Hypokalemia NCLEX Review Notes

Studying hypokalemia and want to know how to remember hypokalemia and how it is different from hyperkalemia?

In this article, I want to give you some super easy ways on how to remember the causes of hypokalemia, signs and symptoms, and the nursing interventions for this condition. I want to highlight the material you will be tested on in lecture class or the NCLEX exam.

After you read these notes, be sure to take the quiz on hypokalemia and hyperkalemia.

Video Teaching Tutorial on Hypokalemia

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Hypokalemia

You will learn the following:

• Causes (easy mnemonics to remember it)
• Signs & Symptoms (tricks on how to easily remember)
• Nursing Intervention…things that NCLEX and lecture exams look for

Hypo= low

Kal= root word for potassium….. don’t get it confused with cal= calcium

Emia=blood

Meaning of hypokalemia: Low Potassium in the Blood

Normal Potassium Level 3.5-5.1 (2.5 or less is very dangerous)

Most of the body’s potassium is found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. Therefore, potassium helps control the fluid inside the cell, while sodium helps control the fluids outside the cells. Therefore, if there is an imbalance of these electrolytes, fluid inside and outside the cell can become imbalanced. Blood tests measure potassium levels via the outside of the cell (extracellular fluid).

In addition, potassium is responsible for nerve impulse conduction and muscle contraction.

Causes of Hypokalemia

“Your Body is trying to DITCH potassium”

Drugs (laxatives, diuretics, corticosteroids)

Inadequate consumption of Potassium (NPO, anorexia)

Too much water intake (dilutes the potassium)

Cushing’s Syndrome (during this condition the adrenal glands produce excessive amounts of cortisol (if cortisol levels are excessive enough, they will start to affect the action of the Na+/K+ pump which will have properties like aldosterone and cause the body to retain sodium/water but waste potassium)…hence hypokalemia

Heavy Fluid Loss (NG suction, vomiting, diarrhea, wound drainage, sweating)

(Other causes: when the potassium moves from the extracellular to the intracellular with alkalosis or hyperinsulinism (this is where too much insulin in the blood and the patient will have symptoms of hypoglycemia)

Signs & Symptoms of Hypokalemia

Try to remember everything is going to be SLOW and LOW. Don’t forget potassium plays a role in muscle and nerve conduction so muscle systems are going to be messed up and effect the heart, GI, renal, and the breathing muscles for the lungs.

• Weak pulses (irregular and thread)
• Orthostatic Hypotension
• Depression ST, flat or inverted T wave and prominent u-wave

• Shallow respirations with diminished breath sounds….due to weakness of accessory muscle movement to breath)
• Confusion, weak
• Flaccid paralysis
• Decrease deep tendon reflexes
• Decreased bowel sounds

Easy way to Remember 7 L’s

1. Lethargy (confusion)
2. Low, shallow respirations (due to decreased ability to use accessory muscles for breathing)
3. Lethal cardiac dysrhythmias *ST depression, shallow T wave, projecting U wave)
4. Lots of urine (frequent urination…kidneys unable to make the urine concentrated)
5. Leg cramps
6. Limp muscles (decrease deep tendon reflexes)
7. Low BP & Heart

Nursing Interventions for Hypokalemia

Watch heart rhythm (place on cardiac monitor…most are already on telemetry), respiratory status, neuro, GI, urinary output and renal status (BUN and creatinine levels)

Watch other electrolytes like Magnesium (will also decrease…hard to get K+ to increase if Mag is low), watch glucose, sodium, and calcium all go hand-in-hand and play a role in cell transport

Administer oral Supplements for potassium with doctor’s order: usually for levels 2.5-3.5…give with food can cause GI upset

IV Potassium for levels less 2.5 (NEVER EVER GIVE POTASSIUM via IV push or by IM or subq routes)

-Give according to the bag instruction don’t increase the rate…has to be given slow…patients given more than 10-20 meq/hr should be on a cardiac monitor and monitored for EKG changes

-Cause phlebitis or infiltrations

Don’t give LASIX, demadex , or thiazides (waste more Potassium) or Digoxin (cause digoxin toxicity) if Potassium level low…notify md for further orders)

Physician will switch patient to a potassium sparing diuretic Spironolactone (Aldactone), Dyazide, Maxide, Triamterene

Instruct patient to eat Potassium rich foods

Remember POTASSIUM to help you remember the foods

• Potatoes, pork
• Oranges
• Tomatoes
• Avocados
• Strawberries,
• Spinach
• fIsh
• mUshrooms
• Musk melons: cantaloupe

Also included are: (carrots, raisins, bananas)

Don’t forget to take the Hypokalemia Quiz