Fluid & Electrolytes Nursing Students Hyperkalemia Made Easy NCLEX Review

Summary

In this educational video, Sarah from registernurseRN.com discusses hyperkalemia, a condition characterized by high levels of potassium in the blood. She contrasts it with hypokalemia, covered in a previous video, and emphasizes the importance of understanding both for nursing exams. Sarah breaks down the term 'hyperkalemia', explains the normal potassium range, and outlines the dangers of levels exceeding 7. She delves into the cellular mechanics, causes, symptoms, and treatment options, including the use of K exelate and hypertonic glucose with insulin. The video concludes with a recommendation to take a quiz on the website for further practice.

Takeaways

• 😀 Hyperkalemia refers to a high level of potassium in the blood, with normal levels being 3.5 to 5.1 mmol/L and levels above 7 mmol/L being dangerous.
• 🔬 The term 'hyperkalemia' can be broken down into 'hyper' meaning excess or high, 'kal' from 'potassium,' and 'emia' indicating blood, thus meaning high potassium in the blood.
• 🌐 Potassium is primarily found inside cells (intracellular), but in hyperkalemia, it shifts to the outside (extracellular), affecting blood test results.
• 🏥 Causes of hyperkalemia include cellular shift, adrenal insufficiency, renal failure, excessive potassium intake, and certain drugs like potassium-sparing diuretics and ACE inhibitors.
• 🏃‍♂️ Signs and symptoms of hyperkalemia include muscle weakness, decreased urine output, respiratory failure, decreased cardiac contractility, muscle twitching and cramps, profound weakness, and rhythm changes on EKG.
• 📊 EKG changes in hyperkalemia include tall, peaked T-waves, flat or absent P-waves, wide QRS complexes, prolonged PR interval, and potentially life-threatening cardiac arrhythmias.
• 🛑 Interventions for hyperkalemia involve monitoring cardiac, respiratory, neuro, muscular, and GI status, stopping IV potassium infusions, initiating a potassium-restrictive diet, and preparing the patient for possible dialysis.
• 🥗 Foods high in potassium, which should be restricted in hyperkalemia, include potatoes, pork, oranges, tomatoes, avocados, strawberries, spinach, fish, mushrooms, muskmelon, carrots, raisins, and bananas.
• 💊 Medications that may be used to treat hyperkalemia include K-exelate (sodium polystyrene sulfonate), Lasix (furosemide), and insulin with glucose to drive potassium back into cells.

Q & A

What is hyperkalemia?

Hyperkalemia refers to a condition where there is an abnormally high concentration of potassium in the blood. It is characterized by a potassium level higher than the normal range of 3.5 to 5.1 mmol/L, with levels above 7 mmol/L being considered dangerous.

What are the normal potassium levels in the blood?

The normal potassium levels in the blood are typically between 3.5 to 5.1 mmol/L, although some sources may vary slightly and consider the range to be 3.4 to 5.2 mmol/L.

How does potassium move from intracellular to extracellular fluid in hyperkalemia?

In hyperkalemia, potassium shifts from the intracellular fluid to the extracellular fluid due to factors such as tissue damage, burns, or acidosis, leading to an increased concentration of potassium in the blood.

What are the causes of hyperkalemia as described in the video?

The causes of hyperkalemia include cellular movement of potassium, adrenal insufficiency, renal failure, excessive potassium intake, and certain drugs such as potassium-sparing diuretics, ACE inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs).

What is the significance of the acronym 'CARED' in relation to hyperkalemia?

The acronym 'CARED' is used to remember the causes of hyperkalemia: Cellular movement, Adrenal insufficiency, Renal failure, Excessive intake, and Drugs.

What are the clinical signs and symptoms of hyperkalemia?

Clinical signs and symptoms of hyperkalemia include muscle weakness, decreased or absent urine production, respiratory failure, decreased cardiac contractility, muscle twitching and cramps, profound weakness, and rhythm changes on an EKG.

What does the word 'MURDER' help remember in the context of hyperkalemia?

The word 'MURDER' is a mnemonic to remember the signs and symptoms of hyperkalemia: Muscle weakness, Urine output issues, Respiratory failure, Decrease in cardiac contractility, Early muscle twitching, Late profound weakness, and Rhythm changes.

What are the key differences in an EKG reading for a patient with hyperkalemia?

In hyperkalemia, EKG changes include tall, peaked T-waves, flat or absent P-waves, wide QRS complexes, prolonged PR interval, and potentially cardiac arrest rhythms like ventricular fibrillation or tachycardia.

What interventions are recommended for a patient with hyperkalemia?

Interventions for hyperkalemia include monitoring cardiac, respiratory, neuromuscular, and GI status, stopping IV potassium infusions or oral supplements, initiating a potassium-restrictive diet, preparing the patient for possible dialysis, administering K exelate, using potassium-wasting drugs like Lasix, and administering hypertonic glucose and insulin to shift potassium back into cells.

How can one remember which foods are high in potassium?

A mnemonic to remember foods high in potassium is 'POTAS': Potatoes, Pork, Oranges, Tomatoes, Avocados, Spinach, Strawberries, Fish, Mushrooms, Muskmelon, Carrots, Raisins, and Bananas.

Outlines

00:00

📚 Introduction to Hyperkalemia

Sarah from registernurseRN.com introduces the topic of hyperkalemia, contrasting it with the previously discussed hypokalemia. She emphasizes the importance of understanding hyperkalemia for lectures, exams, and the in-service exam (inlex). Sarah suggests visiting her website to take a quiz on hyperkalemia and hypokalemia after watching the video. She breaks down the term 'hyperkalemia' into 'hyper' meaning excess or high, 'kal' for potassium, and 'emia' for blood, indicating high potassium levels in the blood. Normal potassium levels are specified as 3.5 to 5.1, with levels above 7 being dangerous. Sarah then explains the cellular level of potassium, noting that potassium is typically found inside cells but can move to the extracellular fluid, leading to high blood potassium levels. She discusses the roles of potassium in nerve conduction and muscle contraction, and how high levels can cause issues with muscles and nerves, manifesting in various symptoms.

05:02

🔍 Causes and Symptoms of Hyperkalemia

The paragraph delves into the causes of hyperkalemia, using the acronym 'CARED' to remember them: Cellular movement of potassium, Adrenal insufficiency, Renal failure, Excessive potassium intake, and Drugs. Sarah explains how each cause can lead to an increase in extracellular potassium. She then describes the signs and symptoms of hyperkalemia using the mnemonic 'MURDER': Muscle weakness, Urine production issues, Respiratory failure, Decrease in cardiac contractility, Early muscle twitching and cramps, and Late profound weakness and Rhythm changes. Sarah provides a detailed explanation of how each symptom relates to the role of potassium in the body, particularly affecting muscles and the heart. She also discusses the importance of recognizing these symptoms clinically and how they can be remembered using the provided mnemonic.

10:03

🩺 Managing Hyperkalemia

Sarah discusses the interventions for hyperkalemia, focusing on the importance of monitoring the patient's cardiac, respiratory, neuromuscular, and GI status due to potassium's role in nerve and muscle function. She advises stopping IV potassium infusions and PO supplements, initiating a potassium-restrictive diet, and preparing the patient for possible dialysis. Sarah also mentions the administration of K exelate, Lasix, and hypertonic glucose with insulin as potential treatments to lower potassium levels. She emphasizes the need to recognize potassium-rich foods to educate patients on dietary restrictions. The paragraph concludes with a reminder to visit Sarah's website to test knowledge on hyperkalemia and a call to action to subscribe to her YouTube channel for more educational content.

Keywords

💡Hyperkalemia

Hyperkalemia refers to a condition where there is an abnormally high concentration of potassium in the blood. In the video, it is the main topic discussed, and the script provides an overview of its causes, symptoms, and treatments. The video aims to educate on how to identify and manage hyperkalemia, a critical topic for healthcare professionals.

💡Potassium

Potassium is an essential electrolyte that plays a crucial role in nerve conduction and muscle contraction. The video script explains that hyperkalemia involves a high level of potassium in the blood, which can be dangerous. The term 'K' is used in the script to denote potassium, emphasizing its importance in the context of the video.

💡Intracellular and Extracellular

These terms describe the location of substances within or outside of cells, respectively. The script explains that potassium normally resides inside cells (intracellular) but in hyperkalemia, it shifts to the outside (extracellular), leading to increased blood potassium levels. This shift is central to understanding the pathophysiology of hyperkalemia.

💡Nerve Conduction

Nerve conduction is the transmission of signals along nerve fibers, which is vital for the proper functioning of the nervous system. The video script connects hyperkalemia to nerve conduction, noting that high potassium levels can disrupt this process, leading to symptoms such as muscle weakness and potentially life-threatening conditions.

💡Muscle Contraction

Muscle contraction is the process by which muscles generate force and movement. The script mentions that potassium is responsible for muscle contraction, and hyperkalemia can interfere with this function, causing muscle weakness and other symptoms that are critical for patient assessment.

💡Cellular Movement

Cellular movement, as discussed in the script, refers to the shift of potassium from inside cells to the extracellular fluid, which can lead to hyperkalemia. This concept is essential for understanding one of the mechanisms behind the condition and how it can be influenced by factors like tissue damage or acidosis.

💡Renal Failure

Renal failure is a condition where the kidneys fail to function properly, often leading to the accumulation of waste products and electrolytes like potassium in the blood. The video script identifies renal failure as a cause of hyperkalemia, highlighting the importance of kidney function in maintaining electrolyte balance.

💡Dialysis

Dialysis is a medical treatment for patients with renal failure that helps to remove waste products and excess electrolytes from the blood. The script mentions dialysis as a treatment option for patients with hyperkalemia, emphasizing its role in managing potassium levels in patients with compromised kidney function.

💡EKG

An EKG, or electrocardiogram, is a test that measures the electrical activity of the heart. The video script uses EKG changes as a diagnostic tool for hyperkalemia, noting specific abnormalities like tall T-waves and flat P-waves that can indicate high potassium levels and potential cardiac risks.

💡Potassium-Sparing Diuretics

Potassium-sparing diuretics are medications that help the body retain potassium, which can be beneficial in some conditions but risky in hyperkalemia. The script warns about these drugs, advising healthcare professionals to be aware of their potential to contribute to high potassium levels.

💡Hypertonic Solution

A hypertonic solution is one with a higher concentration of solutes than the surrounding medium, which in the context of the video, is used to draw potassium back into cells. The script describes the administration of a hypertonic glucose and insulin solution as a treatment to correct hyperkalemia by shifting potassium from the extracellular to the intracellular space.

Highlights

Introduction to hyperkalemia, a condition characterized by high levels of potassium in the blood.

Normal potassium levels range from 3.5 to 5.1, with levels above 7 being dangerous.

Hyperkalemia affects cellular function, particularly impacting nerve conduction and muscle contraction.

Causes of hyperkalemia include cellular movement of potassium, adrenal insufficiency, renal failure, and excessive potassium intake.

Mnemonic 'CARED' to remember the causes: Cellular movement, Adrenal insufficiency, Renal failure, Excessive intake, Drugs.

Signs and symptoms of hyperkalemia include muscle weakness, low urine output, respiratory failure, and changes in cardiac rhythm.

Mnemonic 'MURDER' to remember the symptoms: Muscle weakness, Urine output issues, Respiratory failure, Decrease in cardiac contractility, Rhythm changes.

EKG changes in hyperkalemia include tall T-waves, flat P-waves, and wide QRS complexes.

Comparison of a normal EKG to one showing hyperkalemia, highlighting the differences in P-waves, QRS complexes, and T-waves.

Importance of monitoring a patient's cardiac, respiratory, neuro, muscular, and GI status in hyperkalemia.

Interventions for hyperkalemia include stopping IV potassium infusions, initiating a potassium-restrictive diet, and preparing for dialysis.

Use of K exelate and Lasix as medical treatments to reduce potassium levels.

Administration of hypertonic glucose and insulin to encourage potassium to move back into cells.

Educational resources available on register nurse rn.com for further learning and quizzes on hyperkalemia.

Recommendation for viewers to take a quiz on hyperkalemia and hypokalemia to test their knowledge.

Encouragement for viewers to explore other teaching tutorials and subscribe to the YouTube channel for more educational content.

Transcripts

hey everyone it's Sarah with register

nurse ran.com and in this video I'm

going to go over

hyperkalemia in my previous video I went

over hypokalemia so be sure to check

that video out so you can refresh your

knowledge on that but in this video what

I'm going to do is I am going to give

you an overview of the things that

you're going to need to know for your

lecture exams and for the inlex I want

to hit the high points to make sure you

understand it and then after this video

I highly recommend you go to my website

register nurse rn.com and take the quiz

that goes along with this lecture it's

going to quiz you on hyperemia and hypo

calmia and make sure you know the

difference and you may see some of those

questions on your lecture exam um you

can get that link in the description

below or a card will be popping up so

you can have access to that so let's get

started first let's talk about

hyperia okay what I like to do whenever

I have these big words like that I like

to break them apart because you have a

lot of hyper and hypo conditions and you

need to know exactly what you're dealing

with so let's break it apart you have

hyper hyper means excess High you have

cow k a l which means pottassium that's

the root word for potassium and then you

have emia which means blood so you put

it all together it means high potassium

in the blood so what is a normal

pottassium level a normal potassium

level is 3.5 to

5.1 some books say 3.4 to 5.2 depends on

who you're asking but that is what I go

by and anything higher than seven is

dangerous and the patient

needs interventions fast okay so let's

talk about hyperemia on a cellular level

to help you understand it because

whenever I'm studying stuff that really

helps me if I can see the picture of it

and get a real understanding of what it

is okay so your cell here is your cell

and in your cell you have the organel

and it is made up of a lot of different

electrolytes and then outside your cell

which is the extracellular the inside of

the cell is intracellular and then

outside is extracellular you have your

blood and in your blood you have all

these awesome little things and we have

some sodium potassium among things and

potassium loves to live intracellular

that is its home but it does make up the

extracellular fluid there are some in

the blood now whenever you're getting a

blood test for pottassium so whenever a

doctor orders a potassium level or an

electrolyte level on a patient they are

seeing how much potassium is in the

blood not inside the cell so that's what

blood levels look at they look at the

extracellular potassium so normally

what's happened with

hyperemia is that your pottassium which

has congregated a lot in the cell has

moved outside into this extracellular

fluid so your blood test is picking up

lots of pottassium which can cause us

trouble now remember potassium is

responsible for nerve conduction and

muscle contraction and when you have too

much pottassium the body starts doing

some crazy things and that's going to

help you remember what's causing it and

your signs and symptoms because it's

going to be dealing with those muscles

and nerves and that's why you're going

to be seeing these symptoms so first

let's talk about the causes of

hyperemia okay I have thought of this

phrase to help us remember now remember

hyperemia you have too much potassium so

remember this phrase your body's cared

too much for pottassium it loves it so

it's cared way too much for it so it

decided to keep too much of it around

and the key word is cared c a r e d so

let's remember it through this little

pneumonic acronym okay c one cause is

cellular movement of potassium from the

intracellular this part right here to

extracellular and this happens whenever

a patient is burned they have any other

type of tissue damage or they're

experien acidosis now remember in

hypokalemia a patient can have that due

to alkalosis so it's the opposite okay a

for adrenal

insufficiency and this is seen in

Addison disease now remember in

hypokalemia you have

cushen um disease with that okay R for

renal failure you will see a lot of

patients who get dialysis all the time

one of the top things is that their

potassium levels will be crazy high and

they go and get dialysis and it takes it

off and they're a lot better so renal

failure e for excessive potassium intake

they've consumed too much potassium or

maybe they're diuretic which we'll get

here to it in a second um has con

conserved way too much potassium maybe

they've overdosed on their supplement or

something like that or um their kidneys

aren't working good so they've been

keeping the potassium and then D for

drugs um your potassium sparing drugs

will keep that and you need to remember

those these are test questions you'll be

given a scenario and you'll need to know

drugs that are potassium wasting

diuretics and potassium sparing

diuretics and your pottassium sparing Di

itics are your

alao triamine are your major ones and

then you also have what's called ACE

inhibitors these are cardiac medications

and they will mess with your potassium

levels and so will ineds like ibuprofen

things like that okay so those are the

causes of hyperemia now let's look at

the signs and symptoms how is a patient

going to present clinically to you a

great way to remember this is the word

murder okay remember hyperemia can be

dangerous it's going to murder them so

murder okay M muscle weakness like we

said potassium is Big with your muscles

and your nerve conduction so you're

going to have muscle weakness every it's

not going to work right you urine

production will be low or probably

absent because they're in renal failure

patients who have renal failure they

don't urinate so not going to have good

urinary output respiratory failure R for

respiratory failure and this is because

whenever you breathe we use our

accessory muscles those aren't going to

be working very well patients in

alkalosis too I mean acidosis too and

you can also have seizures with this so

that's going to cause respiratory

failure D for decrease cardiac contract

ability um this the patient will have a

decreased pulse their pulse will be weak

whenever you f it and they'll have a low

blood pressure e for early signs of mus

muscle twitching and cramps again that

goes back to potassium's roll in your

muscle conduction so you'll have that

and a late sign meaning this isn't good

they will have profound weakness

literally just can't move it's almost

like they're paralyzed or flaccid and

then R last part is rhythm changes and

this is another thing you definitely

need to pay attention to I'm going to

show you what a normal EKG looks like

and then I'm going to show you another

EKG with hyperemia but let's talk about

what you can see okay what will you see

Rhythm change you will see tall peaked

t- waves you will see flat p waves or

they may be absent may not even be there

at all and you can see wide QRS

complexes a pro or a prolong PR interval

and then this will advance the cardiac

arrest like vfib vtac anything like that

so let's take a look at what a normal

EKG looks like and then compare it to a

one of a person in hyperemia first let's

look at the normal kg okay you have your

P wve right here it's nice a big little

hump then you have a little dip called

The Q and then you have a spike called

the r and then a dip called the S and

then an and then a little segment and

then a t-wave notice how you have the

prominent little r wve then you have the

PRS complex it's nice and narrow and

then you have a mediumsized t-wave that

is normal now let's look over here okay

this is not normal if you see this this

is funky okay one thing is that you're

going to have flat p waves p waves start

right here notice how this is nice and

round this right here there is nothing

there it's pretty much flat it's very

low then you're going to have a p

interval which is prolonged notice right

here starts the PR interval where I'm

going up and down and then it ends right

here notice it's super short there's

like no lengthening but here your P way

your PR interval would start here and

then over here and notice how long that

is that is super long that's a prong PR

interval not good at all then you can

have QRS complex lengthening it's

widening notice how narrow this is over

here this one is not it's very very wide

anything greater than

0.12 squares whenever you're measuring

this out seconds is too wide then you

can also have the tall t-wave notice how

this t wave it's a little bit bumpy

nothing major it's normal but this

t-wave is tall peeking up it's peeking

up almost where your QRS complexes so

that is absolutely abnormal now one way

to try to remember this because I know

it can get really confusing hyper

everything's increased it's it's big

it's it's going all out so remember the

QRS complex it's super wide it's big and

your t-wave is going to be really tall

and really big a lot of patients are

going to have that t-wave I've seen that

a lot in the clinical setting so just

remember it's just going to be tall and

exaggerated your PR interval is just

going to be tall and exaggerated

everything's hyper and then your p-wave

he's just a little bit flat and boring

so just try to remember that especially

the t-wave that's a really big exam

question now let's take a look at the

interventions this is the part you

definitely want to pay particular

attention to because this is where a lot

of test questions are going to come from

because you're going to be given a

scenario and you're going to need to

know what to do for this patient with

hyperemia as the nurse and you need to

know what's the doctor going to order

what to be looking out for and things

like that okay so first you want to

monitor the patients cardiac status

respiratory status their neuro status

muscular status and GI status because

remember potassium is responsible for

Nerf conduction and muscle conduction

and all these systems are going to be

affected so put them on a cardiac

monitor an spo2 monitor things like that

stop IV potassium infusions if the PA

patient has them running or hold any po

supplements if they're getting those and

call the doctor initiate a potassium

restrictive diet and a lot of times

these tests will ask you the patients T

eating this this and this which foods

should they stop and they're going to

test your knowledge so you want to know

what potassiums are rich in I mean what

foods are rich in potassiums and a

clever way to remember that have the

word potassium written out and P is for

potatoes and pork O is for oranges T is

for Tomatoes A is for a avocados s is

for strawberries the other s is for

spinach and then I fish use the I and

the fish and then U for mushrooms the U

and the mushrooms you can put that there

and then M for muskmelon which is a

cantaloupe and then as a side there's

carrots raisins and bananas but those

are the lot of the foods that questions

are going to ask and you need to know

that those are potassium rich and also

for hypokalemia you want to know that as

well because you'll want to actually

encourage the patients to eat that and

next you'll want to prepare the patient

for dialysis again a lot of these

patients who are having hyperkalemia are

dialysis renal patients and going to

dialysis will help relieve this if not

if they've never had dialysis before

you'll probably start needing to prepare

and educate them how that's going to

take place um another thing a doctor May

order is called K exelate it can be

given by mouth or an enema the enema

tends to be the most popular route and

it what it does is it causes GI

enters the GI system and it causes

sodium absorption which will promote the

excretion of potassium next the doctor

May order Lasix remember Lasix is a

potassium wasting drug it'll cause them

to urinate a lot and get rid of that

potassium or other potassium wasting

drugs so make sure you know those um

another category is the thide like

hydrocor thide and of course you would

stop those um sparing potassium drugs

and the doctor May order a hypertonic

solution of glucose and Insulin regular

insulin and what this does is it will

cause potassium to be pulled back into

the cell because remember that cell

drawing we had what's happened is that

normally potassium lives inside the cell

and it's moved outside of the cell into

the extracellular fluid so giving this

hypertonic solution will cause that

potassium to go back into the cell which

is where we want it okay so that is

about hyperemia now I encourage you to

go to my website register nurse rn.com

and test your knowledge on this

information and thank you so much for

watching and please be sure to check out

my other teaching tutorials and consider

subscribing to this YouTube channel