Potassium (Regular, Hypo, & Hyperkalemia) Flashcards
what is the normal range for K+
3.5-5.0
what is K+ king of
king of hearts
K+ is a major electrolyte in which fluid
Intracellular fluid
what does K+ maintain (2)
heart & muscle contraction
what regulates K+ (2)
regulate by kidneys & aldosterone
Increased K+ in the cell means H+ does what
moves out of the cell
Increased H+ in the cell means K+ does what
moves out of the cell
what is a main source of K+
diet
what causes hypokalemia (8)
potassium loss
corticosteriods
increased secretion of aldosterone
GI loss
Excessive diaphoresis
Kidney disease
Inadequate K+ intake
Alkalosis, Metabolic
what med can cause K+ loss (1)
Diuretics
what medication should we be careful using with diuretics
digoxin
when the K+ is low is digoxin toxic
yes
when we use diuretics with digoxin what are we are at an increased risk for
hypokalemia
corticosteroids causes water retention which cause what dilution
hemodilution
increased secretion of aldosterone causes what disease
Cushing’s
aldosterone is K+ excretion through
kidneys
if there are higher levels of aldosterone more K+ is what
excreted
What can cause K+ to be lost through the GI system (3)
Vomiting
Diarrhea
NG suction
what can excess insulin do to K+
moves K+ into the cell
what is the severe level of hypokalemia
2.5 or less
what will the pt’s cardiovascular system look like if they have hypokalemia (4)
torsades de pointes
irreg. apical HR
lethal dysrhytmisas
bradycardia
what does tosades look like/what will it look like on an EKG
a long QT interval
what does a long QT interval mean for the heart (what is the heart doing)
heart takes longer to electrically charge for the next heartbeat
what does torsades de pointes mean in english
twisting of the points
what do torsades de pointes look like in hypokalemia
irreg. QRS complexes appearing to wrap around the EKG baseline
what does an EKG look like for a pt with hypokalemia
increased amplitude & width of P wave, T wave flattening and inversion, prominent U waves and apparent long QT intervals due to merging of the T & U wave
how does an EKG look like in a pt with hyperkalemia
Peaked T waves
P wave flattening
PR prolongation
Wide QRS complex
how will a hypokalemic pt’s neuromuscular function present (4)
confusion
lethargy
muscle weakness
diminished DTRs
how will a hypokalemic pt’s GI function present to us
Constipation
what should we think is happening in the GI system if there are absent bowel sounds in a hypokalemic
think paralytic ileus
what is a paralytic ileus
portion of bowel not moving & can lead to small bowel obstruction
what other electrolyte should we check with hypokalemia
Mg+
What if the Mg+ level is low in a hyperkalemic pt
if Mg+ is low it enhances K+ loss, correct Mg+ loss first then fix K+
what interventions do we do for hypokalemic pt’s (4)
monitor cardiac & respiratory status
admin K+ supplements orally or via IV
If pt on diuretic, may need to stop it
K+ rich foods to replace K+
Should we admin K+ fast or slow
slow because it’s lethal if given too fast
what diuretic should we give to a pt that will spare K+ from being excreted
Spironolactone
if we give K+ orally what should we always give it with
food
K+ is never admined in which routes (3)
IV push, IM, or SubQ
IV K+ is always what
diluted
What can cause hyperkalemia (6)
excess K+ intake
decreased K+ excretion
adrenal insufficiency
kidney disease- #1 cause
traumatic burns
acidosis, metabolic
what is the number 1 cause of hyperkalemia
kidney disease
what drugs can cause hyperkalemia (3)
K+ sparing diuretics (sprionolactone)
Ace inhibitors
NSAIDS (decrease renal perfusion)
what adrenal insufficient disease can cause hyperkalemia
addison’s
why does addison’s cause hyperkalemia
addison’s had low aldosterone which causes retention of K+
why does kidney disease cause hyperkaleima
there is a decrease in urine output and increase in K+
how can acidosis cause hyperkalemia
because H+ levels are elevated in blood, K+ moves out as H+ moves into the cell
what is the severe level of a patient in hyperkalemia
greater than or equal to 6.5
what is the lethal level of a pt w/ hyperkalemia
greater than or equal to 8.5
how will a pt’s cardiovascular system look with hyperkalemia (4)
low bp
dysrhythmias
V fib
Cardiac standstill
how will a pt’s GI system sound like with hyperkalemia
hyperactive bowels
what do the hyperactive bowels indicate in a pt with hyperkalemia (2)
diarrhea & increased motility
what weakness can result in paralysis & respiratory arrest
muscle weakness
how will an EKG look in a pt with hyperkalemia (3)
peaked narrow T wave, ST segment depressed, prolonged PR interval
what interventions will we do for a pt with hyperkalemia (6)
monitor cardiac rhythm changes
restrict K+ in diet
Diuretics
Cation exchange resins
Stop meds causing increase in K+
Dialysis
what cation exchange resin do we give to a pt w/ hyperkalemia
sodium polystyrene sulfate (Kayexalate)
what happens to a pt’s bowels when we give Kayexalate
explosive diarrhea
what emergency medical treatments (meds) do we give to a pt w/ severe hyperkalemia (3)
Ca+ Gluconate 10% IV
Hypertonic glucose & insulin
NaHC03
What does Ca+ Gluconate protect the heart from
myocardial irritability
what does Ca+ Gluconate not lower
does not lower K+
how long must Ca+ Gluconate be given
given over 3-5 mins
what should we monitor when giving Ca+ gluconate (3)
HR & BP
Dysrhythmias
where does insulin move K+
into the cells
where does hypertonic glucose & insulin move excess K+
into the cells
where does NaHCO3 (sodium bicarb) shift K+
into the cell
when NaHCO3 shifts K+ into the cell what is also raised
pH
