Running head: HYPERKALEMIA

Alisa M. Higgins
Weekly Review #2

Hyperkalemia

Wayne County Community College District NUR 112

Instructor: L. Dolphus, R.N. June 06, 2010

Description: Hyperkalemia will manifest from an excessive amount of potassium in the blood usually caused by inadequate excretion of potassium or by the shift of potassium from tissues. Causes of inadequate secretion include acute renal failure, severe chronic renal aldosteronism, renal tubule disorders, hypo-excretion due to kidney disease or drugs such as NSAIDS, ACE inhibitors, or angiotensin receptor blockers that inhibit potassium excretion. The shift of potassium from tissues occurs in tissue damage due to trauma, hemolysis, acidosis, and insulin deficiency. Signs and Symptoms: Hyperkalemia is often a symptomless condition until very high levels of potassium are present in the blood. The precise level at which cardiac or skeletal toxicities arise varies greatly from patient to patient. Eventually, muscular weakness, electrocardiographic abnormalities (such as peaked T waves, widened QRS complex, prolonged PR interval and depressed ST segment), and intractable cardiac rhythm disturbances leading to cardiac arrest may result. Diagnosis: The normal serum level of potassium is 3.5 to 5 mEq/L. Doctors will diagnose hyperkalemia generally from blood tests for renal function (creatinine, blood urea nitrogen), glucose and occasionally creatine kinase and cortisol. Calculating the trans-tubular potassium gradient can sometimes help in distinguishing the cause of the hyperkalemia. In many cases, renal ultrasound will be performed, since hyperkalemia is highly suggestive of renal failure. An EKG/ECG may be performed to determine if there is a significant risk of cardiac arrhythmias. With mild to moderate hyperkalemia, there is reduction of the size of the P wave and development of peaked T waves. Severe hyperkalemia results in a widening of the QRS complex, and the EKG complex can evolve to a sinusoidal shape.

Treatment: Mild hyperkalemia can be treated by eliminating its cause, often a medication or a potassium source in the diet or dietary supplement (such as potassium chloride taken as a salt substitute). Severe or progressive hyperkalemia can be treated with infusions of calcium gluconate, sodium bicarbonate, or insulin and glucose, or by the administration of potassiumbinding resins orally or rectally. Priority Nursing Diagnosis: Decreased Cardiac Output related to altered heart rhythm as evidenced by palpitations and arrhythmias. Expected Outcomes: Within 24 hours prior to hospital discharge, patient will: Demonstrate adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within the patients normal parameters; strong peripheral pulses, and an ability to tolerate activity without symptoms of dyspnea, syncope or chest pain. Remain free of side effects from medications used to achieve adequate cardiac output. Explain actions and precautions to take for primary or secondary prevention of cardiac disease.