nursing care plan for HYPOKALEMIA plsss.

tsible03 · Jun 2, 2009

I am taking a pharmacology class as one of my prerequisites before the nursing program. This was one of the questions asked on a take home assignment. The four statements below the question were the four answers to choose from. In researching for the answer I came upon this site and thought that I would put the question out there and maybe get some advice on what the first priority of the nurse would be. The assignment was designed to have questions like those that I would face on the NCLEX exam. :specs:

tsible03 · Jun 2, 2009

Also, I do understand with hypokalemia, why you would monitor for dysrhythmias, but I did not know if that would be the first priority if immediate care was needed. My first guess was monitoring for dysrhythmias, but I sometimes over think questions and then begin to doubt.

Thanks for your time.

Valerie Salva, BSN, RN · Jun 2, 2009

Also, I do understand with hypokalemia, why you would monitor for dysrhythmias, but I did not know if that would be the first priority if immediate care was needed. My first guess was monitoring for dysrhythmias, but I sometimes over think questions and then begin to doubt.
Thanks for your time.

Google potassium and heart function.

Daytonite, BSN, RN · Jun 2, 2009

also, i do understand with hypokalemia, why you would monitor for dysrhythmias, but i did not know if that would be the first priority if immediate care was needed. my first guess was monitoring for dysrhythmias, but i sometimes over think questions and then begin to doubt.
thanks for your time.

in caring for a client with hypokalemia, what is the nurse's highest priority?

-provide adequate oral fluid intake

-position to increase circulation

-administer supplemental sodium

-monitor for cardiac dysrhythmia

priority of care has to do with treating the symptoms that are going to do the most harm to the patient if left alone. symptoms that are not as harmful get treated last. when a person's potassium level begins to drop below normal the patient begins to feel weak and fatigued. the next symptoms to appear involve the muscles. the skeletal muscles may begin cramping. the smooth muscles of the gi track which are responsible for peristalsis slow down. in the heart muscle the low potassium levels cause disturbances with the electrical conduction system which leads to dysrhythmias and the affect on the cardiac muscle results in a slowed heart rate. as the potassium level continues to drop the heart will eventually stop beating. the medical treatment for hypokalemia is to replace potassium asap. an iv route is preferred when levels are low because it is faster than oral replacement, but care with iv infusions must be taken and no more than 10 meq/hour of potassium can be given and needs to be infused by pump.

the answer choices provided in the question need to be considered in relation to what is known about hypokalemia and its treatment. provide adequate oral fluid intake, position to increase circulation and administer supplemental sodium have absolutely nothing to do with the treatment of hypokalemia and are all incorrect choices. so, that leaves monitor for cardiac dysrhythmia as the answer. a patient with hypokalemia should be placed on ekg monitoring and their hearts monitored.

loricatus · Jun 2, 2009

Also, I do understand with hypokalemia, why you would monitor for dysrhythmias, but I did not know if that would be the first priority if immediate care was needed. My first guess was monitoring for dysrhythmias, but I sometimes over think questions and then begin to doubt.
Thanks for your time.

You will begin to hear the terms ABCs when priorities come up. This refers to Airway, Breathing and Circulation. The priority will always be in that order. You will never go wrong if you analyze a question this way. So, with your question on why monitoring for dysrythmias would be a priority, look at it as the most important thing being related to circulation (since potassium imbalance can affect the heart). The reposition for better circulation answer isn't relevent to anything directly related to a hypokalemia sign or symptom; but, a dysrythmia is. The other two wrong answers have nothing to do with the ABCs. So, always look for Something to do with Airway first, then with breathing and finally with something related to the circulatory system (not just the word circulation). I think that that answer was purposely put there as a ploy for those that know about ABC prioritization, but do not understand the concept.

Thank you for explaining your reasoning-it helped me understand a way to show you how to form the correct mindset for answering questions in the future.

Savvy20RN, BSN, RN · Jun 7, 2009

WOW! Thank you Daytonite. :bow:

CBsMommy · Jun 8, 2009

My question is, if Hypokalemia can cause paralysis, including the lungs, wouldn't the first priority be to give someone potassium through an IV? The second would be to find a cause of the hypokalemia and treat that as well (such as diarrhea)? And then I would focus on the cardiac monitering and on any type of muscle pain/weakness (which should go away with potassium)?

Daytonite, BSN, RN · Jun 8, 2009

my question is, if hypokalemia can cause paralysis, including the lungs, wouldn't the first priority be to give someone potassium through an iv? the second would be to find a cause of the hypokalemia and treat that as well (such as diarrhea)? and then i would focus on the cardiac monitering and on any type of muscle pain/weakness (which should go away with potassium)?

you can only give potassium if a doctor has ordered it. so, in that regard, we are dependent upon an order from a physician in order to do that. it is not within the practice of a nurse to go about finding the cause of the hypokalemia. that really is for the physician to do. as far as medical treatment goes, doctors also determine their priority order of treatment by what kills the patient faster. what is likely to kill the patient faster: diarrhea or heart arrhythmias? it will be heart arrhythmias. diarrhea is going to lead to dehydration, electrolyte disturbances and eventually heart arrhythmias, but it will take a while for the arrhythmias to happen when the patient has diarrhea. review maslow's hierarchy of needs (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs). diarrhea, which classifies to an elimination need, comes after fluid needs. fluid needs come after cardiac needs. cardiac needs only come after airway needs where breathing and the direct intake of air (oxygen) into the body is involved.

however, these were not answer choices that were given by the question. the only answer choice that we could choose was "monitor for cardiac dysrhythmia".

yoginurse2b · Jun 10, 2009

In our facility, we have emergency protocol for hypokalemic pts without doctor's order. The K must be lower than 3.2 mEq with association with new onset or symptomatic PVC or V tach. Nurses can administer KCL 20 mEq in 50 cc D5W over 1 hour via central line or KCL 10 mEq in 100 cc D5W over 1 hour. Also, we must get Mg level stat because if Mg is not corrected, hypokalemia cannot be corrected.

yoginurse2b · Jun 10, 2009

thanks! we will be having our grand case presentation by next week. i have a question, what causes hypokalemia? what will be the system involved in hypokalemia? kidney?

Yes, kidney is one of them. Think of how K works, where are they most abundant, and how do they get excreted. Hypokalemia could happen if:

1) Decrease K intake

2) Increase K excretion via kidneys and GI tract. Example would be diuretics such as Lasix, or diarrhea/vomiting.

3) Shifting of K from extracellular to intracellular. Because K is most abundant inside the cells, a small shift could make a big difference, hence the narrow normal level of K (3.5 to 5.0 mEq). Some medications, such as insulin, or pathologic conditions, such as alkalosis, can shift K back into the cells and cause hypokalemia. That's one of the reasons why we give regular insulin with D50 to treat pts with hyperkalemia.

Daytonite, BSN, RN · Jun 10, 2009

in our facility, we have emergency protocol for hypokalemic pts without doctor's order. the k must be lower than 3.2 meq with association with new onset or symptomatic pvc or v tach. nurses can administer kcl 20 meq in 50 cc d5w over 1 hour via central line or kcl 10 meq in 100 cc d5w over 1 hour. also, we must get mg level stat because if mg is not corrected, hypokalemia cannot be corrected.

for clarification. . .an emergency protocol is still a physician's order. they are standing orders that have been approved by the medical staff of the facility. very specific conditions must be present (in the case of your facility k must be lower than 3.2 meq with association with new onset or symptomatic pvc or v tach--this must be documented as well) before you can administer kcl 20 meq in 50 cc d5w over 1 hour via central line or kcl 10 meq in 100 cc d5w over 1 hour. i would also check that written protocol. it probably requires the nurses to actually write those doctors orders on the physician's order sheet and to notify the patient's doctor at some point of what is going on as well. at the next visit by the doctor, those orders for the kcl need to be signed by that physician. if not, when that chart gets reviewed by the medical records people they are going to be all over the nurse who gave the kcl and the doctor for not completing the written documentation.

yoginurse2b · Jun 10, 2009

Yes, for clarification too, if it's an emergency, and you are unable to get a verbal/written order from a physician for whatever reason, then it's OK to initiate such orders. That's what the hospital emergency protocols are for. If it's not emergency, and/or pt is asymptomatic, then it's advisable to wait for physician to get the order. All nurses who work on my floor are given such written orders in clear prints.