Page 408 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 393

Hyperkalemia Related to CRF

What Went Wrong?
7 Hyperkalemia occurs when the potassium level is greater than 5.5 mEq/L.
High potassium levels are one of the most severe complications of ARF and
CRF. Hyperkalemia is caused by retention of potassium, metabolic acidosis,
excessive intake of potassium-containing foods and medications, and cellular
catabolism. The critical care nurse must be aware of cardiac changes with
hyperkalemia and emergency treatment to lower blood levels quickly.

Prognosis
The prognosis is excellent for treating hyperkalemia, but early recognition is key.

Interpreting Laboratory/Diagnostic Results
Potassium level greater than 5.5 mEq/L.
ABGs show a metabolic acidosis.
Early ECG changes show tall, tented T waves, QRS widening.

Later changes show flattened P waves and PR interval prolongation. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Hallmark Signs and Symptoms
Muscle cramps and weakness
Abdominal pain accompanied by nausea, vomiting

Treatment

Restrict potassium-containing intake in foods, IV fluids, and medications.
Administer Kayexalate therapy.
Dialyze potassium from the body.
Administer glucose and insulin to drive potassium into the cells.

Administer NaHCO and monitor ABGs.
3
Administer calcium salts.

Nursing Diagnosis for Hyperkalemia Expected Outcomes
Decreased cardiac output due to The potassium level will remain
electric conduction disturbances between 3.5 and 5.2 mEq/L
The patient will describe foods
containing potassium and limit the
amount in his or her menu