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Hypokalemia, Hyperkalemia, and Fluid Volume Excess > Hypokalemia, Hyperkalemia, and Fluid Volume Excess > Flashcards

Hypokalemia, Hyperkalemia, and Fluid Volume Excess Flashcards

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1
Q

Prerenal, intrarenal, or Postrenal: Dehydration, hemorrhage, diarrhea, vomiting, excessive diuresis, hypoalbuminemia, burns

A

prerenal

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2
Q

Prerenal, intrarenal, or Postrenal: BPH, bladder cancer, renal calculi (kidney stones), neuromuscular disorders, prostate cancer, spinal cord disease, strictures, trauma to back, pelvis, or perineum

A

postrenal

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3
Q

Prerenal, intrarenal, or Postrenal: Malignant hypertension, systemic lupus erythematosus, thrombotic disorders, hemolytic blood transfusion reaction, ACE inhibitors, severe crush injury

A

intrarenal

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4
Q

Prerenal, intrarenal, or Postrenal: septic shock, anaphylaxis, neurologic injury, renal artery thrombosis

A

prerenal

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5
Q

Prerenal, intrarenal, or Postrenal: exposure to chemicals such as lead or arsenic

A

intrarenal

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6
Q

Prerenal, intrarenal, or Postrenal: aminoglycosides such as gentamicin, allergies to drugs, NSAIDS

A

intrarenal

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7
Q

Prerenal, intrarenal, or Postrenal: cardiac dysrhythmias, cardiogenic shock, heart failure, MI

A

prerenal

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8
Q

Prerenal, intrarenal, or Postrenal: bacterial, viral, or fungal infection

A

intrarenal

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9
Q

Prerenal, intrarenal, or Postrenal: contrast media

A

intrarenal

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10
Q

Prerenal, intrarenal, or Postrenal: loss of blood in a car wreck

A

prerenal

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11
Q

Prerenal, intrarenal, or Postrenal: kidney stones

A

postrenal

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12
Q

What is the normal serum potassium level?

A

3.5 to 5.0 mEq/L (varies in hospitals)

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13
Q

About 98% of potassium in our body is inside the cells or outside the cells?

A

inside the cells (potassium is the major intracellular cation)

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14
Q

Insulin causes these ions from extracellular fluid (such as blood) to move into the cells: _____, _____, and _____.

A

potassium, magnesium, and phosphate (This means insulin can be used to reduce the ‘hyper’ state of these ions in the blood, and excess insulin can lead to ‘hypo’ state of these ions in the blood. This is useful to understand the electrolyte balance in the body, esp. diabetic patients on insulin).

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15
Q

Insulin helps stimulate ______ pump which helps move potassium into the cells.

A

sodium-potassium pump (this means insulin helps reduce potassium in the blood. Good if there is too much potassium in the blood, Bad if potassium level is normal or hypo. Important consideration for diabetic patients.)

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16
Q

An example of ____ is potassium 2.4 mEq/L; an example of _____ is potassium 8.0 mEq/L.

A

hypokalemia; hyperkalemia

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17
Q

Potassium affects the _____ membrane potential of nerve and muscle cells which in turn affects the neuromuscular and cardiac functions.

A

resting

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18
Q

Potassium helps in protein synthesis which helps in normal growth and building muscles. True or false.

A

True

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19
Q

90% of potassium is eliminated through the ____.

A

kidneys (this means kidney disorders/diseases can cause potassium accumulation in the blood)

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20
Q

Renal failure is the most common cause of _____ (hyperkalemia or hypokalemia).

A

Hyperkalemia (this is because if the kidneys are not able to remove potassium in urine, the excess potassium stays (retained) in the blood).

21
Q

What are the causes of hypokalemia?

A
  1. Decreased K intake (starvation, diet, IV with little or no K when NPO)
  2. Shift of K from extracellular into the cell (insulin, epinephrine, alkalosis)
  3. Increase in K output (diarrhea, polyuria, vomiting, suction, diuretics - loop & thiazide, dialysis, ileostomy drainage, excess aldosterone, excess corticosteroid, diaphoresis, low magnesium)
22
Q

What are the clinical manifestations of hypokalemia?

A

R – Respiratory - Shallow respirations, weak diaphragm (check respiratory status q2h)
S – Skeletal weakness - too weak to stand, decreased deep tendon reflexes, leg cramps, fatigue
U – prominent U wave, ST depression, flat or inverted T wave, difficulty in repolarization, peaked P wave, prolonged (wide) QRS.
C - Constipation, nausea, paralytic ileus
T – Toxic effects of digoxin, nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium, visual disturbances (blurred, yellow vision)
I – Irregular, weak pulse, thready, dysrhythmia
O – Orthostatic hypotension
N - Numbness, paresthesias, lethargy, acute confusion, coma

23
Q

What are the prominent EKG changes in hyperkalemia and hypokalemia?

A

Hyperkalemia - tall peaked T waves

Hypokalemia - prominent U waves

24
Q

Never give potassium via injection - no SubQ, no IM, no IV push, or bolus. True or False.

A

True

25
Q

Potassium is always given either oral (pills or liquid) or IV (not IV push). True or False

A

True

26
Q

Can a nurse add concentrated potassium to IV solution to dilute it?

A

No. The Joint Commission mandates only pharmacist can add potassium concentration to an IV solution.

27
Q

What are the nursing considerations of oral potassium medication?

A

Taste can be unpleasant. Don’t crush it. Can break for elderly. Tell patient not to chew it. Give with full glass of water.

28
Q

How does serum glucose get affected by hypokalemia?

A

Hypokalemia impairs insulin secretion, leading to glucose intolerance and hyperglycemia.

29
Q

How frequently do you monitor IV site for potassium infusion?

A

every hour

30
Q

What are the safety precautions for hypokalemia patients?

A

Fall precautions – unsteady on feet
Possibly bed rest
Telemetry – done for both hypo and hyper K
Pulse oximetry
Monitor respiratory status for signs and symptoms of distress and hypoxia (diaphragm is weak)

31
Q

What are the safety precautions for hypokalemia patients?

A 
Fall precautions (unsteady on feet), possibly bed rest, 
Telemetry (done for both hypo and hyper K), pulse oximetry, monitor respiratory status for signs and symptoms of distress and hypoxia (diaphragm is weak)
32
Q

What are the food high in potassium?

A

Bananas, oranges, dates, raisins, plums, fresh vegetables, potatoes, meat, and fish, apricots, whole grain cereals, and legumes.
AVOID eating large amount of LICORICE

33
Q

What are the signs of digoxin toxicity the patients on diuretics taking digitalis need to know?

A

confusion, irregular pulse rate, loss of appetite, N/V, diarrhea, abdominal pain, fast heart beat, dizziness, headache, delirium, visual disturbances (blurred, yellow vision)

34
Q

What are the nursing considerations for IV potassium chloride infusion?

A
  1. IV KCl must always be diluted and never given in concentrated amounts.
  2. Never give IV push or as a bolus.
  3. Mix solution in the bag by inverting IV bag several times
  4. Do not add KCl to a hanging IV bag to prevent giving a bolus dose.
  5. Start IV in a large vein (avoid hands)
  6. Must be given by infusion pump
  7. Infusion rates should not exceed 10 mEq/hr unless the patient is in a critical care setting with continuous EKG monitor and a central line.
  8. Assess IV site at least every hour for phlebitis and infiltration (look for signs of necrosis and sloughing of the surrounding tissue)
  9. Monitor serum potassium level and urine output (urine output must be at least 0.5 mL/kg per hour)
  10. Monitor for digitalis toxicity
35
Q

If a patient is showing signs of infiltration or phlebitis at IV site on KCl infusion, what is the priority intervention you would do?

A

Stop the infusion

36
Q

The most common cause of hyperkalemia is ______ (heart / renal) failure.

A

renal

37
Q

What are the causes of hyperkalemia?

A
  1. Excess potassium intake (excess or rapid IV potassium, potassium containing drugs, potassium-containing salt substitute)
  2. Shift of potassium out of the cell (acidosis, DKA, rhabdomyolysis, crush injuries, massive cell destruction such as sepsis, burns, intense exercise, tumor lysis syndrome, blood transfusion) Note: digoxin and beta blockers can impair potassium entry into the cells increasing serum potassium level.
  3. Failure to eliminate potassium (kidney failure, renal disease, adrenal insufficiency, ARB, ACE inhibitors, uncontrolled diabetes, heparin, potassium-sparing diuretics, NSAIDs, penicillin containing potassium)
38
Q

What are the clinical manifestations of hyperkalemia?

A
  • Tingling and burning, numbness in hands and feet (tetany, paresthesia), leg cramps, decreased deep tendon reflexes
  • Fatigue, weakness, confusion, irritability
  • Increased respiratory distress
  • Irregular pulse
  • Worsening sign - muscle twitching and flaccid paralysis without obvious causes such as disease or trauma
  • Increased GI motility, hyperactive bowel sounds, watery diarrhea, vomiting, abdominal cramping
  • Tall, peaked T waves, Ectopic beats (PVCs, PACs, failure to capture with pacemaker), complete heart block, asystole, V-Fib
  • Hypotension (due to loss of muscle tone)
  • Cardiac arrest (most common cause of death)
39
Q

What are the nursing management (drug therapy) of hyperkalemia?

A
  • Increase fluids and Furosemide (if tolerated and not a dialysis patient)
  • Sodium polystyrene sulfonate (Kayexalate) given PO or rectal enema, takes hours to work, given often
  • Patiromer (Veltassa) given PO for chronic hyperkalemia, takes several hours to days, affects other drug effectiveness so give 6 hrs gap, not given often
  • Regular insulin IV with Dextrose 50% and calcium gluconate or calcium chloride (calcium lowers membrane excitability, restores electrical gradient, protects from v-fib so good for heart - monitor BP as it can cause hypotension; insulin helps K move into cells; dextrose helps stabilize blood sugar - check blood sugar)
  • Sodium Bicarbonate (helps move K back into cells, fixes acidosis)
  • Albuterol (beta-adrenergic agonists) (helps move K back into cells by stimulating NaK pump)
  • Hemodialysis (for renal failure patients)
40
Q

What is the generic name of Kayexalate?

A

Sodium polystyrene sulfonate

41
Q

What are the nursing interventions of hyperkalemia?

A
  • Remove all potassium for IV solutions
  • Stop oral potassium
  • Potassium reduced diet
  • Continuous EKG monitoring (for dysrhythmia)
  • Digoxin effects (have decreased effect of medication, don’t give more, treat hyperkalemia first then treat condition needing digoxin)
  • Patient teaching (which food are high in K, which drugs can increase K, s/s of hyperkalemia)
42
Q

What are the causes of fluid-volume excess (hypervolemia)?

A
  • Too much fluid intake
  • Abnormal fluid retention such as in heart failure, renal failure
  • Shift of fluid from interstitial to the plasma
  • Excessive isotonic or hypotonic IV fluids
  • SIADH syndrome (defined by hyponatremia and hypo-osmolality resulting from inappropriate continuous secretion or action of ADH (arginine vasopressin) despite normal and increased plasma volume which results in impaired water excretion)
  • Excessive Na intake (water follows Na)
  • Polydipsia (such as in uncontrolled diabetes)
  • Long term use of corticosteroids (including prednisone can cause Na retention in turn cause fluid retention)
  • Cushing syndrome (excessive cortisol causes Na and H2O retention resulting in edema and increased K excretion)
43
Q

What are the clinical manifestations of fluid volume excess?

A

Headache, lethargy, peripheral edema, bounding pulse, jugular vein distention, ↑ BP, ↑ CVP, weight gain, dyspnea, crackles in lungs, pulmonary edema, confusion, coma, seizure, coma

44
Q

What lab tests can help indicate fluid volume excess (FVE)?

A
  • Serum Osmolality (Normal 275-295 mosm/kg)
  • H/H (decreases with low RBC or with normal Hgb in the presence of FVE)
  • Urine Osmolality (Normal 300 to 1300, more accurate than specific gravity, depends on state of hydration, high indicates dehydration or concentration, low indicates dilute urine or unable to concentrate urine)
  • Urine Specific Gravity (Normal 1.003 to 1.030, less than 1.003 indicates FVE, greater than 1.030 indicates dehydration or concentration)
45
Q

A patient has urine specific gravity of 1.000. Does it indicate fluid volume excess (FVE) or dehydration?

A

FVE

46
Q

A patient has urine specific gravity of 1.032. Does it indicate fluid volume excess (FVE) or dehydration?

A

Dehydration

47
Q

What are the nursing interventions for fluid volume excess?

A
  • Weigh your patient daily (in same clothes, same time. Wt gain of 2.2 lbs = 1 kg = 1000 mL or 1 L of fluid)
    Accurate I and O (IV, NG, wound, drains, vomit, urine, suction)
  • Monitor labs (decreased - BUN, Na, Hct, serum osmolality and urine osmolality)
  • Cardiovascular care (increased CVP, increase in BP, JVD, bounding pulses, S3 sound)
  • Respiratory care (monitor pulse ox, could develop pulmonary edema, SOB, crackles, ↑ RR, may need for O2)
  • Patient Safety (changes in LOC, bed alarm for patient who have confusion, fall prevention)
  • Skin Care (edema, skin can be stretched, thin, taut, feel cool to touch due to poor perfusion, and tear easily. Turn pt, elevate extremities)
  • Fluid Therapy (may need fluid restriction depending on what is causing FVE)
48
Q

How do diuretics help in the treatment of fluid volume excess (FVE)?

A

Decrease the plasma and extracellular fluid volumes
Decrease preload
Decrease cardiac output
Decrease total peripheral vascular resistance
Decrease workload of the heart (decrease afterload)
Decrease blood pressure

49
Q

What are the different diuretics used in treatment of fluid volume excess?

A

Osmotic diuretics (Mannitol)
Carbonic anhydrase inhibitors
Loop diuretics (bumetanide - Bumex, furosemide - Lasix)
Thiazide and thiazide-like diuretics (hydrochlorothiazide - HydroDIURIL, chlorothiazide - Diuril, chlorthalidone - Hygroton)
Potassium-sparing diuretics (spironolactone - Aldactone, triamterene - Dyrenium)

Hypokalemia, Hyperkalemia, and Fluid Volume Excess (1 decks)

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