Electrolyte Disorder

1. Kanchan Kusatha

2. Normal serum levels is 3.5-5.5mEq/L.
98% of body potassium is intracellular (150mEq/L)
whereas only 2% of it is extracellular (3.5-5.5mEq/L)

3. Maintenance of acid-base balance
Transmission of nerve impulse
Contraction of skeletal, cardiac and smooth muscle cells
Gastric secretion, renal function
Tissue synthesis and carbohydrate metabolism.
Reduces mean SBP and DBP

5. Defined as the serum potassium level of <3.5 meq per liter.

6. A.Decreased intake:
 Starvation
 Alcoholism
 malnutrition

7. B. Increased loses:
 GI: vomiting, diarrhea, gastric or intestinal
suctioning
 Laxatives
 diuretics
C. Shifting of potassium from ECF to ICF:
 Increased insulin
 Alkalosis

9. Serum potassium level decreases ↓
Increased potassium gradient between cell and
plasma
↓ Reduced excitability

10. ↓ Slowed muscular contractions
↓ Respiratory movement and ventilation is slowed
↓ Slow and thready pulse

15. Medical management
Restoration of potassium level
For minor potassium deficit, administer food high in
potassium diet.
Oral potassium replacement therapy is usually prescribed
for mild hypokalemia (k+ 3.3 -3.5 meq per liter)
Sever hypokalemia requires IV administration.

16. Nursing management
A. Assessment
Assess vitals signs, especially cardiac rate and
rhythm
Monitor electrolyte values.

17. B. Nursing diagnosis
Hypokalemia related to diuretics use, vomiting,
Diarrhea
Risk of injury related to muscle weakness and
hypotension or seizures secondary to hypokalemia
Imbalance nutrition less than body requirement related
to insufficient intake of food rich in potassium.

18. D. Implementation
Give Oral Potassium Replacement therapy- for mild
hypokalemia (Serum Potassium- 3.3-3.5 meq/L).
Instruct client to take potassium supplement with a glass
of water or juice to decrease GI irritation and should not
be taken in empty stomach

19.  I/V kcl: for moderate to severe hypokalemia.
 Must be diluted in I/v fluids.
 Potassium by I/v push may result in cardiac arrest.
 Give potassium in doses of 10-20 meq/hour diluted in
I/v fluid if client is on cardiac monitor.
 Intravenous potassium is irritating to veins and can
cause phlebitis, thus the rate of flow must be carefully
monitored.

20.  Employ safety and seizure precautions to reduce the
risk of injury
 Bed must be kept in low position with side rails up.
 Before the patient ambulates, the path should be cleared
of obstacles
 Patient should wear shoes to prevent slipping.

21.  Restraints should be used as needed to prevent harm.
 Instruct client to choose and consume food rich in
potassium that helps to correct and further prevent
further potassium loss.
 Adult recommended allowance- 1875- 5625mg.

24. It is defined as potassium level greater than 5.5meq per liter

25. A. Excessive potassium intake:
 Over ingestion of potassium containing foods
 Rapid infusion of potassium containing IV solution

26. B. Decreased potassium excretion:
 Potassium sparing diuretics
 Renal failure
 Adrenal insufficiency

27. C. Movement of potassium from intracellular fluid to
extracellular fluid:
 Tissue damage
 Acidosis
 Hyperuricemia
 Hyper catabolism.

29. Serum potassium level increases
decreased potassium gradient between cell and
plasma
increase excitability

30. increased muscular contractions
Respiratory muscle weakness
tachycardia

34. Medical management
 If potassium level than 5.5meq per liter dietary
restriction of potassium.
 If hyperkalemia is severe, then
oIV calcium gluconate is given
oInfusion of insulin and glucose
oSodium bicarbonate.

35.  If potassium Excess is due to metabolic acidosis,
correcting the acidosis with sodium bicarbonate
promotes potassium uptake into the cells.
 Improving urine output decreases elevated serum
potassium level.

37. Nursing management
A. Assessment
Review laboratory report of potassium
level
Assess vitals signs, ECG changes

38. B. Nursing diagnosis
 Hyperkalemia related to specific etiology
 Risk for Activity Intolerance
 Risk for Decreased Cardiac Output
 Risk for Imbalanced Fluid Volume

39. D. Implementation
 Administer fluids as order to promote renal excretion of
potassium.
 Discontinue IV potassium and hold oral potassium
supplements.
 Prepare to administer potassium-excreting diuretics if
renal function is not impaired.

40.  IV administration of hypertonic glucose with regular
insulin to move excess potassium into the cells.
 Avoid the food containing potassium
 If client is to receive blood transfusion:
o Do not give more than 2 weeks old blood
o Use 18 gauze needle for blood transfusion.
 Prepare the client for dialysis if potassium levels are
critically high.