Potassium Balance
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| How important are small alterations in potassium levels to neuromuscular and cardiac functioning? | vitally important, serious business - slight variations have profound effects
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| 2% | the amount of potassium found in extracellular fluid
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| 98% | the amount of potassium found in intracellular fluid
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| What percent of potassium is intracellular and what percent is extracellular? | intracellular 98%, extracellular 2%
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| What does potassium maintain in cells? | electro-neutrality and osmolality
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| Potassium aides in the transmission of what? | neuromuscular impulses
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| Potassium helps with skeletal and cardiac ______ ________ and ______ ___________. | muscle contraction ; electrical conductivity
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| Potassium affects acid/base balance in relationship to what cation? | Hydrogen
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| Name four ways that potassium contributes to the function of the body’s cells, nerves, and muscles. | maintain cells electrical neutrality and osmolality; aiding neuromuscular transmission of nerve impulses;Assisting skeletal and cardiac muscle contraction and electrical conductivity; affecting acid-base balance in relationship to the hydrogen ion
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| Normal range for potassium | 3.5-5 mEq/L
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| Excessive potassium in the blood stream | Hyperkalemia
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| What happens when the hydrogen ion concentration in extracellular fluid increases (acidosis)? | Hydrogen moves into cells
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| How does potassium fix acidosis? | Potassium ions move out of the cells in order to maintain intracellular electroneutrality
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| What blood condition results if potassium ions move out of cells into the blood stream? | hyperkalemia
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| What happens when the hydrogen ion concentration in extracellular fluid decreases (alkalosis)? | hydrogen ions move from inside the cells to outside the cells and potassium ions move into the cells to maintain electroneutrality
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| What blood condition results if potassium ions move from the blood to inside the cells? | hypokalemia
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| Too little postassium in the blood | hypokalemia
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| Normal serum potassium level | 3.5 – 5 mEq/L
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| Normal intracellular potassium level | 140 mEq/L
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| Why do we have to have some potassium every day? | The body cannot conserve potassium.
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| What is the RDA for potassium? | 40 mEq
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| What is the average daily intake for potassium? | 60 – 100 mEq
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| Give 2 broad reasons for elevated serum potassium levels. | cell destruction with contents released into blood; potassium shifts out of cells to balance hydrogen influx ( acidosis)
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| Name some delightful snacks that are good sources of potassium. | CHOCOLATE, dried fruit, nuts and seeds – YUM!
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| Name four fruits that are good sources of potassium. | bananas, oranges, apricots, cantaloupes
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| What ion can be replenished by having a nice juicy steak? | potassium
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| Name some veggies that are good sources of potassium. | beans, potatoes, mushrooms, tomatoes, and celery
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| It is normal for each liter of urine to contain 20 – 40 mEq/L of potassium. Why? | about 80% of the potassium we ingest is excreted in urine
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| Moves sodium and potassium against the concentration gradient | Sodium potassium pump
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| What can the kidneys do to prevent potassium loss? | Nothing really useful, we lose 10-15 mEq/day in urine even if potassium levels are low and we haven't eaten any potassium.
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| If aldosterone causes the reabsorption of sodium in the kidney tubules which ion is excreted in its place? | potassium
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| ____ ions and ______ ions freely exchange across plasma cell membranes. | Potassium and hydrogen
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| Under what condition do hydrogen ions move into cells and potassium ions move out? | Acidosis
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| Acidosis causes what blood condition related to potassium? | hyperkalemia
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| Alkalosis causes what blood condition related to potassium? | Hypokalemia
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| Under what condition does hydrogen move out of cells and potassium move in? | alkalosis
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| Why does potassium switch places with hydrogen? | to maintain electric neutrality in the cell
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| Moderate hypokalemia | 2.5 – 3 mEq/L
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| Severe hypokalemia | <2.5 mEq/L
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| 3 conditions that could cause a decrease in potassium levels | prolonged intestinal suctioning, recent ileostomy, villous adenoma
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| If potassium is low in the blood because it has gone somewhere else in the body, where would it be? | in the cells
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| Give 2 big reasons that a person would have hypokalemia. | Not enough potassium in or too much potassium out
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| Under what conditions might a person not have enough potassium intake (3)? | not enough potassium rich foods, on potassium deficient IV fluid, Total parenteral nutrition that lacks potassium supplementation
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| Why does suctioning, lavage, or prolonged vomiting/diarrhea cause potassium depletion? | Intestinal fluids contain large amounts of potassium
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| What can potentially happen due to diarrhea, fistulas, laxative abuse, or severe diaphoresis? | Potassium loss/ hypokalemia
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| How does high glucose cause hypokalemia? | glucose in the urine causes osmotic diuresis leading to potassium loss
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| Name three GI related conditions that could cause a decrease in potassium levels. | intestinal suctioning, recent ileostomy, and villous adenoma (a type of polyp that grows in the colon and other places in the gastrointestinal tract )
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| What is a possible complication with a newly functioning transplanted Kidney? | diuresis can lead to hypokalemia
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| What could result from renal tubular acidosis, magnesium depletion, Cushing’s syndrome, and periods of high stress? | Potassium loss
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| Name drugs that can deplete potassium ( A A, CC, DIL). | Adrenergics (albuterol and epinephrine), Antibiotics, Cisplatin, Corticosteroids, Diuretics, Insulin, and laxatives (used excessively).
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| Give 2 examples of adrenergics that could cause potassium loss. | albuterol and epinephrine
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| Give 3 examples of antibiotics that can cause potassium loss. | amphotericin B, carbenicillin, and gentamicin
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| What is cisplastin for? | chemotherapy/cancer
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| Give 2 examples of diuretics that are especially capable of causing potassium loss. | furosemide and thiazides
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| What does asthma have to do with potassium? | Potassium levels drop when albuterol or epinephrine are used to treat asthma
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| If there is insulin in the blood where does potassium go? | into the cells
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| What do dextrose IV solutions have to do with potassium? | Patients receiving large amounts of dextrose solution will produce insulin which causes potassium to shift into cells (serum potassium levels drop)
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| What condition can result with hepatic disease, hyperaldosteronism, acute alcoholism, heart failure, malabsorption syndrome, nephritis or acute leukemias? | hypokalemia
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| What are the signs and symptoms of hypokalemia related to muscles? | starts with muscle weakness especially in the legs, then paresthesia and leg cramps, deep tendon reflexes are decreased or absent, rarely paralysis possible involvement of respiratory muscles leading to tachycardia and tachypnea
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| Your patient has just taken albuterol for an asthma attack. They are feeling weak in the knees and are beginning to experience leg cramps. Would could the problem be? | hypokalemia
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| What is rhabdomyolysis? | a break down of muscle fibers leading to myoglobin in the urine
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| What signs would accompany hypokalemia if it affects smooth muscle? | anorexia, nausea, vomiting, myoglobin in the urine.
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| Why would potassium cause rhabdomyolysis? | because potassium functions in the excitability, electrical balance, and osmotic balance of a cell. The lack of it would lead to cell dysfunction and cell damage.
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| What are the signs and symptoms of hypokalemia in relation to the GI syswdtem? | decreased bowel sounds, constipation, and paralytic ileus. If hypokalemia is prolonged –large amounts of dilute urine.
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| What is the problem with hypokalemia and digoxin? | hypokalemia potentiates the action of digoxin (slow and strengthen the heart beat)
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| What are the signs and symptoms associated with hypokalemia in relation to the cardiac system? | weak and irregular pulse, orthostatic hypotension, palpitations
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| What would an ECG look like if the patient has hypokalemia? | flattened or inverted T wave, depressed ST segment, Characteristic U wave
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| What are the signs and symptoms associated with the cardiac system in moderate to severe hypokalemia? | ventricular arrhythmias, ectopic beats, bradycardia, tachycardia, or full cardiac arrest
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| What kind of results would you expect to see for serum potassium, 24 hour urine level, serum glucose level, pH and bicarbonate level if a patient has hypokalemia? | serum potassium below 3.5mEq/L, increased urine level, elevated pH and bicarbonate levels, slightly increased serum glucose
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| If a patient has hypokalemia and is on digoxin what would we expect to see happen to digoxin levels? | increase
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| What kind of magnesium levels would we expect when a patient has hypokalemia? | decreased
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| Name 3 things we focus on when treating hypokalemia. | restore potassium balance/level, prevent serious complications, get rid of or fix the cause.
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| Name 3 successive steps for restoring potassium levels. | low sodium/high potassium diet, potassium chloride supplements, IV potassium replacement therapy (oral and parenteral potassium supplements may be given additionally)
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| SUCTION | skeletal muscle weakness, U wave, constipation, Toxicity (digoxin), Irregular weak pulse, Orthostatic hypotension, Numbness (paresthesia)
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| Paresthesia | An abnormal sensation of the skin, such as numbness, tingling, pricking, burning, or creeping on the skin that has no objective cause.
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| Heart beats are electrically generated from the wrong place. | Ectopic Beat
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| What are the danger signs of hypokalemia ( ACDMPP)? | Arrhythmias, Cardiac Arrest, Digoxin Toxicity, Muscle Paralysis, Paralytic Ileus, Respiratory Arrest.
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| While monitoring the vital signs of a patient with hypokalemia, which two will be especially important and why? | Pulse and BP because hypovolemia is often associated with hypokalemia.
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| Why would we watch our patients heart rate, rhythm and ECG if they had hypokalemia? | Because hypokalemia is associated with hypovolemia which can lead to tachyarrhythmias.
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| Severe hypokalemia | Less than 3 mEq/L
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| Why would we monitor the respiratory rate, rhythm and pattern of our patient with hypokalemia? | Hypokalemia may weaken or paralyze respiratory muscles
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| What precautions must be taken since hypokalemia my weaken or paralyze respiratory muscles? | monitor respiratory rate and rhythm; keep a resuscitation bag at the patients bedside
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| What respiratory signs would require immediate notification of the physician? | respirations become shallow or rapid, oxygen sat levels fall
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| Your patient is receiving potassium but his potassium levels are not improving. What are you going to check? | Is he losing it somewhere? ( diuresis, vomiting, diarrhea, diaphoresis). Does he have enough magnesium? (magnesium helps the kidneys preserve potassium)
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| Why is especially important to monitor for signs of hypokalemia if a patient takes digoxin? | Because potassium is needed to balance the level of digoxin in the blood. Without potassium digoxin levels can become toxic.
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| Why do we monitor patients who are taking diuretics for signs of hypokalemia? | Because 40 mEq of potassium is lost in every liter of urine.
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| If our patient who has hypokalemia shows signs of irritability or paresthesia what should we suspect? | hypokalemia related metabolic alkalosis.
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| When choosing a vein for potassium by IV what do we need to keep in mind? | Potassium preparations can irritate peripheral veins and cause discomfort.
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| Giving our patient potassium by IV push or bolus is likely to make them what? | Dead – Never give potassium by IV push or bolus
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| How can we help prevent stomach ache when giving oral potassium supplements? | Administer with at least 4 oz of fluid or with food
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| When is it okay to crush slow-release potassium tablets for administration? | When you feel the need to be involved in a hellish lawsuit and/or bear the responsibility for a patient’s demise.
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| Since one of the signs of hypokalemia is constipation we need to watch for signs of constipation. What are they? | distention, reduced bowel sounds
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| If we give medication to relieve constipation, what do we need to think about? | laxatives can cause potassium loss.
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| What should we include in patient education when our patient has hypokalemia? | what is it; what causes it; how to prevent it; drug interactions ( signs and symptoms of digoxin toxicity) ; how and when to take supplements; potassium rich foods; signs and symptoms to report
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| What are the signs of digoxin toxicity? | pulse irregularities, anorexia, nausea, and vomiting
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| Monitor heart rate and rhythm and ECG tracings of patient receiving potassium infusion of more than _____per hour or a concentration of more than ________ per liter of fluid. | 5mEq/hour or 40mEq/liter
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| Prevent or reduce toxic effects by keeping IV concentrations of potassium at ______ or less at a rate of _____ per hour. | 40mEq/liter at a rate of 10mEq/hour
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| If potassium infusion is faster than 10 mEq/hour, what do we monitor more diligently and why? | cardiac status, because a rapid rise in serum potassium can lead to hyperkalemia/cardiac complications
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| The usual maximum adult dose of potassium does not exceed _________ in 24 hours unless prescribed. | 200 mEq/24 hours
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| Name two ways of administering potassium that should never be employed and one way that should be employed in order to control the flow rate. | Never administer potassium IV push or bolus because doing so can cause cardiac arrest, arrhythmias, death. Use an infusion device to administer potassium.
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| Why don’t we administer potassium IV push or bolus? | potentially fatal.
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| When a patient is receiving potassium IV for hypokalemia we need to monitor urine output. Why? | Because levels below 30mL/hour could mean the patient is in danger of hyperkalemia.
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| We monitor potassium levels while our patient is on IV potassium how often and why? | every 1 to 3 hours to evaluate the results of treatment and to avoid hyperkalemia.
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| Why do we monitor our patient receiving IV potassium cardiac rhythm? | to prevent toxic effects from hyperkalemia.
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| What if our patient’s cardiac rhythm becomes a little irregular while receiving IV potassium? | Report irregularities immediately.
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| What are the signs of toxic reaction to IV potassium? | muscle weakness or paralysis
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| Name three things that could go wrong at the IV site when our patient is receiving potassium. | infiltration, phlebitis, tissue necrosis
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| Can we relax our monitoring if the patient is receiving potassium by oral supplements? | Use the same care when giving an oral supplement as you would when giving potassium by IV.
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| 9 Things that we should document when caring for a patient with hypokalemia. | assessment findings; vital signs (arrhythmias); serum potassium levels (labs); I&O; practitioner notification; potassium administration; interventions and responses; safety measures; patient teaching/response
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| Potassium level above 5 mEq/L | Hyperkalemia
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| Moderate Hyperkalemia | levels of 6.1 to 7 mEq/L
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| Severe hyperkalemia | levels above 7 mEq/L
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| Which is more common, hyperkalemia or hypokalemia? | hypokalemia
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| Which is more serious, hyperkalemia or hypokalemia? | hyperkalemia
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| Why are the kidneys vitally important to preventing toxic build up of potassium? | The kidneys are responsible for the excretion of potassium.
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| How does acidosis cause hyperkalemia? | Hydrogen ions move into cells while potassium ions move out of cells into the blood.
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| Why would cell injury cause hyperkalemia? | The injured cells release/spill potassium into the blood stream.
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| What happens to the potassium level of donated blood as it ages? | The potassium level increases.
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| What kind of drugs work by inhibiting the shift of potassium into cells and therefore may cause hyperkalemia? | beta-adrenergic blockers
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| What kind of drug is spironolactone? | potassium sparing diuretic
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| Name three kinds of drugs that are thought to cause hyperkalemia by suppressing aldosterone secretion, which decreases potassium excretion. | ACE inhibitors, nonsteroidal anti-inflammatory drugs, and heparin
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| We monitor patients for hyperkalemia when they are taking aminoglycosides, because aminoglycosides are examples of drugs that can cause injury to what organ? | The kidneys
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| How can chemotherapeutic drugs cause hyperkalemia (2 ways)? | cell damage, sometimes renal damage
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| Name 9 drugs that are associated with hyperkalemia (AABCDHNPP). | ACE inhibitors, Antibiotics, Beta blockers, Chemotherapeutic, Digoxin, Heparin, Nonsteroidal anti-inflammatory, Potassium (in excess), and potassium sparing diuretics.
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| What are salt substitutes made with? | potassium
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| What is diminished in patients with renal failure, especially if they are on dialysis? | Potassium excretion
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| What are the early signs of hyperkalemia? | paresthesia and irritability
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| What are the signs of hyperkalemia related to muscle? | muscle weakness that tends to spread from the legs to the trunk and involves respiratory muscles, Deep tendon reflexes decrease, smooth muscle hyperactivity in the GI tract causes N&V, abdominal cramping, and diarrhea.
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| What can hyperkalemia cause in relation to the heart? | decreased heart rate, irregular pulse, decreased cardiac output, hypotension, cardiac arrest, heart block, ventricular arrhythmias, and asystole.
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| At what potassium levels would you expect to see the especially dangerous arrhythmias? | 7mEq/L
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| Name 3 test results used to confirm hyperkalemia? | serum potassium > 5mEq/L, Decreased arterial PH/acidosis, ECG abnormalities
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| Name 4 goals of treatment for hyperkalemia. | lower potassium level; treat the cause; stabilize the myocardium; promote renal and GI excretion of potassium
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| Give 4 treatment measures taken for a patient with mild hyperkalemia. | loop diuretic ( fix acidosis – get rid of excess potassium); treat cause; potassium restricted diet (no pecan pie); alter drugs that raise potassium levels
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| What treatment may be employed if a diuretic does not do the job for a patient with moderate hyperkalemia? | hemodialysis
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| What does kayexalate do? | It pulls potassium from the blood and puts sodium into the blood ( potassium is pooped out in loose stools)
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| How is kayexalate administered? | orally, nasogastric tube, or retention enema (may require repeated treatments)
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| What are you going to do for your patient with hyperkalemia in regards to medications? | administer, monitor for effectiveness and side effects, document
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| How long does a patient try to hold a kayexalate enema? | 30 to 60 minutes
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| If our patient receives kayexalate for 2 or more consecutive days we should monitor for what? | hypokalemia
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| A patient with hyperkalemia is not responding to diet restrictions, kayexalate, and loop diuretics. What do we do next? | prepare him for dialysis
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| What safety measures do we need to employ for our patient with hyperkalemia? | Evaluate muscle weakness. Address possible falls due to muscle weakness. Advise patient to ask for help getting up out of bed.
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| What kind of foods would be good choices for our patient with hyperkalemia(AABBCCNPR)? | Apples, Asparagus, Bread, Berries, Carrots, Corn, Noodles, Rice, Pears
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| Why would we check the date on donated blood if our patient with hyperkalemia needs a transfusion? | because potassium levels increase as donated blood ages
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| Our patient has muscle weakness, diarrhea, and pulse irregularities. What should we suspect? | hyperkalemia
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| What symptoms should we have our patient at risk for hyperkalemia report? | muscle weakness, diarrhea, pulse irregularities
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| What are the signs and symptoms associated with hypokalemia (ACDHNPPVLDP)? | anorexia, cramps, decreased bowel sounds, hyporeflexia, nausea, paresthesia, polyuria, vomiting, leg cramps, decreased/absent deep tendon reflex, paralysis
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| U wave | hypokalemia
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| Tall Tented T wave | hyperkalemia
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| Signs and symptoms of hyperkalemia | abdominal cramping, diarrhea, Twave, hypotension, irregular pulse rate, irritability, muscle weakness/lower extremities, flaccid paralysis, nausea, paresthesia, bradycardia
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| What are the treatments for hyperkalemia ( L and CBIGKD)? | loop diuretics- mild to moderate, severe -Calcium chloride or glucose, Bicarbonate, Insulin, Glucose, Kayexalate, Dialysis
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| What does potassium have to do with the heartbeat? | Potassium is vital for cardiac function because it plays a key role in cardiac muscle contraction and electrical conductivity.
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| What effect does aldosterone have on the kidneys? | makes them reabsorb sodium and excrete potassium
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| Decreased deep tendon reflexes equals hyperkalemia or hypokalemia? | hypokalemia
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| What does insulin do to help hyperkalemia? | causes potassium to move into cells
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