Nursing Assessment: Hypokalemia is a dangerous electrolyte imbalance that can result in cardiac arrhythmias, flaccid paralysis and rhabdomyolysis (respiratory depression) in some cases. Hypokalemia can be caused by many different medical conditions; however one of the more common causes is excessive loss of potassium, often associated with extensive fluid loss. Excessive fluid loss occurs in situations such as extensive vomiting or diarrhea.
The potential patient received a prescription for hydroclorothiazide one week ago, and has been taking one tablet a day to treat his hypertension and fluid retention caused by congestive heart failure. He has been experiencing frequent diarrhea (twelve bowel movements per day) and vomiting (three to five times per day) for the last two days, and is unable to retain any fluids. The patient also complained of muscle weakness, fatigue, and polyuria. Serum and plasma testing both revealed low (below 3.5) potassium levels, and an ECG detected electrical changes within the heart, all indicative of hypokalemia. The physician prescribed IV potassium administration due to the patient’s inability to hold fluids, an antiemetic (Phenergan) for the vomiting, and an antidiarrhoeal (Imodium) to relieve the frequent bowel movements.
Nursing Diagnosis: Deficient knowledge as related to potassium deficiency and the treatment regimen as manifested by inability to understand directions for proper care and possible complications.
Nurse Planning: Learning objectives will include teaching the patient: what hypokalemia actually is, how hypokalemia can be prevented and treated, the importance of potassium in their regular diet, and how laxative and diuretic abuse could increase the risk of hypokalemia. By teaching the patient about his condition, the treatment for it, and some of the risk factors associated with the condition, the patient will then be empowered with the knowledge necessary to provide proper self care and monitoring.
The patient must first learn what hypokalemia actually is. It would be necessary to teach the patient that his condition is actually caused by a low level of potassium. Low levels of potassium can have many adverse affects on the body, resulting in fatigue, muscle weakness, cardiac arrhythmias, polyuria, as well as paresthesias or tender muscles (Taylor, Lillis, and Lemone, 2005, p. 1453). Hypokalemia can be very dangerous, and can also lead to other disorders such as alkalosis (increased alkalinity of the blood, which can be deadly if not treated).
Next, the patient should learn about prevention and treatment of hypokalemia. In order to help prevent hypokalemia, the patient should avoid potassium-free fluids and alcoholic beverages. The patient can also decrease risk of hypokalemia by including potassium rich foods in a regular diet (such as bananas). In order to treat the hypokalemia disorder, the patient should expect potassium administration (which will increase potassium levels and return potassium levels back to normal), decreased dosages or complete removal of any diuretic (especially potassium wasting) medications, as well as digitalis treatment.
Lastly, the patient should learn about things to avoid in order to decrease the risk of hypokalemia. Abuse of laxatives and diuretics can drastically increase fluid output, which in turn places the patient in danger of losing potassium in large amounts (Taylor, Lillis, and Lemone, 2005, p. 1453). Patients should avoid the use of laxatives if at all possible, and should never consume alcoholic beverages, and should limit their intake or completely remove soda from their diets.
These teachings can be performed within the cognitive learning domain, and evidence of the patient’s understanding can be observed by simply asking “yes or no” questions.
Nurse Evaluation: The methods of evaluating the learning objectives could be as simple as asking the patient simple questions to gage their level of understanding. Examples of such questions could be, “Should you drink any beer while you are taking this medication?” or “What kinds of foods are rich in potassium?” By monitoring the patient’s response it would be rather easy to see whether or not they understood the aforementioned learning objectives.
The patient will evaluate the teaching process by rating their old (prior to the teaching experience) understanding of each objective and comparing it to their new (after the teaching experience) level of understanding. Should the level of understanding increase from old to new then the teaching process was helpful.
Patient handouts should include information on certain risk factors for hypokalemia, which include: diarrhea, vomiting, diuretic consumption, steroid administration, anorexia nervosa, alcoholism, frequent urination, certain antibiotics, and gastric suction. The handout should also include a list of things to avoid, such as: alcohol, soft drinks and sodas, laxatives, sugar free chewing gum, large amounts of fatty foods, and hot peppers. Handouts should also have a list of things to include in a diet, which are: foods rich in potassium; bananas, raisins, and potatoes (with skins), bran flakes or wheat, and whole-meal pasta.
Keep in mind that you should always make sure your physician knows every type of medication you are taking, including vitamins and herbal supplements! If you have hypokalemia, or are at risk for getting hypokalemia (because of diuretic medications) you should also make sure your physician is aware of that. There can be many dangerous interactions caused by other medications if you are suffering or at risk for hypokalemia.
If at any time you begin to experience any of the following symptoms, contact your physician immediately: Fatigue, anorexia, nausea and vomiting, muscle weakness, diarrhea, chest pains or heart fluttering, increased urination.
Reference:
Taylor, C., Lillis, C., LeMone, P. (2005). Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott, Williams & Wilkins
