When you have too much potassium in your blood, it is called _____.
hyperkalemia
Hyperkalemia: serum potassium level greater than _ mEq/L
5
In older adults, there is an increased risk of hyperkalemia due to decreases in _____ and ______.
renin and aldosterone
Hyperkalemia is often caused by ______ (treatment-induced)
causes
iatrogenic
T or F: hyperkalemia is less common than hypokalemia
T
T or F: Hyperkalemia is usually more dangerous because cardiac arrest is more frequently associated with high serum potassium levels
T
What are the major causes of hyperkalemia? (3)
☠ decreased renal excretion of potassium,
☠ rapid administration of potassium
☠ movement of potassium from the ICF compartment to the ECF compartment
Patients with _______ or ________ are at risk for hyperkalemia because of a lack of aldosterone.
hypoaldosteronism or Addison disease
Medications have been identified as a probable contributing factor in more
than 60% of hyperkalemic episodes. Medications commonly implicated are: (8)
KCl,
heparin,
ACE inhibitors,
NSAIDs,
beta-blockers,
cyclosporine,
tacrolimus,
and potassium-sparing diuretics
low blood pH
acidosis
a false hyperkalemia
pseudohyperkalemia
Contributing factors of hyperkalemia: (9)
★Pseudohyperkalemia,
★oliguric kidney injury,
★use of potassium conserving diuretics in patients with renal insufficiency,
★metabolic acidosis,
★Addison disease,
★crush injury,
★burns,
★stored bank blood transfusions,
★rapid IV administration of potassium,
certain medications such as ACE
inhibitors, NSAIDs, cyclosporine
Signs and Symptoms of hyperkalemia:
★Muscle weakness,
★tachycardia →bradycardia,
★arrhythmias,
★flaccid paralysis,
★paresthesias,
★intestinal colic,
★cramps,
★abdominal distention,
★irritability,
★anxiety.
ECG: tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
The most important consequence of hyperkalemia is its effect on the _____.
myocardium
Assessment and Diagnostic Findings
_______ and _______ are crucial to the diagnosis of hyperkalemia
Serum potassium levels and ECG changes
Medical Management:
In disorders involving potassium level changes, an ___ should be obtained immediately
ECG
In nonacute situations, restriction of dietary ______ and _____ may correct the imbalance
potassium and potassium containing medications
Administration, either orally or by retention enema, of _______ (e.g., sodium polystyrene sulfonate) may be necessary
cation exchange resins
T or F: The use of cation exchange resins does not require normal bowel function
F - The use of cation exchange resins requires normal bowel function
T or F: The use of cation exchange resins does not require normal bowel function
F: The use of cation exchange resins requires normal bowel function
______ is another oral agent that is a potassium removing resin used to treat hyperkalemia.
Patiromer sorbitex calcium
Side effects of Patiromer sorbitex calcium: (3)
GI intolerance, hypomagnesemia, and edema
Emergency Pharmacologic Therapy:
If serum potassium levels are dangerously elevated, it may be necessary to administer IV _____.
calcium gluconate
Emergency Pharmacologic Therapy
The ECG should be continuously monitored during administration; the appearance of _____ is an indication to stop the infusion
bradycardia
Emergency Pharmacologic Therapy
IV administration of ______ may be necessary in severe
metabolic acidosis to alkalinize the plasma, shift potassium into the cells, and furnish sodium to antagonize the cardiac effects of potassium
sodium bicarbonate
Nursing Management:
Patients at risk for potassium excess (e.g., those with kidney disease) need to be identified and closely monitored for signs of ______.
hyperkalemia
Nursing Management:
The nurse monitors for: (9)
★I & O
★ vital signs
★ observes for signs of muscle weakness and arrhythmias
★ presence of paresthesias and GI symptoms (nausea and intestinal cramping)
★ Serum potassium levels
★BUN
★Serum creatinine
★Serum glucose
★ABG values
Preventing Hyperkalemia:
What are the measures to be taken to prevent hyperkalemia in patients at risk?
when possible, by encouraging the patient to adhere to the prescribed potassium restriction.
Potassium-rich foods to be avoided include:
many fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa
foods with minimal potassium content include:
butter, margarine, cranberry juice or sauce, ginger ale, gumdrops or jelly beans, hard candy, root beer, sugar, and honey
Labels of cola beverages must be checked carefully because some are high in ____ and some are not
potasisum
when administering potassium solutions, IV administration should only be via an _____.
infusion pump
T or F: potassium-conserving diuretics, potassium supplements,
and salt substitutes should not be given to patients with kidney injury
