In this video we’re walking through the pathophysiology, signs and symptoms, and nursing interventions of hyperkalemia, or high potassium. Hyperkalemia happens if potassium level gets above 5 mEq/L.
Causes of hyperkalemia:
Hyperkalemia can be caused by excessive intake of high potassium foods or medications, use of potassium-sparing diuretics, issues with the kidneys, adrenal insufficiency, or movement of potassium across cell membranes.
Signs and symptoms of hyperkalemia:
Cardiac arrhythmias, ECK changes, and muscle changes can all be signs of hyperkalemia.
Nursing interventions and assessments for hyperkalemia:
Monitor: Your patient should be on a cardiac monitor since hyperkalemia can cause life threatening cardiac arrhythmias. You’ll also need to regularly assess their potassium level. Monitor their heart rate, blood pressure, neuromuscular status to look for muscle twitching, cramping or paralysis, monitor them for GI upset, and check their respiratory status.
Reverse: We want to try to get rid of the excess potassium inside their body. You might give medications like potassium-excreting diuretics, or glucose and insulin to try to reduce the potassium level. They may also need dialysis to rebalance their electrolytes.
Prevent: Encourage the patient to follow the prescribed diet plan, usually a low-potassium diet, but be aware of those salt-substitutes that are high in potassium, so those should be avoided. You’ll need to educate your patient on the signs and symptoms of hyperkalemia and help them seek medical care early if they experience any of them.
We just walked through not only the pathophysiology, signs and symptoms, and nursing interventions of hyperkalemia.
Great job! You’ve got this, friend!
TIMESTAMPS:
0:00 What you’ll learn about hyperkalemia
1:18 Role of potassium
2:51 Causes of hyperkalemia
8:18 Signs and symptoms of hyperkalemia
12:56 Nursing interventions and assessments
VIDEO TRANSCRIPT
Hi there friend! In this video we’re walking through Hyperkalemia, or high potassium levels. We will break it down, step by step, and make sure you know the pathophysiology, or what is happening inside the body that could be causing hyperkalemia. Since fully understanding the patho is the foundation for critically thinking through hyperkalemia and all other disorders you’ll learn about in nursing school. You want to be able to apply what you are learning for your nursing school exams. So don’t worry we will walk you through that step by step.
You will also learn the signs and symptoms and nursing interventions of hyperkalemia, too. And you’ll finally understand the critical thinking behind it all.
We all know your nursing exam is not going to test you on how well you memorize things. They want to know how well you apply the information you’re learning and how well you critically think about it. “Think like a nurse”, right?
That’s why we break hyperkalemia down, step by step, so you can critically think about it.
And of course, I have a free cheat sheet to help you learn things faster and critically think better in nursing school. So be sure to stay until the end of the video and I’ll let you know where you can snag that.
Now hit that subscribe button and click the notification bell and let’s dive in.
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Alright, so potassium is a really important electrolyte to know about, yes that’s why we are talking about it, of course it is important. But really, it is so important, and you will be tested on it. Over and over again.
Potassium plays a big role in the body, and there are 2 key things that potassium affects: muscle contraction and it keeps the heart pumping. So keep these 2 things in mind as we dive into what could be causing hyperkalemia.
But before we dive deep into the patho of hyperkalemia, let’s talk really quick about the normal potassium levels. Now, the normal potassium range is between 3.5 -to 5 milliequivalents per liter. And hyperkalemia happens if that value gets above 5. The normal range is very small and it’s really important that the potassium level in the body stays within that range and stays stable.
It’s also super important to know that potassium has a big effect on the heart, so any swing in potassium level either way, you must be checking for cardiac symptoms, and especially be watching their cardiac conduction through an ECG. We’ll talk more about this later on in this video, so keep that in mind as we go.
So again, when you think of potassium, think muscle contraction, specifically the heart, and stable levels. It helps the muscles function and it needs to remain at a stable level within the body.
Now what can cause a shift in potassium levels, specifically hyperkalemia, or potassium level greater than 5? Let’s dive in and break down what might cause hyperkalemia and the pathophysiology behind it, step by step. Because you know your nursing exam won’t ask for a list of reasons why your patient could have hyperkalemia. No, they’ll want you to be applying what could be causing the hyperkalemia. They will want you to be critically thinking about hyperkalemia.
So let’s do just that! Hyperkalemia can be caused by excessive intake of high potassium foods or medications, use of potassium-sparing diuretics, issues with the kidneys, adrenal insufficiency, or movement of potassium across cell membranes.
Now there is our list of what could cause hyperkalemia, but let’s dive deep and critically think about why these would cause hyperkalemia. We’ll go through each of these step by step so we are sure we know what is happening inside the body that could result in hyperkalemia.
So obviously, if the patient eats a whole lot of potassium, their potassium level will increase. These could be foods high in potassium, potassium chloride medications, and salt substitutes. If a patient is taking potassium supplements, obviously their potassium level will increase, and salt substitutes are very high in potassium.
So for example, your patient with a cardiac disorder who we told “don’t eat too much salt!” they went and bought a whole lot of salt substitute to put on their food, right? Well, salt substitute is high in potassium, so you’ll need to be aware of that and do some education about that, they just can’t have too much or it could increase their potassium level.
Now, potassium sparing diuretics are important as well. These diuretics will get rid of sodium and water, but they hold onto potassium. So if your patient is taking them for a while, their potassium level may increase. So that’s why I always say it’s super important to be checking all of their electrolytes if your patient is on a diuretic, because it can cause those swings in electrolyte levels, especially potassium.
Now let’s talk about kidney issues and adrenal insufficiency. The kidneys are imperative to regulating electrolytes in the body. It’s the kidney’s job to balance all of those electrolytes out and keep them within normal range.
So let’s do some critical thinking here. If the kidneys are damaged and they’re not functioning, what do you think will happen to the potassium level? Will it increase or decrease?
Well, if the kidneys aren’t functioning to make urine and move electrolytes OUT of the body, those electrolytes are going to STAY in the body, so they’re going to increase. So with kidney issues or kidney failure, the potassium level may increase.
And adrenal insufficiency is another critical thinking exercise we need to walk through. The adrenal glands are in charge of releasing aldosterone. And what is aldosterone’s job? It has 3 main jobs: it tells the kidneys to hold onto sodium, hold onto water, and get rid of potassium. Ding ding ding! There’s that potassium!
So normally, the adrenal glands release aldosterone, which helps the body to get rid of excess potassium. But during adrenal insufficiency, the adrenal glands aren’t making as much aldosterone, so what do you think is going to happen?
The potassium level is going to INCREASE! Because there’s not as much aldosterone there to tell the kidneys to get rid of it. One big disorder where adrenal insufficiency is present is Addison’s disease. During Addison’s disease, the adrenal glands aren’t functioning properly to produce that aldosterone, so the potassium level may increase.
We have a whole video series on Addison’s disease inside our NursingSOS Membership Community if you want more of a deep dive on that.
And finally, let’s talk about how the movement of potassium can cause hyperkalemia. Potassium loves to hang out inside the cell. It’s a homebody, it likes to be inside it’s little cell. But there are a few things that can cause it to leave the cell and move outside. These are things like acidosis, burns, and cell breakdown.
So when the body is acidic, potassium will move out of it’s cell to try to balance out the acidity. It comes to try and help. The same thing with burns, during a burn or other injury, potassium will leave the cell to try to balance out the electrolytes. And of course, during cell or tissue trauma, if the cell is ruptured, all of that potassium is going to leak out of the cell, which also can cause hyperkalemia. Because now all of that potassium that’s supposed to be inside the cell, is now outside of the cell, which causes that serum potassium level to rise.
Alrighty, now let’s jump right into the many signs and symptoms of hyperkalemia. We know the role that potassium plays in the body, and there are 2 key things I want you to keep in mind: potassium helps muscles contract, and it keeps the heart pumping. Remembering these two things is going to make learning these signs and symptoms a whole lot easier.
So the signs and symptoms of hyperkalemia are: a potassium level greater than 5 milliequivalents per liter, cardiac arrhythmias, decreased heart rate, decreased blood pressure, muscle twitching and cramping (in the early stages), diarrhea, flaccid muscles and respiratory depression (in the late stages). The ECG may also show flatter P waves, the PR interval may be longer, the QRS complex may be wider, and the T wave may be tall.
Now I just gave you a big list of symptoms…. Do you really think your nursing school exam is going to ask you to write down the symptoms of hyperkalemia? No, no my friend, they will not.
They want you to apply the patho and what is happening inside the body to these signs and symptoms. They want you to be critically thinking about hyperkalemia. So let’s walk through the critical thinking behind these signs and symptoms.
Let’s start with the heart. So like we said, potassium plays a huge role in regulating the heart, it keeps it pumping and regulating the electrical system. So when there’s too MUCH potassium, there is too much stimulus on the heart!
So the heart is trying to stay consistent in pumping, but there’s so much potassium that it’s sending more and more impulses telling the heart’s electrical system to fire more and more. This leads to cardiac arrhythmias. That potassium is causing the heart’s electrical system to fire and fire and fire, that the heart gets confused, and this leads to irregular beats.
Now, as that potassium keeps pushing the heart to work harder and harder, the heart gets tired, and weaker and slower. So this leads to that weak pulse, and therefore, decreased blood pressure because the heart just can’t get the blood out.
So that’s the first role of potassium and the first set of signs and symptoms: potassium helps regulate the hearts electrical system, so when there’s too much potassium, it causes so much stimulus on the heart, which leads to cardiac arrhythmias, and the heart saying, “Ummm…I can’t keep up with all of your potassium!” so it slows down, gets weaker, which causes the blood pressure to drop.
Now the second role of potassium that we’ll talk about is muscle contraction. This is very similar to what was happening with the heart. When there is too much potassium, there is too much stimuli on the muscles, which cause them to twitch or cramp up.
There’s so much stimuli on those muscles, all of that potassium is causing them to fire and fire and fire, that they twitch and cramp. AND because the GI system is muscle, it will cause the GI system to work harder and be hyperactive, and this can lead to diarrhea.
Now, as time goes on and the potassium level stays increased, those muscles will just say, “I’ve had enough,” and they’ll stop working. They’ll go numb and weak. So later on in hyperkalemia, the muscles give out, and they go flaccid, so the muscles in the arms and legs may be flaccid.
Now here’s the key that you need to know: the diaphragm is ALSO a muscle. So when the muscles give out, so does the diaphragm. And the diaphragm helps you to BREATHE. So when those muscles give out, it can cause respiratory depression and failure, because the muscles just can’t keep the breathing up anymore.
And now let’s talk about those ECG changes. When you look at the patients cardiac monitor, you may see flatter P waves, the PR interval may be longer, the QRS complex may be wider, and the T wave may be tall. So compared to a “normal” ECG, those are the changes you can expect to see.
And now that we are confident on the patho and signs and symptoms of hyperkalemia, let’s dive into what type of interventions and assessments you will do as the nurse. Now, these are important. These are topics that your nursing exams will definitely cover, and they really want to be sure you are critically thinking about hyperkaliemia, and able to apply what you are learning. So don’t worry, we will break these down into three major categories: monitor, reverse, and prevent, that you will do for your nursing interventions for hyperkalemia.
Remember, we’ve talked about how with hyperkalemia you want to be sure you are keeping a good eye on your patients heart and how it is functioning. So what does this mean? Your patient should be on a cardiac monitor since hyperkalemia can cause life threatening cardiac arrhythmias. This will help you monitor their heart closely. You’ll also need to regularly assess their potassium level, to make sure that it’s decreasing or staying stable, and not increasing more.
Remember, we want their potassium level to stay between 3.5-5 and remain stable, we don’t want any big shifts one way or another.
Of course you’ll need to monitor their heart rate, blood pressure, neuromuscular status to look for muscle twitching, cramping or paralysis, monitor them for GI upset, and check their respiratory status.
So that is what you will monitor, now let’s talk about what we will reverse. Let’s think, we want to reverse the problem, which is hyperkalemia. So we want to try to get rid of the excess potassium inside their body.
Of course, you’ll need to go off what they’re doctor orders, but you might discontinue any potassium supplements, including any IV’s they’re getting that contain potassium. You might give medications like potassium-excreting diuretics, kayexalate, or glucose and insulin to try to reduce the potassium level. They may also need dialysis to rebalance their electrolytes.
Now we’ve talked about what we will monitor and reverse, but we also want to prevent this from happening again. So you’ll need to encourage the patient to follow the prescribed diet plan, which will most likely be a low-potassium diet, but be aware of those salt-substitutes that are high in potassium, so those should be avoided.
You’ll need to educate your patient on the signs and symptoms of hyperkalemia and help them seek medical care early if they experience any of those symptoms that we talked about earlier on, cardiac symptoms, muscle twitching, GI upset, or respiratory depression.
So remember: monitor, reverse, and prevent.
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