College of nursing ,

Allied hospital
Faisalabad,FMU

Topic: Urethral
Strictures
Presented to : Mam tallat-ul-Nisa
Presented by: Nimra Abubakar
Roll number: 54
Class: 2nd year
Batch: (B)
Table of content


 Defination
 Risk factors/causes
 Pathophysiology
 Clinical manifestations
 Physical assessment
 Diagnostic criteria
 Medical management
 Nursing management
 Nursing diagnosis
 Complications
 NCP
 Summary
 Reference
 Learning Objectives :
After this presentation students will be able to learn
that:
 Define the hypokalemia and hyperkalemia and
give the value range.
 Discuss the causes/ risk factors of potassium
imbalance.
 Illustrate the pathophysiology of hyperkalemia
and hypokalemia.
 Enlist the clinical manifestations of the disease.
 Describe physical assessment of hypokalemia
and hyperkalemia.
 Discuss the diagnostic criteria of disease.
 What are the complications of the potassium
imbalance.
 Give medical management of hypokalemia and
hyperkalemia.
 Discuss the nursing management of
hypokalemia and hyperkalemia.
 Illustrate the nursing diagnosis of disease.
 Illustrate nursing care plan of diseases.
 Summerize the topic.
Potassium imbalances:
 Potassium is major intracellular electrolyte.98%
of potassium is inside the cell. Remaining 2% is in
ECF. It is important for neuromuscular and cardiac
function.
 Alternation in potassium concentration can
change myocardial irritability and rythym.
 Normal serum potassium concentration ranges
from 3.5 to 5mEq/L
 Potassium imbalances are commonly associated
with various diseases, injuries, medications.
 80% of potassium excreted daily leaves body by
way of kidney . The other 20% is lost in bowel and
sweat .
 As serum potassium increases , so does
potassium that is excreted in urine .
 Aldosterone increase secretion of potassium by
kidney. Because kidneys don’t conserve potassium
as well as sodium, potassium may still be lost in
urine in presence of potassium deficit.
Defination:
Hypokalemia (serum potassium level below 3.5
mEq/L )
Usually indicates a deficit in total potassium stores .

Causes / Risk factors:

 Vomiting
 Renal disorders
 Self-inducing vomiting
 Diarrhea
 Cushing syndrome
 Alcohol abuse
 Poor dietary intake of potassium
 Alkalosis
 Hyperaldosteronism
 Drugs (Diuretics , laxative, levodopa)
 Very low calorie diet
Signs and symptoms:
 Myalgia
 Flaccid paralysis
 Abdominal distension
 Ventricular asystole
 Muscle cramps
 Muscle weakness
 Elevation of blood pressure
 Polyuria
 Decreased bowel motility
 Hypoactive reflexes
 Impairment of skeletal muscle function
 Low blood pressure
 Respiratory depression
Pathophysiology :
 Use of Diuretics(Thiazides, loop Diuretics)
  Medications like corticosteroids, Sodium
penicillin, Amphotericin
 Vomiting and gastric suction
 Hyperaldosterone
 Insulin promotes entry of potassium into cells
from bloodstream

Assessment and Diagnostic Findings:

Physical Examination:
General findings in hypokalemia includes:
 Skeletal  Depression  Irregular
muscle pain heartbeat
 Paralysis  Delirium  Abdominal
pain
 Constipation  Decreased  Paresthesia
deep tendon
reflexes
Laboratory tests:
• Complete blood count
• Blood Urea Nitrogen (BUN)
• Arterial blood gases
• Aldosterone level test
• Sweat chloride test

ECG changes:
ST segment depressed
Decreased T wave amplitude
Prominent U wave
Other diagnostic Studies:
Ultrasonography:
 Unilateral adrenal hyperplasia
 In primary hyperaldosteronism and Cushing
syndrome
Medical management:
 A potassium-sparing diuretic should also be
considered when the etiology of hypokalemia
involves renal potassium wasting as
potassium replacement therapy alone may
not suffice.
 Potassium chloride is the preferred
formulation for replacement therapy in most
cases.
Nursing management:
 Monitor for the signs and symptoms of
hypokalemia
 Monitor ECG continuously and strictly monitor
intake and output
 Assist client in selecting the foods rich in
potassium as such as banana,fruit juices and
melon,lean meats ,milk and whole grains.
 Administration of 40 to 60 mEq/ L of potassium
is adequate in adult if there are no abnormal
losses of potassium
 Patients receiving digitalis who are at risk for
potassium deficiency should be monitored
closely for signs of digitalis toxicity, because
potassium potentiates action of digitalis.
Nursing diagnosis:
 Altered electrolyte balance related to active
fluid loss secondary to vomiting and diarrhea
 Nutrition less than body requirement related to
insufficient intake of food rich in potassium.
Complications:

1)Cardiac arrhythmias
2)Cardiac arrest
3)Respiratory failure
4)Paralysis
5)Ileus
 NCP for Hypokalemia:
Assessment Diagnosis Planning Interve

Subjective Data: Altered Long term goal:  Mo

electrolyte sym
I am imbalance After 48 hours of Fati
experiencing (hypokalemia) nursing we
diarrhea for past related to interventions, dec
few days.Now, active fluid client will be able mo
my body feels loss to maintain dys
weak . secondary to serum potassium thr
Objective data: vomiting and level with in  Mo
1.Urine output diarrhea. normal range. con
is 400cc.  Stri
2.vomiting of Short term goal : of i
yellow fluid. out
3.Diarrhea After 1 hour of  Ass
watery stool health teaching,
sele
4.Febrile with client will be able
sele
Temperature to :
38.5 °C  Identify rich
 Ban
Laboratory measures to ,m
data: prevent fru
hypokalemia veg
Potassium level=  Participate in
2.5mEq/ treatment
regimen.

Defination:

The clinical condition in which serum

potassium level is greater than normal or
above 5 mEq/L.
Causes/Risk Factors:
 Muscle weakness
 Renal disorders
 Metabolic disorders
 Addison disease
 Hyperaldosteronism
 Addison disease
 Medications like KCL, heparin,ACE inhibitors
and potassium sparing diuretics
Clinical manifestations:
 Muscle weakness
 Urinary problems
 Abdominal distension
 Decreased cardiac contractility
 ECG changes
 Respiratory distress
 Paresthesia
 Intestinal coliec cramps
 Anxiety
Pathophysiology:
 Increased dietary Intake
 Shift of potassium from ICF to ECF such as
acidosis,beta blockers, Insulin deficiency,
periodic paralysis
 Decreased renal Excretion
 Medications like KCL, Heparin,Ace
inhibitors, NSIAD’s ,
cyclosporine ,Tacrolimus
 Medical Management:
i. Administration of cation exchange
resins (Sodium polystyrene sulfonate)
ii. Patiromer Sorbitex calcium is another
oral agent that is potassium removing
resin.it exchanges calcium for
potassium
iii. Gastrointestinal intolerance is side
effects
Nursing interventions:
 Monitor ECG changes.
 Administer calcium solutions to
neutralize the potassium.
 Monitor muscle tone
 Don’t draw blood above potassium
infusion site
 Monitor ABGs
 Insulin therapy will lead to shift
potassium into the cells
 Bicarbonate therapy
 Administration of Salbutamil by
nebulisation
 Hemodialysis or hemofiltration in
sever conditions
 Diuretics eg: furosemide
 Advice client to have Food with
minimum potassium content include
butter,margarine,ginger, jelly beans.
 Hard candy, gum drops, gummy bears
are kidney friendly candies.
Assessment and Diagnostic Findings:
 Physical examination:
Vitals:bradycardia (heart
block) ,Tachypnea (Respiratory muscle
weakness)
Lung assessment: decreased
chest expansion
Normal tactile fremitus
Abdomen assessment: normal bowel
sounds
Neurological assessment: muscle
weakness, flaccid paralysis, muscle
tenderness associated with muscle
weakness
 Laboratory findings:
 Complete blood counts
 Metabolic profile
 Urine potassium, Sodium and
osmolality
 Arterial or venous blood gas
(acidosis)
 ECG changes:
 Peaked T wave are earliest sign of
hyperkalemia
 Differential diagnosis of EKG
changes are bradycardia or stroke
 Loss of P wave , wide QRS complex
Nursing Diagnosis:
 Electrolyte imbalance
related to malnutrition
 Risk for injury related to
lower extremity muscle
weakness and seizures
 Risk for decreased cardiac
output related to dysrhythmias
 Ineffective breathing
patterns related to muscle
weakness and paralysis
  Diarrhea related to
neuromuscular changes and
irritability
Complications:
 Potentially fatal cardiac
dysrhythmias
 Heart failure
 Respiratory failure

Nursing Care Plan For Hyperkalemia

Assessmen Diagnosis Planning Interventio
t
Subjective Electrolyte Long term goal:  Mo
Data: imbalance After 48 hours of change
Complain (hyperkalemia nursing  Ad
of nausea ) interventions calcium
and Related to client will be able to neu
vomiting, Acute kidney to maintain serum potass
 shortness injury as potassium level  Mo
of breath, evidence by with in normal muscle
muscle higher range Short term Monito
pain potassium goal:  Ins
Objective level therap
data : After 1 hour of to shift
health teaching into th
EKG client will be able  He
changes: P to or hem
wave loss,  Identify in seve
tall peaked measures to conditi
QRS prevent  Diu
complexes hyperkalemia furose
and ST  Fo
segment  Participat low po
elevated e in treatment like bu
regimen marga
Increased , jelly b
potassium candy,
and gu
bears.

:
 Summary:
Hyperkalemia and hypokalemia are common
electrolyte disorders caused by changes in
potassium Intake, altered excretion or
extracellular shifts. Both imbalances of potassium,
hypokalemia and hyperkalemia, have muscle-
related symptoms, such as muscle weakness and
cramping; these can also affect the cardiac
muscle and cause arrhythmias. Hypokalemia can
also cause constipation, whereas hyperkalemia
can lead to abdominal pain or diarrhea.
References
 Brunner’s Siddharth Textbook of medical
Surgical Nursing volume #1 page number #243
 Pathology by Inam danish
 SlideShare from internet