Hypokalemia and Hyperkalemia ; Nurses assessment findings

 Hypokalemia and Hyperkalemia

HYPOKALEMIA

Cardiovascular 

• Thready, weak, irregular pulse.
• Weak peripheral pulses.
• Orthostatic hypotension. 

Respiratory 

• Shallow, ineffective respirations that result from profound weakness of the skeletal muscles of respiration. 
• Diminished breath sounds. 

Neuromuscular 

• Anxiety, lethargy, confusion, coma.
• Skeletal muscle weakness, leg cramps.
• Loss of tactile discrimination. 
• Paresthesias.
• Deep tendon hyporeflexia.

Gastrointestinal 

• Decreased motility, hypoactive to absent bowel, sounds.
• Nsusea, vomiting, constipation, abdominal distension. 
• Paralytic ileus

Laboratory findings 

• Serum potassium level lower than 3.5 mEq/L (3.5mmol/L)
• Electrocardiogram changes: ST depression ; shallow, flat, or inverted T wave; and prominent U wave. 

HYPERKALEMIA

Cardiovascular 

• Slow, weak, irregular heart rate.
• Decreased blood pressure. 

Respiratory 

• Profound weakness of the skeletal muscles leading to respiratory failure. 

Neuromuscular 

• Early: muscle twitches, cramps, paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
• Late: profound weakness, ascending flaccid paralysis in the arms and legs ( trunk, head, and respiratory muscles become affected when the serum potassium level reaches a lethal level.)

Gastrointestinal 

• Increased motility, hyperactive bowel sounds
• Diarrhea 

Laboratory findings 

• Serum potassium level that exceeds 5.0 mEq/L ( 5.0mmo/L)
• Electrocardiographic changes: Tall peaked  T waves, flat P waves, widened QRS complexes, and prolonged PR intervals.