Fluid & Electrolytes Nursing Students Hyperkalemia Made Easy NCLEX Review
Summary
TLDRIn 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
📚 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.
🔍 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.
🩺 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.
Mindmap
Keywords
💡Hyperkalemia
💡Potassium
💡Intracellular and Extracellular
💡Nerve Conduction
💡Muscle Contraction
💡Cellular Movement
💡Renal Failure
💡Dialysis
💡EKG
💡Potassium-Sparing Diuretics
💡Hypertonic Solution
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
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