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Potassium
Potassium
Major ICF cation necessary for
Transmission and conduction of nerve and muscle impulses
Cellular growth
Maintenance of cardiac rhythms
Acid-base balance
Sources
Fruits and vegetables (bananas and oranges)
Salt substitutes
Potassium medications (PO, IV)
Regulated by kidneys
Hyperkalemia
High serum potassium caused by
Impaired renal excretion
Shift from ICF to ECF
Massive intake
Most common in renal failure
Manifestations
Cardiac dysrhythmias
Cramping leg pain
Weak or paralyzed skeletal muscles
Abdominal cramping or diarrhea
ECG effects of Hyperkalemia
Decreased R wave amplitude
Widened QRS
Wide, flat P wave
Depressed ST segment
Prolonged PR interval
Tall, peaked T wave
The most clinically significant manifestations of hyperkalemia are the disturbances in cardiac conduction.
Cardiac depolarization is decreased, leading to flattening of the P wave and widening of the QRS complex.
Repolarization occurs more rapidly, resulting in shortening of the QT interval and causing the T wave to be narrower and more peaked.
Ventricular fibrillation or cardiac standstill may occur.
Nursing diagnosis
Risk for electrolyte imbalance related to excessive retention or cellular release of potassium
Risk for activity intolerance related to muscle weakness
Risk for injury related to muscle weakness and seizures
Potential complication: dysrhythmias
Nursing implementation
Eliminate oral and parenteral K intake
Increase elimination of K (diuretics, dialysis, Kayexalate)
Force K from ECF to ICF by IV insulin and a b-adrenergic agonist or sodium bicarbonate
Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
Hypokalemia
Low serum potassium caused by
Increased loss of K+ via the kidneys or gastrointestinal tract
Increased shift of K+ from ECF to ICF
Dietary K+ deficiency (rare)
Manifestations
Cardiac most serious
Skeletal muscle weakness (legs)
Weakness of respiratory muscles
Decreased GI motility
Hyperglycemia
ECG effects of Hypokalemia
Slightly peaked P wave
Shallow T wave
Slightly prolonged PR interval
Prominent U wave
ST depression
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