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adult health exam 1 > potassium > Flashcards

potassium Flashcards

1
Q

Potassium is a major____cation

A

ICF cation- most of the potassium

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2
Q

Potassium serum range is_____.

98% ICF

A

narrow; little change in potassium has a huge impact because the range is narrow;
small changes can be significant cardiac response)

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3
Q

Potassium is excreted by

A

kidneys

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4
Q

if potassium concentration within muscle cells is about 140mEq/L; ECF is 3.5-5.0mEq/L then…

A

sodium potassium pump in cell membrane maintains this concentration difference by pumping potassium into the cell and sodium out.
B/c ratio of ECF Potassium to ICF potassium is the major factor in the resting membrane potential of nerve and muscle cells, neuromuscular and cardiac functions are commonly affected by potassium imbalances

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5
Q

disruption in dynamic equilibrium between ICF and ECF potassium can cause clinical problems.

A

potassium regulates intracellular osmolality and promotes cellular growth.
potassium is required for glycogen to be deposited in muscle and liver cells

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6
Q

diet and meds is source of potassium

A

fruits, dried fruits, veggies

IV fluids, transfusion of stored hemolyzed blood, meds

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7
Q

how does the body regulate potassium

A

kidneys-primary route for potassium loss (90%)

rest is loss in sweat and stool

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8
Q

inverse relationship between sodium and potassium

A

factors that cause sodium retention (low blood volume, inc aldosterone levels) cause potassium loss in urine
large urine volume= excess loss of potassium in the urine ( a lot of urine= a lot of potassium loss in urine)

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9
Q

what happens if there is an impaired kidney function?

A

retained potassium= toxic levels

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10
Q

potassium labs

A

3.5-5.0 mEq/L

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11
Q

hyperkalemia- pts at risk

A 
(high serum potassium) 
impaired renal excretion
shift of K from ICF to ECF 
massive intake of K 
dec renal excretion (RF most common cause of hyperkalemia) 
hypoaldosteronism
K containing salt substitute
K shifting from cells to plasma 
impair entry of potassium into cell (digoxin- higher ECF K concentration)
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12
Q

what is the most common cause of hyperkalemia?

A

RF

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13
Q

hyperkalemia- pts at risk: what is hypoaldosteronism?

A

addison’s disease: adrenal gland insufficiency

adrenal insufficiency with aldosterone deficiency leads to retention of K

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14
Q

hyperkalemia- pts at risk: what happens when K shifts from cells to plasma?

A

k sparing/conserving diuretics;
cell destruction- excessive exercise, catabolism(every time a cell dies, its going to release K)
factors causing K to move from ICF to ECF

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15
Q

hyperkalemia- pts at risk: factors causing K to move from ICF to ECF

A

metabolic acidosis-( exchange of hydrogen ions moving into the cell)
massive cell destruction (burn, tumor, lysis, severe infection)
exercise

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16
Q

hyperkalemia- pts at risk: development of hyperkalemia

A

K-sparing drugs and aldosterone receptor blockers and angiostensin-converting enzyme (ACE) inhibitors

reduces kidney’s ability to excrete potassium

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17
Q

hyperkalemia- pts at risk: inc cell excitability( inc concentration of K outside the cell)

A

as K levels inc, pt experiences cramping leg pain and weakness/paralysis of skeletal muscle

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18
Q

hyperkalemia- pts at risk: inc cell excitability( inc concentration of K outside the cell)- cardiac/ meds

A

most clinically significant for hyperkalemia

altered cardiac function (ask about meds; K sparing meds, ACE inhibitors); dysrhythmias

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19
Q

hyperkalemia- pts at risk: inc cell excitability( inc concentration of K outside the cell) - NM

A

early: muscle twitching, paresthesia in hands, feet and around mouth
later: skeletal muscle weakness (muscle groups)
respiratory muscles affected with very high K levels

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20
Q

hyperkalemia- pts at risk: inc cell excitability( inc concentration of K outside the cell) - GI

A

smooth muscle- hyperactivity

abdominal cramping and diarrhea

21
Q

Hypokalemia- pts at risk

A

low serum K

inc loss of K from an inc shift of K from ECF to ICF

22
Q

Hypokalemia- pts at risk: GI Loss

A

most common causes- GI and kidneys
diarrhea, laxative abuse, vomiting, and ileostomy drainage
hyperaldosteronism- adrenal tumor

23
Q

Hypokalemia- pts at risk: Renal Loss

A

low magnesium level or is diuresing
(esp in pt with elevated aldosterone levels)
aldosterone is released when circulating blood volume is low (causing Na retention in kidneys with a loss of K in urine)
low magnesium stimulates renin release and inc aldosterone levels -> results in K excretion

24
Q

Hypokalemia- pts at risk: Meds

A 
K wasting diuretics (Furosemide- lasix; Hydrochlorothiazide- HCTZ)
corticosteroids
laxative overuse 
steroids 
excessive insulin- cell uptake of K
25
Q

Hypokalemia- pts at risk: Alkalosis

A

shift of K into cells in exchange for hydrogen

this lowers K in ECF which causes hypokalemia

26
Q

Hypokalemia- Assessment

A

alters resting membrane potential

results in hyperpolarization and impaired muscle contraction (involves cardiac and muscle functions)

27
Q

Hypokalemia- Assessment: cardiac

A

most serous clinical problem
dysrhythmias- EKG changes( dec BP- orthostatic hypotension); weak thready pulse; inc digoxin toxicity (inc sensitivity of excitable membranes with hypokalemia; always assess latest K levels before administering digoxin; do not administer with low K)

28
Q

Hypokalemia- Assessment: Musculoskeletal

A

a stronger stimulus is needed;
dec excitability of cells;
skeletal muscle weakness, fatigue (dec hand grasp, Dec DTR, leg cramps), respiratory muscle weakness(priority assessment)

29
Q

Hypokalemia- Assessment: GI (alteration of smooth muscle function)

A

dec peristalsis: dec bowel sounds- (abdominal distention; N/V; cramping; constipation); paralytic ileus with severe hypokalemia

30
Q

Hypokalemia- Assessment: Respiratory

A

priority assessment with hypokalemia: breath sounds; ease of respiratory effort; rate and depth; color of nail beds/mucous membrane
weak muscle
shallow respiration

31
Q

Hypokalemia- Assessment: nonmucsle function

A

by impairing insulin secretion: causes hyperglycemia

32
Q

Hyperkalemia- Nsg Dx: risk

A

activity intolerance- related to lower extremities muscle weakness(fatigue)
electrolyte imbalance- excessive retention or cellular release of K (diarrhea- inc peristalsis)
injury related to lower extremities muscle weakness and seizures (falls)

33
Q

Hypokalemia- Nsg Dx: risk

A

activity intolerance- lower extremity muscle weakness
electrolyte imbalance- excessive loss of K
injury related to muscle weakness and hyporeflexia
constipation
dc CO

34
Q

Hyperkalemia- Nsg DX: complicaitons

A

dysrhythmias, CO

35
Q

Hypokalemia- Nsg Dx: complications

A

dysrhythmia

36
Q

Hyperkalemia- Goals

A

dec K and treat cause

37
Q

Hyperkalemia- Goals: treatment

A

eliminate oral and parenteral K intake
inc elimination of K (using diuretics, dialysis, and ion exchange resins; insulin with glucose)
force potassium from ECF to ICF (using IV administration of regular insulin; IV sodium bicarbonate for correction of acidosis)
reverse membrane potential effects of elevated ECF K by administering IV calcium gluconate ( calcium can immediately reverse the membrane excitability)

38
Q

Hyperkalemia- Goals: treatment of mild potassium evaluation

A

withhold K from diet and IV sources

inc renal K elimination by administering fluids and loops or thiazide diuretics

39
Q

Hyperkalemia- Goals: treatment of moderate

A

additionally receive one of the treatment to force K into cells; usually IV insulin and glucose

40
Q

Hyperkalemia- Goals: monitor EKGs in clinically significant hyperkalemia

A

to detect dysrhythmias

dangerous cardiac dysrhythmias should receive IV calcium gluconate immediately

41
Q

Hyperkalemia- Goals: Monitor BP

A

B/c rapid administration of Ca can cause hypotension

42
Q

Hyperkalemia- Goals: hemodialysis

A

effective means of removing potassium from the body in the pt with RF

43
Q

Hyperkalemia- Goals: monitor

A 
telemetry
K lab report 
bowel sound and stool
UOP 
muscle tone and all body systems affected
44
Q

Hypokalemia- Goals: treatment

A

oral or IV KCl supplements and dietary intake of K
EXCEPT: in severe deficiencies; KCl is not given unless there is a urine output of at least 0.5mL/kg of body weight per hour

45
Q

Hypokalemia- Goals: inc K intake

A

foods(bananas, cantaloupe)
PO supplements: can be gastric irritants
(K-dur, micro-K, slow-K: dont crush/chew; dont open capsule)
intravenous K: monitor UOP; use large vein sites as K b/c is irritating

46
Q

Hypokalemia- Goals: diuretics

A

use K sparingly (spironoalctone)

hold loop and thiazide diuretics( this inc K excretion)

47
Q

Hypokalemia- Goals: treat constipation

A

colace
miralax
metamucil
surfak

48
Q

Hypokalemia- Goals: safety measures

A

skeletal muscle weakness (remove throw rugs, assist with ambulation)

49
Q

Hypokalemia- Goals: monitor

A

telemetry
VS, HR, Respiratory status( critically ill pts should have cardiac monitoring to detect cardiac changes due to K imbalance)
serum K levels and UOP (pts on digoxin therapy have an inc risk of toxicity if serum K level is low)

adult health exam 1 (6 decks)

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