Potassium- Electrolytes

Question 1

what is the normal serum potassium level?

Answer 1

3.5 to 5.0

Question 2

what is the action of potassium in the body?

Answer 2

Influences both skeletal and cardiac muscle activity
(sodium potassium pump)

Question 3

what is potassium a major electrolyte in?

Answer 3

major electrolyte in the intracellular fluid (ICF)

Question 4

where is potassium obtained, absorbed and secreted?

Answer 4

obtained by the diet
absorbed by the Intestines
excreted through the kidneys and bowels

Question 5

why is the renal system so important for maintaining and balancing potassium?

Answer 5

Renal system important in keeping balanced potassium because the body does not conserve potassium

Question 6

what are some things that can cause HYPOkalemia?

Answer 6

• think the body is trying to “DITCH” potassium
  Drugs: medication
  Inadequate consumption of potassium
  Too much water intake
  Cushing’s syndrome
  Heavy Fluid Loss

Question 7

what are the 7 “SLOW” signs and symptoms of HYPOkalemia?

Answer 7

“SLOW”
1. Weak, Irregular pulses
2. Orthostatic Hypotension
3. Depressed ST, flat or inverted T wave, prominent U wave
4. Shallow Respiration
5. Confusion, weak
6. Decreased deep tendon reflexes
7. Decreased bowel sounds

Question 8

what are the 7 “LOW” signs and symptoms of HYPOkalemia?

Answer 8

“LOW”
1. Lethargy (confusion)
2. Low, shallow respirations
3. Lethal cardiac dysrythmias
4. Lots of urine
5. Leg cramps
6. Limp muscles
7. Low BP and HR

Question 9

Renal (kidney) loss of potassium can be caused by what?

Answer 9

1. Diuretics
2. Hyperaldosteronism (too much aldosterone = Aldosterone causes sodium to be absorbed and potassium to be excreted)
3. High dose of sodium PCN’s
4. Large dose corticosteriods

Question 10

how is the heart affected by HYPOkalemia? 4

Answer 10

1. strength of contraction
2. myocardium irritability
3. ST segment depression
4. digoxin toxicity

Question 11

potassium less than 2.7 may cause what?

Answer 11

PAC’s (premature atrial contractions)
PVC’s (premature ventricular contractions)
V-fib or cardiac arrest

Question 12

potassium less than 3.5 may be associated with what?

Answer 12

metabolic alkalosis
high ph
and a
high bicarb

Question 13

what is the medical treatment for HYPOkalemia ? 5

Answer 13

1. potassium replacement either PO or IV
2. Increase on a daily basis (40-80mg/day)
3. At risk patient
   (50-100 mg/day)
4. potassium rich foods
5. treat the underlying cause

Question 14

how do you give potassium PO to minimize GI upset? 3

Answer 14

1. Dilute liquid & effervescent supplement
   2.Give tabs & capsules w/ 8 oz. H2O
2. Give K+ with food

Adverse reaction – N/V, diarrhea, GI bleed

Question 15

how do you give potassium through an IV? 7

Answer 15

1. Must be diluted
2. DO NOT GIVE BY Direct IVP
3. Max. dose is 60 mEq at a time
4. Must use IV pump
5. Monitor renal output
6. CHS policy – pt on heart monitor
7. Monitor IV site

Question 16

what are the nursing interventions of HYPOkalemia? 7

Answer 16

1. Identify pt at risk – esp. if on Digoxin
2. Monitor ECG & BP
3. Monitor serum K+
4. Pt education – diuretics & laxatives
5. Administer K+ supplements PO or IV
6. dietary K+
7. Monitor urine output

Question 17

what are some causes of HYPERkalemia? 5

Answer 17

• Think “CARED”*
  1. Cellular movement
  2. Adrenal Insufficiency
  w/ Addison’s disease
  3. Renal Failure
  4. Excessive potassium intake
  5. Drugs: medications

Question 18

signs and symptoms of HYPERkalemia? 6

Answer 18

think MURDER*
1, Muscle weakness
2. Urine production is little to none
3. Respiratory failure
4. Decreased cardiac contractility
5. Early signs of muscle twitches /cramps
6. Rhythm changes

Question 19

how is the heart affected by HPERkalemia?

Answer 19

1. slow heart rate
2. ECG changes:
   Tall, peaked T wave, short QT interval
   Longer PR interval, widening QRS complex
   ** Risk for Heart Block, A-fib, or, V-fib

Question 20

severely high potassium levels effect on the heart?

Answer 20

1. Decreased heart contraction strength
2. Dilated & flaccid heart

Question 21

HYPERkalemia medical treatment? 5

Answer 21

1. potassium restricted diet
2. stop potassium containing medications
3. monitor for digitalis toxicity
4. Cation-exchange resins
   Polystyrene sulfonate (Kayexalate) – PO or PR
   1Gm of resin removes 1 mEq K+
5. conservative methods not suffice

Question 22

what is the emergency medical treatment for hyperkalemia?

Answer 22

1. Calcium Gluconate IV: - does not lower potassium
   - antagonizes potassium action on the heart
   - monitor ECG
2. Hypertonic Glucose and insulin:
   - Insulin - facilitates K+ movement into cells
   - Glucose - ↑ insulin release from pancreas
3. Sodium Bicarbonate
   - potassium shifts into the cell

Question 23

Nursing interventions for HYPERkalemia: 5

Answer 23

1. Be aware of pt at risk
2. Monitor for:
   Generalized weakness & dysrhythmias
   Irritability & GI symptoms
   Nausea & intestinal colic
   ECG or lab abnormalities
3. Prevention of hyperkalemia
4. Educate pt: medication & diet
5. Do NOT draw blood above K+ infusion site