HYPOKALEMIA : MEDICAL SURGICAL NURSING

HYPOKALEMIA is a condition that occurs when the serum potassium concentration less than 3.5 mEq/L.
CAUSES-HYPOKALEMIA
Diarrhea
Excessive sweating
Chronic Kidney disease
Refeeding syndrome
Excessive Secretion of aldosterone
Acid base disorder
Suction : Gastric
Excessive Secretion of insulin
Drugs
Drugs leads to Hypokalemia
Adrenergics: (albuterol and epinephrine)
Antibiotics (carbenicillin and gentamicin)
Corticosteroids
Diuretics (furosemide and thiazides)
Insulin
Laxatives.
Clinical Manifestations of HYPOKALEMIA
HYPOKALEMIA Signs & Symptoms
Confusion
Anorexia
Tingling & numbness (Parathesia)
Irregular,Weak,thready pulse
Orthostatic Hypotension / palpitations
Nausea
Skeletal muscle weakness
Constipation
Cramps -Leg
U Wave prominent in ECG
Cardiovascular
Dysrhythmias
Thready, weak, irregular pulse
Orthostatic hypotension / palpitations
ECG Changes: Hypokalemia
Slightly peaked P Wave
Slightly prolonged PR interval
ST depression
Shallow, flat, or inverted T wave
Prominent U wave
Respiratory
Shallow respiration
Dyspnea
Respiratory muscles weakness : tachycardic and tachypneic.
Neuromuscular
Skeletal muscle weakness
Decreased muscle strength
Deep tendon reflexes
Paresthesias (numbness and tingling)
Confusion
Lethargy
Coma
Renal :
Inability of the kidneys to concentrate urine, causing dilute urine (resulting in polyuria, nocturia) and excessive thirst.
Gastrointestinal
Decreased motility /Hypoactive bowel sound
Anorexia
Nausea
Vomiting
Constipation
Paralytic ileus
Laboratory Findings
Decreased serum potassium level less than 3.5 mEq/L
Decreased serum Magnesium level
Increased serum glucose level
Increased 24-hour urine level
Increased pH and bicarbonate levels
Increased digoxin level.
HYPOKALEMIA Management
Identify and treat the underlying cause of Hypokalemia.
HYPOKALEMIA Management
Oral potassium supplements
IV potassium replacement therapy
High-potassium & low-sodium diet
Potassium-sparing diuretic, if needed.
Magnesium replacement therapy is often necessary in
malnourished alcoholics with hypokalemia.
IV infusion rate for SEVERE OR SYMPTOMATIC HYPOKALEMIA
Nursing Management
Vital Signs
Monitor heart rate,rhythm ECG tracing
Mental status / Neurologic status
Electrolytes level
Intake output (gastric, urinary, and wound losses)
Potassium Infusion rate & IV Site for complications (Phlebitis,Infiltration)
ABG (metabolic alkalosis usually associated with hypokalemia)
Digoxin Level
Nursing Management of Hypokalemia.
Position : Semi fowlers Position
Bowel Movement
Activities: Assist the patient with daily activities.
Exercises : ROM exercise & Deep Breathing exercise
Nursing Diagnosis
Risk For Electrolyte Imbalance (Hypokalemia)
May be related to
Diarrhea
Vomiting.
Acid base imbalance.(Alkalosis)
Renal failure.
Excessive sweating