hi guys it's me professor d and welcome back to my youtube channel on this video i'm going to be covering hyperkalemia and i've i've already covered hypokalemia i've done treatment hyponatremia you don't have to necessarily watch it in any order but it would make sense to keep your hypers and your hypo together don't just mix around but you can watch in any order but i strongly encourage you to watch the entire series i'm not done with the series yet but i will do a an entire series on the fluids and electrolytes and i encourage you to watch the entire series before i get started guys please don't forget to like this video subscribe to the channel if you haven't done so already and engage with me in the comment section really helps my algorithm let me know what you thought about this video and something i noticed that you guys really don't do much which if i were a nursing student i would do talk to each other in the comment section if you're struggling with something and you're 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audio lessons available for you on my website nexusnursinginstitute.com and you guys can catch me covering different types of questions almost daily on my other social media platforms such as facebook tick tock and instagram so guys with that being said let's get started hyperkalemia now i always like to put the range just to remind you the normal therapeutic range for potassium is 3.5 to 5. very narrow therapeutic range 3.5 to 5 and anything outside of that therapeutic range we have problems specifically cardiac problems but you know there are lots of other problems as well so just make sure that you understand your therapeutic range is 3.5 to 5 anything less than 3.5 you're hypokalemic anything higher than 5 you're hyperkalemic so let's look what it says it says hyperkalemia is an electrolyte imbalance in which the serum potassium level is higher than five look at this guys even small increases above the normal values can cause excitable tissues especially what the heart when it comes to potassium that's going to be your biggest concern that's what you need to be thinking about the heart the heart is very sensitive to serum potassium increases leading the heart block and v-fam ventricular fibrillation sudden potassium rises cause severe problems at serum levels between six and seven but when it rises slowly problems cannot occur until the potassium level reaches eight or higher so the speed at which that level increases also makes a big difference hyperkalemia is rare in people with normal kidney function why is that because patients with normal kidney function they urinate normally and the potassium comes out of the urine normally right if the kidney is working properly it will reabsorb the correct amount of potassium need needed we really get into problems when that that kidneys not working the way that it's supposed to be working those at greatest risk are those that are chronically ill those that are debilitated which means they're not moving around and older patients and it makes sense because with those older patients the kidney function is going to um decline just because wear and tear of the body right let's take a look at assessment for you you're going to ask the patient about kidney disease because the reason i just explained you're going to ask them about diabetes recent medical or surgical treatment and urine output and even the amount of voidings and i put an arrow down here all of these things you're asking about you're asking them to try to lead you to an idea of the potential reason for hyperkalemia and we'll go over this list in a little bit but this list are reasons that the patient may possibly be hyperkalemic so that's why you're asking about it cardio oh i skipped something let's go up here you're going to ask uh whether the patient has palpitations skipped heartbeats other cardiac irregularities muscle twitching leg weakness unusual tingling or numbness around the face or feet that's what's known as paresthesia you're going to ask about changes in bowel habits especially diarrhea why this whole paragraph everything here that i just mentioned are signs and symptoms of hyperkalemia you're going to ask the patient about medications possibly being taken ask them about potassium sparing diuretics that essence bearing such as spiritolactone makes you hold on to potassium and that can cause the patient to be hyperkalemic so you're going to ask them about a potassium sparing diuretic such as spirulina lactone you're going to ask them about ace inhibitors that can increase the potassium you're going to ask them about the use of salt substitutes patients who are hypertensive and they've been told to stay away from salt but they like their food season they like their food with that salty taste they may use salt substitutes not realizing that salt substitutes are high in potassium it's got hidden potassium in it so you're going to ask the patient about those okay cardiovascular changes are the most severe form um problems of hyperkalemia and are the most common cause of death in patients with hyperkalemia and that's why when it comes to hyperkalemia we're going to be thinking about the heart we're going to be concerned about these heart issues let's talk about the heart issues bradycardia that low heart rate remember your heart rate's supposed to be 60 to 100 not supposed to drop lower than 60 hypotension low blood pressure ecg changes what would we see on the ecg tall peak t waves prolonged pr pr intervals flat or absent p waves and y qrs complexes professor d do i have to memorize this do i have to know this absolutely you're going to see this again complete heart block a systole and v-fib are life-threatening complications of severe hyperkalemia don't know why i didn't have that highlighted different color but you need to know that the complete heart block a systole and ventricular fibrillation those are life-threatening complications of hyperkalemia and you see hyperkalemia has lots of complications but this will kill you faster let's talk about the neuromuscular changes in the early stages of hyperkalemia we'll see muscle twitching we'll see muscle irritation right we'll see tingling and burning sensations followed by numbness in the hands and feet and around the mouth that's their paresthesia but acid as the hyperkalemia gets worse we go from muscle irritation and muscle twitching to muscle weakness right we now see flaccid paralysis it's so weak that those muscles are basically paralyzed we see flaccid paralysis and look at the big difference this is a big difference between hypo and hyperkalemia in hyperkalemia the respiratory muscles aren't affected until the serum potassium level reaches lethal levels look at this respiratory muscles are not affected until serum potassium levels reach lethal levels intestinal changes remember in hypokalemia everything was slow patient could have even had the paralytic ileus the um um what's that word i'm looking for what's that word it's gonna come to me but the movement what moves the fecal matter through the gi tract is not coming to me but it's very um slow here the motility's increased right in hypokalemia we see constipation in hyperkalemia we see increased motility we see diarrhea we see hyper active vowel sounds laboratory data obviously the potassium is gonna be higher than five normal potassium three point five to five if it's hyperkalemia it's going to be higher than five interventions drug therapy that is our key we're going to give the patients medications to bring that potassium back down the priorities of nursing care for the patient with hyperkalemia are assessing for cardiac complications because remember that's what's going to kill the patient the fastest with hyperkalemia those heart issues we're going to assess them for cardiac complications we're going to make sure they're safe because at first they have that muscle it's itching muscle itching muscle twitching right muscle irritation then as it worsens we have muscle what society paralysis so safety is definitely going to be an issue and we're going to monitor the patient's response to therapy the drugs that we're giving is it working is it doing the job because if not we have to place a phone call to the physician or the healthcare provider i should say we're going to stop potassium potassium-containing infusions any infusions that have potassium we're going to stop it patients already hyperkalemic we don't want to make it worse we're going to keep the iv access open we're going to withhold potassium supplements they don't need any more potassium and we're going to put them on a potassium restricted diet and we're going to talk about that potassium restricted diet in a minute because if the patient's hyperkalemic it's important to know what kind of foods to avoid stay away from those foods that are high in potassium where the patient's hypokalemic those same foods that the hyperkalemic patient would avoid we would tell them to eat those type of foods to bring up that potassium so those type of foods are very important to know we'll talk about that in a minute if potassium levels are dangerously high additional measures such as dialysis are going to be needed because we're going to have to bring down the potassium level iv fluids containing glucose and insulin are prescribed to help decrease serum potassium level that's very important so um i talked about this briefly but i talk about this extensively in burns if you want to know about it go back to my video i did about burns but as you know when um we giving that patient insulin we're going to be watching the patient's potassium because giving them the insulin is going to bring down that potassium but we want to make sure we don't over correct the problem and turn them into a hypokalemic patient so that is very important to know i put a star next to it don't say i didn't warn you uh these iv solutions you need to know that they're hypertonic and they're infused through a central line remember guys who's the only patient that can give only patient who is the only one that can give the central lines the registered nurse not the lpn not the lvn so when it comes to this is the rn that's going to be given this infusion okay it needs to be given to a central line or in a vein with high blood flow to avoid local vein inflammation observe the patient for manifestations of hypokalemia because remember us dropping that potassium we might drop it a little bit too much and now we threw them into hypokalemia so we're going to assess them for hypokalemia and hypoglycemia during this therapy why hypoglycemia professor d remember the insulin the insulin that we're giving that's bringing down the potassium it also brings down patients blood sugar what kills the patient faster hyperglycemia or hypoglycemia hypoglycemia so make sure the same insulin we're giving this patient does it cause another set of problems that also kills our patient this is a lot to juggle as a nursing student it's a lot to remember it's a lot to think about but that's why you guys have me this is very important though guys do not forget it cardiac monitoring cardiac monitoring this patient that has hyperkalemia that we're trying to bring that potassium down you better bet your bottom dollar they're going to be on a tele modern monitor they better be critical rescue notify the health care provider or rapid response team if the patient's heart rate falls below 60 beats per minute remember bradycardia is one of those complications of hyperkalemia heart rate's supposed to be 60 to 100 so you better be calling somebody if that heart rate is lower than 60 or if the t waves become spikes both of which accompany hyperkalemia make sure you know those complications health teaching is key to the prevention of hyperkalemia and the early detection of its complications it's always better and easier to prevent than to treat the teaching plan includes diet we're going to teach them the foods high in potassium to stay away from drugs giving them those food giving them foods giving them those medications to decrease the potassium and recognition of the manifestations of hyperkalemia once you see those signs and symptoms you can call the health care provider get in order get those labs drawn to confirm and um perform those nursing interventions as appropriate you're going to collaborate with the dietitian as far as the food and nutrition and teaching is concerned instruct the patient and family to read the labels on drug on drug and food packages so they don't accidentally cause hyperkalemia and warn them to avoid salt substitutes salt substitutes are high in potassium now let's take a look of the foods that they need to avoid when their potassium is high the foods the patients should avoid with hyperkalemia meat especially organ meats organ meats are high in potassium preserved meat such as the bolognese right dairy products dry fruits i put the star next to it because as far as questions are concerned that shows up a lot so does the meat fruits high in potassium bananas that's right up on the list cantaloupe kiwi oranges vegetables high in potassium avocados broccoli uh potatoes potatoes that shows up a lot on nclex i don't know why they like potatoes but it does so make sure you know it um spinach and on the other side our list of foods that the patient can eat you guys read that on your own i'm not going to go over that but make sure you know this entire list of the foods that the patient with hyperkalemia needs to stay away from that they need to avoid guys that is your hyperkalemia in a nutshell not as hard or scary as we thought it was so go ahead let me know what you thought about this video in the in the comment section let me know what you'd like to see me cover if you need help in something listen ask your fellow viewers for help go ahead plug that in the comment section you don't never know who's willing to help you don't forget i have audio lessons available on my website nexusnursinginstitute.com guys thank you for watching this video and you guys will catch me on the next video