kidneys.
- Medication intake. Some medications can cause abnormal blood potassium levels.
- Diuretics. Some types of diuretics increase potassium excretion through the kidneys. While others spare potassium from being excreted through the kidneys.
- Asthma medications are also known to cause altered potassium levels. They are mostly related to hypokalemia.
- Blood pressure medications. Some blood pressure medications such as angiotensin-converting enzymes inhibitors, beta blockers, and angiotensin-receptor blocker are known to cause hyperkalemia.
- Non-steroidal anti-inflammatory medications (NSAIDs)
- Potassium supplement. Too much potassium supplementation can cause hyperkalemia.
- Too much or too little potassium in diet. The main source of potassium is from food. Inadequate or too much intake of potassium-rich food can alter the blood levels of potassium.
- High alcohol intake. Excessive alcohol intake is known to reduce potassium levels.
- Folic acid deficiency. Folic acid deficiency is typically related to hypokalemia as most food sources of folic acid are the same food sources of potassium.
- Certain antibiotics. Studies suggest that some antibiotics can cause high potassium levels.
- Diabetic ketoacidosis. Potassium levels can fluctuate in the treatment of DKA. High potassium occurs due to lack of insulin. During the treatment, however, low potassium may result due to the administration of insulin. Insulin causes the entry of potassium to the cells.
- Low magnesium levels. Magnesium helps the movement potassium in and out the cells.
- Other medical causes. Medical conditions related to the breakdown or injury to cells can cause high potassium levels in the blood.
- Hemolysis or breakdown of red blood cells
- Rhabdomyolysis or the breakdown of muscle tissues
- Burns, trauma, and other tissue injuries can also cause the release of potassium from the cells
Complications of Hypokalemia and Hyperkalemia
Abnormal potassium levels can easily become a medical emergency as it can cause life-threatening cardiac arrhythmias.
Hyperkalemia and hypokalemia can also cause paralysis and weakness.
Diagnosis of Hyperkalemia and Hypokalemia
The diagnosis of hyperkalemia includes history taking and physical examination.
A detailed medication list is vital as abnormal potassium levels can be caused by certain medications.
Other diagnostic tests that may be performed are as follows:
- Blood test. A blood test is performed to check the levels of electrolytes in the blood including potassium.
- Urine test. Urinalysis can also show the presence of potassium in the urine.
- Electrocardiogram (ECG). An ECG is performed to check heart rhythm.
Treatment of Hypokalemia and Hyperkalemia
Potassium replacement. Potassium supplementation is the main treatment for hypokalemia. This is commonly done through the administration of oral potassium supplement and high potassium diet. However, potassium will need to be given intravenously in the following conditions:
- Potassium level is severely low
- Oral potassium does not correct the problem
- If hypokalemia is causing abnormal heart rhythms
Treating of underlying disease. Medical conditions can also cause abnormal potassium levels; therefore, treatment also includes correcting the main cause of abnormal potassium levels.
Treatment of hyperkalemia. High potassium levels can be treated through:
- Low potassium diet
- Switching to potassium-sparing diuretics if needed
- Use of potassium binders
- Treatment of kidney disease, which includes dialysis
Nursing Care Plans for Hypokalemia and Hyperkalemia
Nursing Care Plan 1
Nursing Diagnosis: Electrolyte Imbalance related to hypokalemia as evidenced , serum potassium level of 2.9 mmol/L, polyuria, increased thirst, weakness, tachycardia, and fatigue
Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
|Obtain daily blood sample from the patient.||Biochemistry is needed to check for the level of serum potassium|
|Place the patient on high potassium diet as per the physician’s order.||To replace potassium lost by the body. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day.|
|Administer a slow intravenous potassium solution as prescribed.||A slow intravenous potassium solution is given to raise the potassium level in the blood stream. This must be given at a controlled slow rate as potassium solution may cause a burning sensation on the infusion site.|
|Start a strict input and output monitoring.||To accurately measure the input and output of the patient.|
|If the patient is on diuretics regimen, switch to potassium-sparing diuretics as prescribed.||To achieve the therapeutic goal of diuretics without contributing to further potassium loss.|
Nursing Care Plan 2
Nursing Diagnosis: Imbalanced Nutrition Less than Body related to hypokalemia as evidenced by nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Explain to the patient the relation of altered potassium levels to nausea and vomiting and loss of appetite.||To help the patient understand why nausea and vomiting associated with loss of appetite are signs of hypokalemia.|
|Create a daily weight chart and a food and fluid chart.||To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals.|
|Help the patient to select appropriate dietary choices to follow a high potassium diet.||To replace potassium lost by the body. The recommended dietary replacement for potassium is 40 to 60 mEq/L/day.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to the electrolyte imbalance.|
Nursing Care Plan 3
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of hyperkalemia as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hyperkalemia and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)||To address the patient’s cognition and mental status towards the new diagnosis of hyperkalemia and to help the patient overcome blocks to learning.|
|Explain what hyperkalemia is, and how it affects the vital organs such as the kidneys and heart. Avoid using medical jargons and explain in layman’s terms.||To provide information on hyperkalemia and its pathophysiology in the simplest way possible.|
|Educate the patient about hyperkalemia. Inform him/her the target range for serum potassium levels.||To give the patient enough information on hypernatremia and its effects to the body. The normal serum potassium level is between 3.5 to 5.2 mmoL/L.|
|Teach the patient on how to follow a low potassium diet.||Low potassium diet include eating apples, berries, pineapple, breads, and cereals. Boiling potatoes and cutting vegetable sin small pieces are also recommended. The patient needs to avoid foods high in potassium such as bananas.|
|Inform the patient of the need to undergo dialysis, if indicated by the physician.||To treat the kidney disease if this is the underlying cause of hyperkalemia.|
Other Nursing Diagnoses:
- Risk for Deficient Fluid Volume
- Elimination disorders related to increase in urine volume (polyuria)
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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