Nursing is a very diverse field. There are many areas of nursing, such as medical-surgical, oncology, pediatrics, and geriatrics. Each area of nursing requires specific skills and knowledge.
Medical-surgical nurses typically work in the operating room or hospital setting where they care for patients following surgery. Oncology nurses typically work in the cancer clinic or hospital setting where they care for patients with cancer.
Nurses specializing in pediatrics or geriatrics typically work in a doctor’s office or hospital setting where they care for children or older adults, respectively. All areas of nursing require basic skills and knowledge related to health assessment and diagnosis.
Health assessment includes things such as observations, measurements (including blood glucose levels), interviewing the patient, and interviewing family members or other caregivers to get a full picture of the patient’s health. Health diagnoses include identifying symptoms and determining what could be causing them.
How do we fix this?
If a patient’s serum potassium level is low, nurses can administer oral or IV potassium supplements to raise the level. If the level is very low, a blood transfusion may be required to replace missing red blood cells with new plasma.
If the level is high, a patient may need to avoid foods and beverages that are high in potassium. For example, if they report a liking for bananas, nurses can advise them to limit their intake to one per day.
They may also need to use a medication called diuretic that helps remove excess sodium and water from the body through urination. This helps lower the serum potassium level by flushing it out of the body.
Nurses can also check other factors that could be affecting the levels, such as whether the patient is experiencing muscle weakness or experiencing symptoms of diabetes. These would need to be investigated and managed by the nurse.
Is this happening because of another medical condition?
When a person has a low serum potassium level, it may be due to another medical condition affecting the kidneys. For example, some people have chronic kidney disease, in which their kidneys do not function well over time.
When this is diagnosed, doctors do tests of the blood every few months to see how well the kidneys are functioning. A low serum potassium level can be one of the signs of failing kidneys.
Kidneys play a huge role in regulating electrolytes in the body, including potassium. When they fail to function properly, this can lead to problems with other electrolytes like potassium.
People with chronic kidney disease are typically put on a diet that is high in sodium and water to help the kidneys filter water and keep electrolyte levels normal. This is done by nursing staff who are trained in renal care.
What should I watch for?
If you are caring for a client with hypokalemia, you should be alert for signs and symptoms of hypernatremia, weakness, muscle pain, and breathing difficulties.
If the hypokalemia is severe, the individual may have flaccid muscles and no muscle contractions. This is called paralysis, and it can be life-threatening if the individual cannot breathe on their own.
Individuals with chronic kidney disease often have mild hypokalemia that is managed by regular supplementation. If you are unsure if the individual needs more supplements, check with their doctor or a nurse to make sure you are providing enough!
Remember that dialysis removes fluids and waste from the body, so individuals undergoing dialysis may experience swelling as a result. This is something to monitor and treat if necessary.
Is there a way to prevent this from happening?
Yes, and it starts with educating both patients and caregivers. Patients should be aware of the symptoms of hypokalemia and when to ask for additional potassium in their diet.
Caregivers should be aware of all medications a patient is on and whether or they may cause hypokalemia or hyperkalemia.
Additionally, nurses should be checking serum potassium levels every eight hours, not just once a day. This can be done as a routine check along with many other tests that are being done at this time.
Finally, all nurses should have adequate available IV fluids with normal saline having an adequate concentration of sodium to prevent hyponatremia. When these precautions are taken, the risk of fatal hypernatremia or hypokalemia is reduced.
What are some symptoms that the client is experiencing?
The client is experiencing generalized weakness, fatigue, and muscle aches. These are likely due to the low serum potassium level.
Generalized weakness can be frightening for the client and for those around him. He may feel like he has no power in his body and cannot perform basic tasks.
Fatigue can be particularly debilitating when a person does not know the source of the exhaustion. It can be hard to get through the day when you feel like you have no energy.
Muscle aches can also make it difficult to get through the day. The client may find that simple movements, such as getting out of a chair, cause pain and discomfort. This can further reduce their energy levels due to frustration and worry about what is happening.
These symptoms can be very distressing for the client and may cause them to become depressed or anxious.
What should I do next?
Once you have obtained the serum potassium level, you can proceed to give the client appropriate care. If the level is below 3.5 mEq/L, then no additional care is required.
If the level is between 3.5 and 5 mEq/L, then no additional care is required unless symptoms such as cramping or muscle weakness are present. In this case, a diet high in vegetables and fruits and low in sodium is recommended.
If the level is above 5 mEq/L, contact a healthcare provider for further instructions. They may instruct you to administer IV glucose solution to help bring down the potassium level. They may also ask you to distribute bags of specific fluid replacements to help bring down the potassium level.
Once you have completed these tasks, ensure that the client drinks enough fluids throughout the day to avoid dehydration.
How do we fix it?
If the serum potassium level is 3.5 to 4.5, then treatment consists of giving the patient fluids and a diet high in potassium. This is because we need to replace the lost potassium and add more into the body!
If the level is below 3.5, then dialysis is required. This is a medical process that uses machines to filter out substances in the blood.
Patients with chronic kidney disease are usually put on a diet low in potassium to avoid raising the serum level too much. This is because if there is not enough water in the body, then less excretion of minerals will happen, including potassium.
Using laxatives to treat constipation can actually cause more loss of potassium from the body. People with CKD should be aware of this and consult with their doctor about how to treat constipation safely.
Should I refer my client to a doctor?
In cases where the serum potassium level is below 3.5, most people with health care experience will not refer a client to a doctor. This is because this level is considered within the normal range.
However, if your client exhibits any symptoms such as muscle weakness, abnormal heart rhythm, or changes in mental status such as confusion or memory loss, then it would be appropriate to refer them to a doctor.
A nurse may refer a client with a high serum potassium level to a doctor if the value is above 5.1. This is because 5.1 is considered acutely toxic and requires immediate treatment and observation by a health care provider.
Should you be concerned if you are experiencing symptoms of hyperkalemia and your serum potassium level is 3.1? It depends on the other factors involved with your case. A nurse or doctor will evaluate these factors when deciding whether or not to refer you to one.
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