hey everyone it's Sarah with register nurse rn.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 inlex 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 video I highly encourage you to go to my website register nurse ran.com and take the free quiz that goes over hypo and Hyper cenia 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 hypo nutras hyper nutras you want to make sure you know which electr electrolyte you're dealing with so the first one is hypo what does hypo mean it means low cow Kal L is the root word for potassium so we know that we're dealing with low potassium an emia means blood so we have low potassium in our blood so what does that mean okay a nor normal pottassium 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 on a 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 organel 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 pottassium loves to live inside the cell compared to the extracellular area there's less potassium in your extracellular fluid compared to your intra intracellular so whenever a blood test is ordered for a patient because a lot of times in the hospital you're going to draw um 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 ex extracellular so what's happened in hypokalemia is that there is hardly any pottassium left in the blood it's all probably shift shifted into the intracellular so whenever that happens you get some issues now remember potassium is responsible for nerve impulse connection 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 pneumonic 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 Ditch so I have taken ditch and I have highlighted it with what you need to remember that causes it so for d drugs drugs cause low potassium anytime you are having diarrhea you're losing lots of pottassium so laxatives because overuse of laxatives causes low potassium because you lose it in the stool diuretics like lasic it um wastes potassium So the patient's urinating a lot and they're losing a lot of potassium and corticosteroids also cause it as well I inadequate intake of potassium this could be caused by a lot of reasons they're no they've been no for a long time so they're not taking in potassium they're um 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 tea tea 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 um dilute the potassium in the blood C for cushion 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'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 I'll say a patient's hooked up to NG tube section what do you need to look out for you need to watch the pottassium level because GI secretions are really rich in potassium a lot of physicians may um H 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 pottassium has moved from the extracellular fluid into the intracellular um cell and this is through whenever they're having an alkalosis now whenever you have acidosis that happens in hyper calmia but alkalosis can cause hypo calmia and hyperinsulinism this is um where you have too much insulin in the blood and the patient maybe 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 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 um orthostatic hypotension decrease bowel sounds remember everything's 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 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 um flaccid paralysis that happens late with really low potassiums but you could see that confusion I have seen that with really super low potassium levels weakness shallow respirations and diminish breath sounds and this is because whenever you breathe you use your muscles your accessory muscles to breathe and potassium is responsible and muscle movement and contraction so if you don't have a lot of pottassium you're not going to be breathing as well and you're going to have diminish breath sounds and EKG changes pay close attention to this because this is another inlex 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 a depressed ST segment um you could also see a flat or inverted t-wave and a prominent uwave so let me show you what a normal EKG looks like first okay right here is a normal EKG um on your pqrs complexes you have a p wve this little hump right there Then you have this little dip which is called the qwave 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 um over here is 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 uwave notice this does not have a uwave because most people do not have U waves and you have a beautiful uwave 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 um you may have a uwave 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 s t-wave which is inverted or low and then you may have a prominent uwave 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 would 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 pen lot and those diuretics like lasc 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 pottassium 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 the resp resp atory status you're going to watch their GI and renal status you're looking at their urinary output watching their making sure they're not going into renal failure through their bu and creatinin and you probably want to put them on a cardiac monitor as well most patients will be on on a Telemetry box but if not the doctor May order that um watch for watch their magnesium because magnesium and potassium go hand in hand they will usually both go down together and if the potassium level is too I mean 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 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 patient love patients love to take them no not really or you can get a powder and you can mix it in a juice and um 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 Star a pottassium infusion very important to note you never ever ever give pottassium as an IV push a subq injection or an IM injection this is a popular type of test question they'll throw an option 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 I or subq 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 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 mil equivalents per hour and if the patient's receiving at least 10 mli equivalents 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 and so you want to watch for fitis which is inflammation of the vein you notice any redness or if it infiltrates meaning that the canal of the ivy came out of the vein and it leaked into the tissues okay next if you notice you're giving say you're giving a meds and the the patient has ordered some Lasix or Demodex a thide any type of diuretic that waste 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 pottassium level is low what do you want me to do about these medications because you can bottom their potassium out next um say the patient's getting dexin you would not you would want want to check you know their appical pulse you'd also want to check their potassium level with their am Labs because if you give dig whenever the pottassium level is low you can cause cause digge toxicity which is very bad so always as a nurse contact 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 type of diuretic that spares the pottassium 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 spyon aldactone aldactone is the other name for it dizide maxide and triamine these are ones that will actually save potassium okay okay 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 you have P for potatoes and pork o for oranges t for tomato 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 musk melons which is cantaloupe and then as aide 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 hyp B cemia 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