Fluid & Electrolytes Nursing Students Hyperkalemia Made Easy NCLEX Review

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

Channel: RegisteredNurseRN

Views: 685,462

Keywords: fluid electrolytes nursing, fluid electrolytes nclex, hyperkalemia, hypokalemia, fluid electrolytes nursing students, fluid electrolytes made easy, hyperkalemia and hypokalemia, hyperkalemia ekg, registerednursern.com, nclex review, nursing school, nurse, NCLEX

Id: -6b8svtDWys

Length: 13min 40sec (820 seconds)

Published: Wed Jan 06 2016