Potassium

1. Signs & Symptoms (MURDER)
   1. Muscle Weakness, Numbeness & Tingling in the Extremeties
   2. Urine, Oliguria, anuria
   3. Cardiac Dysrthmias
      1. ECG
         1. Depolarization Decreased
            1. P wave Flattened

               Anmerkungen:

               • Decreased Depolarization(Contraction)
            2. QRS widened

               Anmerkungen:

               • Decreased Depolarization(Contraction) 
         2. Replolarization more Rapid
            1. Shortened QT wave
            2. Tented T wave
         3. Complication: Ventricle Fibrillation or Cardiac Arrest
   4. Reflexia, Hyperflexia & areflexia (Flaccid)
   5. More severe
      1. Respiratory Distress
      2. Weak or Paralyzed Skeletal Muscles
   6. Intial
      1. Cramping Leg
      2. Abdominal Cramping & Diarrhea

         Anmerkungen:

         • Hyperactivity of smooth muscle cells
2. Interventions
   1. On-Going Monitoring
      1. Monitor Renal Function (Urine Output & Lab values)
      2. Monitor ECG
      3. I&O
   2. Teaching
      1. Teach S&s
      2. Teach client foods that contain K+
      3. Teach Ace inhibitors & Diuretics increase Potassium
   3. Nursing Considerations
      1. False Lab Results
         1. Hemolysis of Blood Specimen
         2. Drawing blood Above IV site
   4. Drugs
      1. IV insulin Followed By Glucose
      2. Sodium Bicarbonate

         Anmerkungen:

         • Metabolic Acidosis. This treats underlying problem so that potassium stops exhanging hydrogen ions. 
      3. Calcium Gluconate

         Anmerkungen:

         • Immediately if patient have cardiac dysrthmia! Monitor Blood pressure because rapid administration can cause hypotension. 
      4. Kayexalate

         Anmerkungen:

         • Binds to Potassium in Exchange for Sodium. The resin is excreted in the Feces.
      5. Diuretics

         Anmerkungen:

         • May be used 
   5. Eliminate Potasium from Oral & IV sources
3. Causes (MACHINE)
   1. Drugs
      1. Chemotherapeutic therapy
      2. Antibiotic
      3. Beta Blocker

         Anmerkungen:

         • Impair the entry into the cell 
      4. Digoxin
      5. Heparin
      6. NSAID
      7. Potassium Sparing Diuretic/ACE inhibitors

         Anmerkungen:

         • Reduce excretion of Potassium 
   2. Stored Blood (Blood Transfusion)

      Anmerkungen:

      • Especially when near expiration date. (Excessive Intake)
   3. Shift from ICF to ECF
      1. Cellular Injury

         Anmerkungen:

         • Potassium inside the cell will get released on the extracellular area. 
      2. Metabolic Acidosis

         Anmerkungen:

         • Potassium shifts from ICF to ECF in exchange for an Ion.
   4. Impaired Renal excretion
      1. Hypoaldosteronism

         Anmerkungen:

         • (Adrenal Insufficiency) Inverse Relationship with Sodium. When the body detects low volume levels and Low BP Aldosterone would be released and the sodium retain & K+ excreted. When aldosterone is low the potassium levels will rise. 
      2. Chronic Renal Failure
4. Nursing Dx
   1. Risk for Injury
   2. Potential Compliacation: Dysrthmia
   3. Risk for Activity Intolerance
   4. Risk for Activity Intolerance r/t Extrimity Weakness

1. Nursing Dx
   1. Fluid & Electrolyte Imbalance
   2. Risk for Activity Intolerance & Injury r/t muscle weakness & Hyporeflexia

      Anmerkungen:

      • also r/t postural hypotension and Decreased Cardiac Output 
   3. Potential Complication: Dysrthmias
2. Causes

   Anmerkungen:

   • ECF to ICF
   1. LOW magnesium Levels!!

      Anmerkungen:

      • Stimulate release of renin, which in increase aldosterone which promotes excretion of potassium. 
   2. GI LOSSES
      1. Diarrhea
      2. Vomiting
      3. ostomy fluids
      4. Gastric Suctioning
   3. Thiazide & Loop diuretics
   4. Insulin Therapy (especially in DKA)
   5. BETA adrenergic

      Anmerkungen:

      • Allows potassium in causing low k+ levels
   6. Metabolic Alkalosis

      Anmerkungen:

      • Potassium shift into cell in exchange for Hydrogen 
3. Interventions
   1. Oral or IV potassium Chloride
      1. Only given if Urine Output is 0.5ml/kg/hr
      2. IV ALAWAYS DILUTED
      3. inverte Several Times for Even Distribution
      4. Never add KCl to hanging IV bag

         Anmerkungen:

         • Prevent giving Bolus
         1. Never IV push or Bolus
      5. Perrefferred Max. 40mEq/L (for Severe up to 80mEq/L)
      6. DO NOT exceeed 10- 20mEq/hr and Administer by infusion pump!!!
      7. Assess Phlebitis & infiltration

         Anmerkungen:

         • Infiltration can cause necrosis & Sloughing around the tissue
      8. Central Line (Rapid correction necessary)
      9. PAIN
   2. Clients on Diuretics Teach k+ rich foods
   3. Assess Digoxin Toxicity

      Anmerkungen:

      • Increase RISK of digoxin toxicity
   4. N&V, bradycardia, Anorexia, & Dysrthmias
4. Signs & Symptoms
   1. Fatigue/ wakness/ Leg Cramps (Early signs)
   2. Metabolic Alkalosis
   3. Hyperglycemia

      Anmerkungen:

      • Impaired Release of Insulin
   4. Decreased GI motility
   5. Shallow Respirations
   6. ECG
      1. Impaired Repolarization
         1. Flattening of T wave
         2. Prominent U wave
      2. ST segment Depression & slight P Wave Peak
      3. QRS prolonged
      4. Frequent Premature Ventricular Contraction
   7. Thready Pulse

Anmerkungen:

• Body Cannot Conserve so must be consumed Daily.