Hey everyone, it's Sarah with RegisteredNurseAriene.com and in this video I'm going to go over hypokalemia. In this video, I want to simplify hypokalemia for you. I want to show you what you need to concentrate on for lecture exams, for the NCLEX, give you some tips and tricks on how to remember the causes.
and the signs and symptoms. So this will be a good refresher to prepare you for your exam. And the great thing about it is that after this video, I highly encourage you to go to my website, registernurseaarion.com, and take the free quiz that goes over hypo and hyperkalemia. It'll test your knowledge on the two and help you make sure you know the difference.
And you can access that link in the description below, or a card should be popping up that you can click to take that. Okay, let's talk about hypokalemia. Anytime I have a big word like this, I like to take it apart. So, I like to take each phrase and dissect what it is because you have a lot of these. You have a lot of hyponatremias, hypernatremias.
You want to make sure you know which electrode... electrolyte you're dealing with. So the first one is hypo.
What does hypo mean? It means low. Cal, K-A-L, is the root word for potassium. So we know that we're dealing with low potassium. And emia means blood.
we have low potassium in our blood. So what does that mean? Okay, a normal potassium level is 3.5 to 5.1. And this depends on the lab, but generally this is the range.
Some say 5.2, 3.4, but that's what I go with. And anything less than 2.5 or less is dangerous. You need some major intervention. And we'll talk about all those interventions. here in a second.
Okay, so first let's look at it at a cellular level so you'll understand what's going on. Okay, here is a cell and when you have your cell, you have all your little organelles and everything and that's what's in the middle of this and you have your intracellular part of your cell which is the inside of the cell and then you have your extracellular which is the outside of the cell. Now potassium loves to live inside the cell compared to the extracellular area. There's less potassium in your extracellular fluid compared to your intracellular.
So whenever a blood test is ordered for a patient, because a lot of times in the hospital you're going to draw electrolytes on a patient or maybe just specifically a potassium level, the blood test is just looking at the potassium in the blood, in the extracellular part. It's not looking in the intracellular. So it's just looking on the extracellular.
So what's happened in hypokalemia is that there is hardly any potassium left in the blood. It's all probably shifted into the intracellular. So whenever that happens, you get some issues. Now remember, potassium is responsible for nerve impulse conduction and muscle contraction.
And if you don't have a lot of potassium in your blood for your cells to use, you start getting problems with your GI system, your heart, and everything doesn't want to work appropriately. And we're going to go over that here in a second, but understanding that will help you understand why you're getting these signs and symptoms whenever you have low potassium in the blood. Okay.
What causes this to happen? I wanted to use this mnemonic to help you remember. Now, remember there's low potassium in your blood and your body.
Remember this phrase, your body is trying to ditch potassium. The key word you want to get is. is ditch. I have taken ditch and I have highlighted it with what you need to remember that causes it. For D, drugs. Drugs cause low potassium.
Anytime you are having diarrhea, you're losing lots of potassium. Laxatives, because overuse of laxatives causes low potassium because you lose it in the stool. Diuretics, like Lasix, it wastes potassium.
The patient's urinating a lot and they're losing a lot of potassium. And corticosteroids, And narcosteroids also cause it as well. I, inadequate intake of potassium. This can be caused by a lot of reasons. They're NPO.
They've been NPO for a long time, so they're not taking in potassium. They have anorexia or maybe they're just really sick and nauseous and not able to eat anything. So their potassium level goes down.
Okay. T, T is for too much water intake. Whenever you consume too much water with water intoxication. maybe gave the patient way too much fluids, you can dilute the potassium in the blood.
C for Cushing's syndrome. This is where you have too much secretion of aldosterone, which throws off your potassium level. And then H for heavy fluid loss. Now remember, like I said with the laxative use or diuretics, whenever you... you're losing lots of fluids either through NG suction.
Remember that? That is a lot of things that your professors like to hit on on exams. They'll say a patient's hooked up to NG tube suction. What do you need to look out for?
You need to watch the potassium level because DI secretions are really rich in potassium. A lot of physicians may have them ordered H2 blockers so that you don't lose that as much. Vomiting, they lose it in their vomit. Diarrhea, any wound drainage, say you got a wound back going or something like that and it's just taking a lot of that fluid out that has the potassium in it and sweating.
So anytime you're losing lots of fluids, you're at risk for potassium. Now some other causes for low potassium you can have where that potassium has moved from the extracellular fluid into the intracellular cell and this is through whenever they're having alkalosis now whenever you have acidosis that happens in hyperkalemia but alkalosis can cause hypokalemia and hyperinsulinism this is where you have too much insulin in the blood and the patient may be having signs of hypoglycemia and this can also cause hypokalemia because glucose and potassium they like each other and they do a lot of the same things. Okay, signs and symptoms. How are your patients going to present with this? A lot of tests like to hit on showing you signs and symptoms and you're supposed to tell what it is or they'll give you a scenario and they'll have all these signs and symptoms listed and you're supposed to pick which one is not a sign and symptom.
So I'm going to go over the signs and symptoms real fast and then I'm going to give you a neat trick on how to remember those. Okay, remember in order to understand these signs and symptoms, you need to to know that potassium plays an important role in your muscle and nerve conduction and it affects the GI system, the renal system, the heart, and the lung muscles used to breathe. So because when you have low potassium, think of this, everything is going to be slow and low because there's no potassium in the body. The body is just sort of like exhausted and it needs it in order to function so everything's not going to work correctly.
So what you're going to be having is you're going to have a weak pulse that is going to be irregular and thready feeling. Orthostatic hypotension. Decreased bowel sounds.
Remember, everything is just moving really slow so the bowels aren't going to be moving. You're not going to be hearing those bowel sounds with your stethoscope. You're going to have decreased deep tendon reflexes because whenever you're hitting the reflexes with your little hammer, they're not going to respond as well because you have low potassium. Low potassium is responsible for muscle contraction. Flaccid paralysis, that happens late with really low potassium, but you could see that.
Confusion, I have seen that with really super low potassium levels. Weakness, shallow respirations, and diminished breath sounds. And this is because whenever you breathe, you use your muscles, your accessory muscles to breathe. And potassium is responsible in muscle movement and contraction.
So if you don't have a lot of potassium, you're not going to be breathing as well. And you're going to have... have diminished breath sounds.
And EKG changes. Pay close attention to this because this is another NCLEX favorite and professor favorite question to ask you about what you're going to see different on an EKG when a patient has a really low potassium level. Okay, I'm going to show you, but let me tell you what you can see.
You're going to see depressed ST segment. You could also see a flat or inverted T wave and a prominent U wave. So let me show you what a normal EKG looks like first.
Okay right here is a normal EKG. On your PQRS complexes you have a P wave, this little hump right there. Then you have this little dip which is called the Q wave. Then you have the R which is that spike and then it goes down into the S. And then you have this little segment right here and then you have the T wave.
Now whenever you're paying attention for hypokalemia what you're looking for remember number one is an ST depression. So over here is what it will look like. but let me talk to you about this first. The ST segment is from the S to here, and this part right here is going to be depressed.
So it'll look like this. Notice how this is depressed. Normally what you'll have is a line on your EKG that runs right here, and everything needs to be on that line, but it's depressed below the line, so you'll have ST depression. You can also have a flat or inverted T wave, and notice this T wave on the normal EKG, it just has a little bump right there.
and that's a normal but this can be flipped or it can be flat like how it's flat right there and also another thing you may see is a u-wave notice this does not have a u-wave because most people do not have u-waves and you have a beautiful u-wave right there right there so you can also see that with hypokalemia so remember once again you're going to have a depressed st depression you may have a flat or inverted t-wave And you may have a U-wave. I like to remember this. Remember, everything is slow and low in hypokalemia because hypo means low.
So you're going to have a low ST depression. You may have a flat or low ST depression. a T wave, which is inverted or low, and then you may have a prominent U wave. So those are just some tricks on how to remember it. Let's look at those seven L's to help you remember the symptoms of how someone will present with hypokalemia.
Okay, seven L's. First is lethargic. They're going to be tired and just laying around.
Second, they're going to have low, shallow respirations. Remember that comes back to the inability to really use those muscles to breathe. It's going to be just really shallow. three lethal cardiac changes remember those ekg changes we had and they can also if it gets really low they can go in a cardiac arrest um four loss of urine remember they're going to be peeing a lot and those diuretics like lasix can cause that if they're on that because they're wasting potassium um next leg cramps that is because the muscles are cramping because the potassium levels are too low because potassium plays a level in muscles Limp muscles, the flaccid part of that flaccid. And last, low blood pressure and heart rate.
Okay, let's look at these nursing interventions because this is where a lot of your test questions are going to come from with hypokalemia. Okay, whenever you have a patient in hypokalemia, you want to watch their heart rhythm, their respiratory status. You're going to watch their GI and renal status.
You're looking at their urinary output, making sure they're not going into renal failure through their BUN and creatinine. And you probably want to put them on a cardiac monitor as well. Most patients will be on a telemetry box, but if not, the doctor may order that. Watch their magnesium because magnesium and potassium go hand in hand.
They will usually both go down together. And if the magnesium level is too low, it will probably be hard to get that potassium level to go up. So the physician may order a mag level as well. And you'll want to watch the glucose.
the calcium and sodium levels because all that plays a role in cell transport. Okay, typically a doctor, whenever a patient has a level of a 2.5 to 3.5, the physician will normally just order a oral supplement of potassium. And these are the big white pills patients love to take them. No, not really. Or you can get a powder and you can mix it in a juice and you will give that to them.
And you want to give this. with food because these medications can cause GI upset. So if the patient can eat, you probably want to give them something to eat with that.
Now levels less than 2.5, a physician will normally order the nurse to start a potassium infusion. Very important to note, you never ever ever give potassium as an IV push, a sub-q injection, or an IM injection. This is a popular type of test question.
They'll throw an option out. out there and says potassium level is two which of the following would you not do and get potassium IV push would be the option or IM or sub-q so pay attention to that and whenever you're giving potassium IV you want to make sure that you follow the bag's instructions don't adjust the rates because potassium has to be given slowly you don't want to give it too fast most hospitals have protocols on how to give this but generally you don't want to give no more than 20 milliequivalents per hour and if the patients receiving at least 10 mEq per hour or more, you'll want to put them on a cardiac monitor and watch for any EKG changes. And also, potassium infusions are hard on the veins because you're giving this IV.
So you want to watch for phlebitis, which is inflammation of the vein, you notice any redness or if it infiltrates, meaning that the cannula of the IV came out of the vein and it leaked into the tissues. Okay, next, if you notice, say you're giving AM meds and the the patient has ordered some Lasix or Demodex or Thiazide, any type of diuretic that wastes potassium, causes the patient to urinate and it's wasting the potassium, you want to hold that until you talk to the doctor, call the doctor and explain that the potassium level is low. What do you want me to do about these medications?
Because you can bottom their potassium out. Next up, Say the patient's getting digoxin. You would want to check their apical pulse, but you'd also want to check their potassium level with their AM labs.
Because if you give DIG whenever the potassium level is low, you can cause DIG to happen. toxicity, which is very bad. So always as a nurse, contact the doctor before you give these medications if your potassium level is low. If a patient is on a diuretic and their potassium is low, the doctor may switch them to a diuretic.
a type of diuretic that spares the potassium. And this is another big test question that exams like to hit on. They'll ask you about which drugs waste potassium and which drugs save potassium, potassium sparing.
And some are your spiron, aldactone. Aldactone is the other name for it. Diazide, maxide, and triamterine.
These are ones that will actually save potassium. Okay. Now.
Now, another step that you'll want to do is make sure your patient is getting enough potassium in their food. And let me show you a clever way on how to remember potassium rich foods because a lot of times an exam is going to ask you, potassium levels low, which of the following foods will be good to implement in their diet. Let's look at this. A way to remember potassium rich foods is the word potassium. And you have it spelled out here, so let's go over it.
You have P for potatoes and pork, O for oranges, T for tomatoes, A for potatoes, and you have A for avocados, S for strawberries, the other S for spinach, and then you have I, it's fish, F-I-S-H, and then U for mushrooms, and then M for muskmelons, which is cantaloupe. And then as a side, also carrots, raisins, and bananas. So that's just a clever way to help you remember potassium rich foods, since exams love to ask you what foods are rich in potassium.
Okay, so that is an overview of hypokalemia. Now be sure to check out my video on hyperkalemia. me and do not forget to take the quiz to test your knowledge on how well you grasp this material.
So be sure to check out my other teaching tutorials and subscribe to this YouTube channel.