UNIT –II COMMON SIGNS & SYMPTOMS TOPIC: Electrolyte imbalances- hypokalemia and hyperkalemia

1. UNIT –II COMMON SIGNS & SYMPTOMS TOPIC: Electrolyte imbalances-hypokalemiaand hyperkalemia Prepared by, Mrs. AnjuUllas Lecturer Dept. of Medical Surgical Nursing Yenepoya Nursing College

2. Learning objectives Students will be able to: • define hypokalemia and hyperkalemia • explain causes, pathophysiology, clinical manifestations, diagnostic evaluation , complications and management in detail of hypokalemia and hyperkalemia.

3. Introduction Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. 

5. Meaning Hypokalemiais a serum potassiumlevel less than 3.5 mEq/L

6. Etiology • decreased potassium intake • increased losses or shifts in intracellular and extracellular distribution.

7. Increased losses (split to renal and gastro losses) • Gastrointestinal • Prolonged diarrhoea • Vomiting • Excessive use of laxatives

8. Renal • Diuretic therapy* • Urinary loss in congestive heart failure • Hypomagnesaemia • Primary or secondary hyperaldosteronism • Cushings syndrome or disease • Large doses of corticosteroids

9. Pathophysiology Causes Decreased sodium and bicarbonate serum level Decreased perfusion pressure in the renal arterioles Juxtaglomelular cells release Converted Angiotensin I from Angiotensin

10. Pathophysiology Converted Angiotensin II from Angiotensin I Release of Constricts the arterioles the aldosterone Increased activity of the proximal tubule Na+/H+ Acts on renal tubular and gastrointestinal epithellium

11. Pathophysiology Elevated distal Increased H+ excretion tubule flow rate and bicarbonate Increased tubular lumen electronegativity Increased sodium reabsorbed from tubular urine back to the bloodstream Potassium moves from the bloodstream into the tubule

12. Pathophysiology Increased renal excretion of potassium HYPOKALEMIA Signs and symptoms

13. Signs and symptoms

14. Signs and symptoms

15. Laboratory and Diagnostic Findings • Serum potassium levels less than 3.5 mEq/L • ECG changes- flat/inverted T waves, depressed ST segment, elevated U wave • Metabolic alkalosis • Urinary potassium excretion test exceeding 20 mEq/day

16. Complications • Heart problems • Paralysis

17. Management Medicalmanagement • Determining & correcting the cause of theimbalance. • Extreme hypokalemia requires cardiacmonitoring

18. Management Pharmacologicalmanagement • Oral potassium replacement therapy is usually prescribed for mildhypokalemia. • Potassium is extremely irritating to gastric mucosa; therefore the drug must be taken with Glass of water or juice or during meals. • Potassium chloride can be administered intravenously for moderate or severe hypokalemia & must be diluted in IV fluids.

19. Management Pharmacologicalmanagement • Administration of potassium by IV push may result in cardiac arrests. Potassium can be given in doses of 10 to 20 mEq/ hour diluted in IV fluid if the client is on heart monitor. • High concentration of potassium is irritating to heart muscle. Thus correcting a potassium deficit may take severaldays.

20. Management Nutritional management The administration offoodsthat are high in potassium help to correct the problem as well as prevent further potassiumlosses.

21. Management Nursing management Assessment • History collection • Physical examination • Identify ECG changes such as depressed T waves, peaking P waves. • Observe for dehydration. Accurately record state of hydration. • Observe for neuromuscular changes such as fatigue and muscular weakness.

22. Management Nursing management Assessment • Record fluid intake and output. • Check blood volume and venous pressure.

23. Management Nursing diagnosis • Fluid volume deficit May be related to • Active fluid loss-burns, diarrhea, fistulas, gastric intubation, hemorrhage, wounds. •  diabetes insipidus, diabetic ketoacidosis (DKA) • Possibly evidenced by • Abdominal distention. • Confusion, restlessness.

24. Management Nursing diagnosis • Risk For Electrolyte Imbalance May be related to • Diarrhea, vomiting. • Renal dysfunction. • Treatment-related side effect such as medications, gastric suctioning, electrolyte-free intravenous (IV) solutions. • Water intoxication.

25. Management Nursing diagnosis • Risk for injury related to muscle weakness • Risk for ineffective health maintenance related to lack of knowledge about how diuretic therapy and laxative affect potassium levels

27. Hyperkalemia Hyperkalemia is an Elevated potassium level over 5.0 mEq/L.

28. Hyperkalemia ETIOLOGY • Retention of Potassium- Renal insufficiency, renal failure, • decreased urine output, potassium sparing diuretics. • Excessive release of Cellular Potassium - severe traumatic injuries. Severe burns, severe infection, metabolic acidosis. • Excessive IV infusions or Oral administration of potassium.

29. Hyperkalemia

30. Hyperkalemia

31. Lab findings

32. Medical management • When serum potassium level is 5.0 to 5.5 mEq/L restrict potassiumintake. • If potassium Excess is due to metabolic acidosis, correcting the acidosis with sodium bicarbonate promotes potassium uptake into thecells. • Diuretics-Improving urine output decreases elevated serum potassiumlevel.

33. Nutrition management Whenhyperkalemiaissevere,immediateactionsareneeded to be taken to avoid severe Cardiacdisturbances. • The administration of foods that are low in potassium help to correct the problem as well as prevent further potassiumexcess.

35. Nursingmanagement Assessment • History collection • Physical examination • Assessment of cardiovascular, respiratory, neuromuscular, renal, and gastrointestinal status; place the client on a cardiacmonitor.

36. Nursing diagnosis • Activity intolerance related to skeletal muscle weakness as evidenced by • Excess fluid volume related to renal failure as evidenced by • Risk for decreased cardiac output related to hyperkalemia as evidenced by • Risk for ineffective health maintenance related to inadequate knowledge of recommended diet as evidenced by

37. Summary In this topic we have discussed about the definition, causes, pathophysiology, clinical manifestation and managementof hypokalemiaand hyperkalemia

38. Conclusion Electrolytes are chemicals in the body that regulate important physiological functions. Potassium imbalance causes a variety of symptoms that can be severe. These can be life-threatening if not managed appropriately.

39. Evaluation • define hypokalemia • enlist the causes and pathophysiology of hypokalemia • explain the clinical manifestation and management of hypokalemia • define hyperkalemia • enlist the causes and pathophysiology of hyperkalemia • explain the clinical manifestation and management of hyperkalemia

40. References:- • Black MJ. Textbook of medical surgical nursing.7thed.St. louis:Saunders • Brunner. Text book of medical surgical nursing.6thed.Philadelphia:Saunders; • Lewis. Medical surgical nursing.6th ed. St louis:Mosby • Dr. Ajay H. Emergencies in medical practice. 5th edition