Electrolytes

Question 1

Which foods are high in potassium

Answer 1

Fish, grains, nuts,

Vegetables: artichokes, broccoli, brussel sprouts, cabbage, carrots, celery, collards, cucumbers, mushrooms, potatoes with skins, tomatoes,

Fruits: Apricots, bananas, cantaloupes, guava, honeydew melons, nectarines, oranges, prunes, strawberries, watermelon

Question 2

Safety precaution for hypokalemia

Answer 2

Falls

Question 3

Normal serum potassium levels

Answer 3

3.5-5.0 mEq/L

Question 4

Function of potassium in the body

Answer 4

Maintenance of electrical membrane excitability in nerve and muscle cells (smooth, cardiac, and skeletal).

Question 5

Potassium regulation (3 ways)

Answer 5

Kidneys - remove 80%

Gastrointestinal Tract

Sweat

Question 6

What is the normal intracellular potassium fluid levels

Answer 6

140 mEq/L

Question 7

___% of Potassium is inside the cell

Answer 7

95%

Question 8

Hypokalemia affects

Answer 8

Low & Lazy

LESS responsive to stimuli

Question 9

Actual vs Relative depletion

Answer 9

Actual - Excessive loss or not enough intake

Relative - Diluted through excessive water in the body.

Like a ratio, if there’s more water than a normal, the ratio will be more extreme.

Question 10

Causes of hypokalemia (actual deficits)

Answer 10

n/v/d wound drainage

Prolonged NG

Heat-induced diaphoresis

Kidney diseases impairing reabsorption of K

NPO

Drugs (non-K sparing diuretics like furosemide)

Question 11

Causes of hypokalemia (relative deficits)

Answer 11

Alkalosis

IV therapy

Water intoxication

Total parental nutrition

HyperINSULINISM

Hyperalimentation (too many supplements)

Question 12

Priority intervention for hypokalemia

Answer 12

Assess respiratory status first - breath sounds, nail beds, effort of breathing, rate, depth

Question 13

Why should we be concerned in surgical patients for hypokalemia?

Answer 13

Wound drainage

Question 14

Things to assess in hypokalemia

Answer 14

Musculoskeletal (weakness, reduced reflexes, flaccid paralysis)

CV (thready pulse, irregular heartbeat, postural hypotension, EKG ST depression, flat or inverted T wave, dysrhythmias)

Neurological (AMS, irritability, lethargy, anxiety)

Intestinal (Decreased peristalsis, hypoactive bowel sounds, n/v/CONSTIPATION, abd distention, paralytic ileus).

Question 15

Interventions for Hypokalemia

Answer 15

IV potassium that’s diluted, no more than 20 mEq/L

Severe tissue irritant, never give IV push

Oral potassium - do NOT crush

Avoid loop diuretics - non-K-sparing diuretics

Teach potassium rich foods

Fall precautions

Check respiratory status (ability to cough -> strength in diaphragm)

Question 16

Hyperkalemia effects

Answer 16

HYPER excitability, cells may discharge spontaneously (interferes with hearts electrical conduction)

Question 17

Most at risk for hyperkalemia

Answer 17

chronically ill, debilitated, older adults (hospitalized patients)

Question 18

If hyperkalemia is caused by dehydration, what will be elevated

Answer 18

HCT/HGB

Question 19

Assess for what in hyperkalemia

Answer 19

CV (Bradycardia, hypotension, heart block, asystole, vfib)

Neuro (twitch, paresthesia, muscle weakness/flaccid paralysis)

GI (diarrhea, hyperactive bowel sounds)

Question 20

If hyperkalemia is caused by kidney failure, what other labs might we see?

Answer 20

increased serum creatinine

decreased blood pH

normal/low HH

Question 21

Interventions for Hyperkalemia

Answer 21

Stop IV/PO potassium

Potassium restricted diet

Furosemide for functioning kidneys

Kayexalate for non-functioning kidneys (create BM)

Dialysis (6.0+ K)

Insulin increases activity of sodium potassium pumps (with glucose, don’t bottom them out)

Cardiac monitoring

NO salt substitutes (has potassium)