Hypokalemia symptoms

Hypokalemia Symptoms Question

A home health nurse visits a client 2 weeks after discharge from the hospital.  The client experienced an acute myocardial infarction and subsequent heart failure.  Home medications are listed in the exhibit.  Which symptom reported by the client is most concerning to the nurse?

  1. Bruising easily, especially on arms
  2. Fatigue
  3. Feeling depressed
  4. Muscle cramps in legs


Hypokalemia Symptoms Answer

Correct answer
4-Muscle cramps in legs

Hypokalemia Symptoms  Explanation:

The nurse would be most concerned with the client’s report of muscle cramps in the legs.  This could be a sign of hypokalemia caused by use of the diuretic furosemide or possibly a reaction from the statin medication atorvastatin.

Hypokalemia may manifest as muscle cramps, weakness, or paralysis and typically starts with the leg muscles.  Hypokalemia could be dangerous in this client due to possible arrhythmias in the presence of existing cardiac dysfunction.  The client may need to be started on supplemental potassium and a high-potassium diet if the serum potassium level is low.  If the potassium level is normal, atorvastatin may be responsible for muscle cramps.

(Option 1)  Bruising, especially on the upper extremities, is common with the use of antiplatelet agents such as aspirin and clopidogrel.  The nurse should teach the client to monitor for other, more severe signs of bleeding, such as blood in the stool.

(Option 2)  The myocardial infarction and heart failure have most likely reduced the client’s functional capacity and can cause fatigue.  Beta blockers such as metoprolol can also cause fatigue.  This will improve with time, and the nurse should talk to the client about possible cardiac rehabilitation.

(Option 3)  Feeling depressed is common after an acute health-related event such as a myocardial infarction.  The client needs to be evaluated further and may need an antidepressant.  However, feelings of depression are not immediately life-threatening unless the client exhibits suicidal ideation.

Educational objective:
The nurse should recognize muscle cramps in the legs as a possible sign of hypokalemia in the client taking diuretics.  Muscle cramps should be reported to the health care provider in anticipation of checking a potassium level, adding a potassium supplement, and instructing the client to eat potassium-rich foods.

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