Acknowledgement (Autosaved)

UNIVERSIDAD de MANILA

AcknowledgementIn completing this case study, the members of

this group encountered many individuals

who helped by offering their time, knowledge,

and skills.

Before the formal beginning, the group

would like to give thanks and acknowledge those

Individuals who made this study complete.

The group would like to first give thanks to

the patient, and his family, in being more than

hospitable in providing necessary information in

completing the family history and allowing the

physical assessment to be done completely.

The researchers would like to thank the staff

of Justice Jose Abad Santos General Hospital,

who helped to

clarify many things from the chart and also

giving bits of information

concerning to the patient and his treatments.

1UNIVERSIDAD de MANILA


The entire team would also like to give

special thanks to their clinical instructors,

for giving them pieces of advice based on case

studies presented in the previous rotations, so

that they may be strengthened somehow.

And last but not least, To the God Almighty,

Although this case study was made and

passed at such a turbulent time,

it was through God’s will that it had been

completed.

It was completed with whole-heart, eagerness

and passion.

-The Members of Group 1 UDM rotation

October 3, 2011



Abstract

Filipino’s are known for being “matiisin” as long as they can

handle stuffs and other matters by their own, seeking for medical

attention or any kind of help by the medical team or any individual is

less needed as long as their concern is manageable by simple over the

counter drugs and the “BAHALA na” practice. From the past to present

this has become the main STIGMA by the health care delivery system

and the nation itself.

But when the time their case has worsen and is cannot be

manage by their own perception and practices , that is the time they

need the so called “professional treatment” . Just like our 21 year old

client with a very rare condition “hypokalemic periodic paralysis” a

hereditary condition that causes imbalance with the potassium level in

the body that causes an uncontrolled paralysis that can greatly affect

his activities of daily living. His condition is never considered easy,

acute hypokalemic paralysis is an uncommon cause of acute weakness

maybe from stressors and strenuous activity. Morbidity and mortality

associated with unrecognized disease include respiratory failure and

death. Hence, it is imperative for physicians to be knowledgeable



about the causes of hypokalemic paralysis, and consider them

diagnostically. The client has done various self-treatments that could

lead to positive or negative effect to his condition. Which concerns the

medical team especially the nurses because the risk of this practice

has no any guarantee of cure but can worsen the condition if not

properly oriented. A very challenging case but with a thorough

correction management, a series of replacement therapy of potassium

and counseling about the onset of disease is genetic and is not much

preventable, with briefing and definitely the Holistic care we provide

can give a POSITIVE outcome.

Chapter I

INTRODUCTION

Background of the study

The group chose hypokalemic paralysis as our case to be study in

preparation to our grand case presentation at the end of all the

rotation. This is our first time to encounter this kind of case and

because of that; our group was interested in it. We are willing to do

this case to challenge our mind in analyzing the problem and to

enhance our hidden knowledge, and also to gain new experiences

which would bring new learning for the member of the group.

Patient X is a 21 years old male, and was admitted in Justice Jose Abad

Santos General Hospital last August 26, 2011 with a chief complaint of

muscle weakness and vomiting. He was diagnosed with hypokalemic

paralysis.

Significance of the study

This case study will help the group in understanding the disease

process of the patient. This would also help the group in identifying the



primary needs of the patient with hypokalemic paralysis. By identifying

such needs and health problems arise, the group can now formulate an

individualize care plan for the patient that would address these needs

and problems effectively. Effective management of the problems

identified will help the patient recover faster and maintain a holistic

sense of wellness even while in the hospital.

This case study would also equip the group with knowledge, skills and

attitude on how to manage future patients with same or similar

disease.

Objectives of the study

Nurse Centered:

General:

To enhance the students’ skills, comprehension and approach in the

practice of nursing and be able to establish knowledge on the risk

factors, prognosis nursing management, current trends and incidence

of the disease condition that was chosen.

Specific:

To come up with a comprehensive presentation of the disease

condition by means of correct presentation of the data gathered

through the use of nursing process.

To present the current trends about the disease condition, the reason

for choosing such case for presentation, and the importance of the

case study.

Patient Centered:

General:

To enable the client to fully understand and recognize the disease

condition, emphasize the importance of making appropriate action and

to guide the patient towards recovery.

Specific:



To understand the importance of a healthy lifestyle.

To render proper nursing management and medical regimen needed

by the patient.

To identify predisposing factors that aggregate the present condition of

the patient.

Scope and Limitation of the Study

Every form of paper work, research or just any activities have the so

called “limits”. It said to a guide that could lead to success for it place with the

strength of the doer and sense as barracks of our capabilities. It specifies and

gives a thorough picture of what to expect in making research

The case study was conducted at Jose Abad Santos General Hospital to a

21y/o man with a hypokalemic paralysis: data’s and other information was

gathered form the reliable source (esp. the client itself) some data’s was not

that clear and specific for the client wish to keep it for himself for

confidentiality reasons. The client was handled by the researchers themselves

for three days the nature, causes, sign and symptoms, pathophysiology,

medical management and nursing management of the disease are being

deliberated in this study. The researchers done various supportive care to the

client (eg. Vital signs monitoring I and O medication with a strict and definite

supervision of their instructor ); during the interview to the client in is clearly

stated that the familial history of specific disease is not well remembered.

During the physical examination some procedures were refused by the client

to be performed and the researcher respect the decision of the client. The

Gordon’s level of functioning, subtopic sex is quite offensive or too sensitive

for the client to handle that’s why some data is not definite. The client is not

aware on his health history whether or not he is the only one in his family who

suffered to that condition. Some laboratory condition is still pending till the

day of his discharge. Some procedures in the laboratory were not performed

and some results were still not released (TSH, FT4, and ABG).



Even so this shortcoming didn’t stop the medical team to correct the client for

him to achieve the optimum level of functioning.

The discharge planning is completely hypothetical and pictured cut the most

reliable plan to be done.

Over all the study focuses on the onset of any factor that affect and can

improve the client’s condition in regards to hypokalemic periodic paralysis.

Chapter II

NURSING HEALTH HISTORY

Personal data

Name: patient RPB

Date of birth: Dec 04, 1989

Birth place: Tondo, Manila

Age: 21 years old

Status: single

Sex: Male

Address: 315 CM Recto Tondo Manila barangay 11-zones 2

Educational attainment: High school undergraduate

Informant: Patient RPB

Date of admission: Aug. 26 2011

Time of admission: 11:45 pm

Mode of admission: via stretcher carried by NOD of ER

Admitting diagnosis: Hypokalemic paralysis

Final diagnosis: hypokalemic periodic paralysis

Admitting vital sign:

Temperature: 36.5 C



Pulse rate: 77 bpm

Respiratory rate: 35 cpm

Blood pressure: 90/60

Weight: 44 kg

Height: 5’3”

BMI: 17.18

Chief complaint: “Nanghihina ang buong katawan ko” as

verbalized by the patient.

History of present illness

Muscle weakness was never been new to the client’s condition; it

was verbally stated that the client was hospitalized on the 4th day

of May, 1999 at Jose Reyes Memorial Medical Center for almost 4

days, from the year then till 2009, because of extreme muscle

weakness. The client is confident that he is finally relieved with

his condition that leads him to apply to a very strenuous job,

ignoring light muscle weakness thinking that, it’s only because of

his work. Last July 2011 the client was admitted to Justice Jose

Abad Santos General Hospital with the admitting diagnosis of

Hypokalemic Paralysis with a sense of extreme vomiting and

muscle weakness. The client find out with the relative that this is

not just any muscle pain, the client has difficulty in moving his

extremities with complains of difficulty in breathing. The client

was discharged, 2 weeks after the correction but unfortunately

he was rushed again to the ER of JASGH, with a newly findings of

Hypokalemic Periodic Paralysis last August 26, 2011 at exactly

11:45 PM, with the same complains and reason. Upon receiving

from the ER, venocyclysis was already started (D5NM 1L x KVO

at the level of 220 cc) with the side drip of PNSS 80cc + 40mEq



KCl x 25cc/hr on its 1st cycle to run for 3 cycles. Laborartory

exams are requested CBC, Na, K done at ER, to secure for the

results. ABG, UA, TSH, and FT4 were requested. At 1:25 am the

patient was transferred safely to medicine ward via stretcher

carried by NOD of ER.

Past medical history

The client’s family was said to be conscious to his condition

in the past in some ways. Immunizations (BCG, Hep.B, OPV, DPT,

and AMV) was completed before he entered grade I; when he is 8

years old (year 1998) the client was hospitalized because of

pneumothorax.it took 4 weeks to manage his condition at Jose

Reyes memorial Medical Center. He had some wound scars and

deep wound on his right eyelid leading him to have stitches at

OPD setting at the same hospital. The rest of his wound’s cause

is unmentioned for he thinks that is confidential. Cough, fever

and diarrhea are the common illness experienced by the client

that is manageable by over-the-counter drugs like solmux,

motilium and biogesic. The client stated that he is not positive

any form of allergy in food or drugs.





Gordon’s Functional Health Assessment

Health perception – health management patternBefore hospitalization During hospitalization

Prior to hospitalization the client stated that he is aware in his condition, that there are something wrong in him. The client does not go to the hospital if he felt sick, if he has cough and colds he just took solmux (carbocisteine), if he has fever he just took biogesic (anti-pyretics) and if he is suffering from diarrhea he just took motilium. Client stated that this illness like cough and colds, fever and diarrhea does not need special attention. And based on his he can manage this by himself. Client said that he don’t want to take any herbal medicine when his sick. Even his mother insisted because he thought that herbal medicine is not appropriate on his age. Client also verbalized that he was hospitalized several times because of muscle weakness, so he already knew what drug to be take when he experience this at home. That’s why sometimes if he experienced muscle weakness he just took kalium durule as his doctor prescribed to him in his past

During hospitalization the client stated that he wants to be cure, because he cannot longer tolerate his suffering but he felt that it seems like there is no treatment in his condition, that the Doctors doing in him is just a replacement of potassium that had been loss in him. But still the client take medication on time as his doctor prescribed with the help of the nurse. He always follows whatever the nurse and the doctor says. But he felt that it seems like that there is no cure for his condition that the doctor’s doing in him is just a replacement of potassium that has been loss to him.



hospitalization

Interpretation : Client was knowledgeable about his condition he understands what’s happening to him. Because of several times that he was hospitalized in the same reason which is muscle weakness he already realized the importance of seeking a doctor when noticing an abnormalities in his body.

Nutritional metabolic patternBefore hospitalization During hospitalization

Client stated that he ate thrice a day, breakfast, lunch and dinner. In breakfast he often ate heavy meal: 2 cups of rice, 1 viand like vegetables dish and 1 cup of coffee, at lunch: 3 cups of rice, 1 viand like fish and lots of water 3 to 5 glasses. Then in the dinner: 2 cups of rice, 1 can goods like sardines and 3 glasses of water. Client stated that if he has extra money he eats snack like bread or pancit. Client was fun of eating foods high in carbohydrates and he drinks a lot of water (8-10 glass a day) of water. Client verbally stated that he doesn’t drink any alcoholic beverages and seldom took carbonated drinks. The client doesn’t like to eat fruits.

The client was on DAT with high potassium diet as ordered by the doctor, but still the client loss his appetite. Client was hooked on PNSS 1L regulated at 10gtts/min on the left arm, incorporated with 40meqs of KCL. Client BMI is 17 which is underweight body type of ectomorph. The client is suffering from vomiting, that also affects his desire.

Interpretation : Before hospitalization the client has a good eating pattern but because of his muscle weakness that he was experiencing his appetite and



eating pattern were affected.

Elimination patternBefore hospitalization During hospitalization

Client verbally stated that he urinate five times a day, with a total of 1000 mL/ day or 200 mL for every urination. The urine is color light yellow, odorless, clear, no presence of blood or any particle. The client defecates once a day every morning. Stool was semi-formed, no other particles. He often experienced diarrhea, he just thought it’s because of the foods he ate. He defecate five times a day, stool was watery and with particles.

The client I & O is 3960 mL input and output of 2200 mL. Urine is lightly yellow. And slightly turbid without particle and have aromatic smell. He urinates 7 to 9 times for every shift in large volume approximately 240 mL every time he urinates. Client urinates without pain. Client defecate once a day in between of 2-5pm, stool was semi-formed and no particles.

Interpretation : Client elimination pattern before hospitalization was balance in what he takes in and what he excretes but he often experienced diarrhea that may cause him possible for fluid volume deficits (dehydration). Upon hospitalization client has an unequal input and output. Elimination of stool is within normal range which is within 1-2 times per day.

Activity-exercise patternBefore hospitalization During hospitalization

Client stated that swimming is his form of exercised. He does it thrice a week alternately in Dapitan complex together with

Upon interviewing the client verbalized that because of muscle weakness he had difficulty in ambulation that he



his friends. In their house the client stated that he do household chores like washing of dish, cleaning the house and sometimes cooking. Range of motion is active and able to do his activities of daily living. He is a factory worker, strength is required in his field of work because of heavy lifting. He worked five times in a week.

need assistance every time he move like going to the bathroom. Because of that client always stay on the bed and being watch-out by his family to avoid injury.

Interpretation : If the client is not experiencing muscle weakness he was able to do all his activities of daily living by his own but if muscle weakness occurs he become dependent to other people, everything he used to do was affected specially his work.

Sleep-rest patternBefore hospitalization During hospitalizationThe client said that his usual sleeping period is 5 to 6 hours. He often sleeps at around 11pm. For him to fall asleep, he listen to the radio or sometimes texting his friends. According to the client there are no abnormalities when his sleeping. He woke up at 7am but sometimes if his tired he wake-up almost 9am.

The client usually has difficulty in sleeping because of environmental noise like loud chatting of his roommate. He was near at the window; he was destructed by the vehicle noise and the noise coming from the village near at the hospital. Also taking his vital sign interrupts his sleeping.

Interpretation : Client sleeping pattern before hospitalization gives him an adequate rest. And no difficulty in falling asleep. While during hospitalization, environmental noise interrupt



Cognitive-perceptual patternBefore hospitalization During hospitalizationThe client stated that he was a high-school undergraduate, his favorite subject then was mathematics only. He was bored listening to his teacher, he much like skilled work subject, like T.L.E. where he can learn carpentering and mechanical work. Client never mentions any problem in his senses.

Client was conscious and coherent. Oriented to time, place, and person. He response accordingly to every question. He can recall events that happen to him in the past. He answers straight without difficulty. Client can express his thought and emotion. But the client experiencing numbness sensation in his upper and lower extremities

Interpretation : Client mental status was not affected on what he experiencing right now. He was able to answer different questions even it happened in the past. Also his ability to talk is not affected.

Self-perception and self-concept patternBefore hospitalization During hospitalizationClient stated that he is not engaged to any formed of vices like alcohol, smoking, gambling etc. client see himself as a simple, quite, shy type person and a strong man. Client verbalized that he want to be a pilot someday but seems that it will be a dream forever because according to him they

Client stated that he feels so vulnerable and weak and felt pity for himself because he can’t do anything to help him and losing hope to live in a normal life.



don’t have money to support his study, that’s why since high-school his not confident that he may achieve his dream.

Interpretation : Client has a low self-esteem due to his condition and makes him feel more down. Client seems like he don’t have enough strength to go on with his life. That is because of what he’s experiencing. Client having difficulty to pursue his dream and continue a normal living.

Role-relationship patternBefore hospitalization During hospitalization

The client stated that he was living with his family (mother, father and youngest brother). He described his family as a supportive family, they support each other even though sometimes they quarrel they still maintain a good relationship. He has lots of friends but there’s one person that he treat as a brother, his best friend. They help each other in times of needs. He doesn’t belong to any fraternity or affiliation or association. He doesn’t participate to any activities in their community and never mingle with his co-worker because he thought they were too old.

Client stated that his happy with his family and best friend, to all their support like financial and emotional support. Client is dependent with his family. And even though he’s not able to help their in providing their needs and in household chores.

Interpretation : Client is very much attached to his relationship with his family. Now that the client is ill his family gives their full support and become more understanding that this time their son needs their care.



Sexuality-reproductive patternBefore hospitalization During hospitalization

Client refused to talk about his sexuality-reproductive pattern because he stated that it’s too confidential.

Client refused to talk about his sexuality-reproductive pattern because he stated that it’s too confidential.

Interpretation : Client is too shy to share if he had been in-love or engaged to sex. Client still want to preserve his privacy in this matter.

Coping-stress tolerance patternBefore hospitalization During hospitalization

Client verbally stated that if he had major problem he wants to be alone and tried to fixed it by himself but if he thought that he need the help of her parents he will go with them but for him , he don’t want to be a burden in his family. Sometimes he go to his best friend and share what he is going through. Client stated that he is not too tough to face his problem he always need the help of others.

The client is coping with his situation with the help of his family. His getting the strength with his family and best friend. All their encouragement and words of wisdom to lighten his feelings.

Interpretation : With the help of the client’s family, he may be able to cope in a short period of time. And client may not be depressed because his family is there in



times of need.

Values-belief patternBefore hospitalization During hospitalization

Client is a roman catholic since birth. He believes that there’s God who’s watching from above. Client stated that he is not religious because he went to the church once a month most especially if he have problem. He prays when he goes to the church and confesses his sins. His family thought him to be a God-fearing person and to be humble all the time. He believes that every creature will come to death.

Client become more prayerful, he paused for a while and talked to God. Even though he is in this situation he never blame the Lord for what happen to him. He just believed that God wants him to learn something.

Interpretation : Client has faith in God and believes that there’s a powerful God. He has a positive attitude in all these. He never gives up in believing to God. And his parents teach him good values that may help him to be a good and better person.



PHYSICAL EXAMINATION

GENERAL APPEARANCE

Vital signs :BP: 90/60 mmHgPR : 79 bpmRR: 20 cpmT : 36.4 C

Difficulty in ambulating Muscle weakness on upper

and lower extremities Good hygiene and dressed

properly for the weather No body odor and breath

odor noted

MENTAL STATUS

Not in distress The client is cooperative

and responsive in answering the information needed.

The client is conscious and coherent

The client speaks clearly

NUTRITIONALASSESSMENT

BMI : 17 – underweight 5’3 ft 44 kg The client was in Diet as

Tolerated and high potassium

No history of allergy in foods

INTEGUMENTARYSYSTEM

INSPECTION : The client’s skin color is

dark brown No presence of edema Scars are present on the

right eyelid and right arm ; no discoloration noted; arranged in a line



PALPATION :

The skin is moist Temperature : 36.4 C Poor skin turgor

HAIRINSPECTION :

Hair is evenly distributed; black, thick and silky

No dandruff or infestation noted

NAILINSPECTION :

Nail plate shape is convex Nail bed color is pink

PALPATION : Smooth in texture Blanch test performed and

nail bed return to its usual color after 2seconds.

HEADINSPECTION :

Client’s head is round and proportionate to the body

PALPATION: No masses or nodules

present

FACEINSPECTION :

Symmetric facial features ; facial hair is evenly distributed

Symmetric facial movement Mole present in the right

eyelid

EYE INSPECTION : Hair in the eyebrows are

evenly distributed; skin is intact

Eyebrows are 20



symmetrically aligned; movements are equal

Eyelashes are evenly distributed; curled and slightly outward

Eyelids – skin is intact; no discoloration; Lids close symmetrically

Conjunctiva is shiny , smooth, and pink in color

No edema or tenderness present over the lacrimal gland

Sclera is porcelain white in color

Pupils are black in color; equally round and react to light and accommodation

Both eyes coordinated and moved in unison when six cardinal fields of gaze performed

EARSINSPECTION :

The external ears are dark brown in color; in bilateral symmetry; the position of aspect of external ear is at the level of the eye.

No lesions or nodules noted;

PALPATION No swelling or tenderness

present on auricles and mastoid areas

Pinna recoils after it is folded

Mobile when the auricle is pulled upward, downward and backward.

Voice tones are audible by following the command

Client respond to whispered voice by repeating the nonconsecutive numbers that was whispered on each ear

INSPECTION :



NOSE The nose is symmetrically aligned and straight; dark brown in color

No discharge and nasal flaring noted

The nares is pink in color; no discharge and lesions noted

Nasal septum is intact and in midline

PALPATION: No tenderness or masses

present No lesions noted Air moves freely on the

nasal cavity when the client breathes through the nose by occluding one nostril.

The maxillary and frontal sinuses are not tender when palpated and percussed

MOUTH INSPECTION : The outer and inner lips is

pale in color; dryness noted; rough texture ;

The client was able to purse lips

There is presence of dental carries on the 3rd molar lower mandibular teeth

Gums is pink in color; moist and firm texture

The client’s tongue is in central position

Dry and furry tongue No lesions noted The client can move his

tongue upward and from side to side

No nodules noted The soft palate is smooth

and light pink in color The hard palate is lighter

pink in color The uvula is positioned in

the midline of the soft palate



The oropharynx is pink in color ; no presence of lesions

The tonsils is pink in color ; no discharged noted

NECK INSPECTION : Neck muscles are equal in

size The client cannot move his

head using the neck muscles because of muscle weakness

Cannot shrug his shoulder The lymph nodes are not

palpable Trachea is at the midline of

neck No swelling or enlargement

noted upon the inspection and palpation of thyroid gland

RESPIRATORY SYSTEM POSTERIOR THORAX

INSPECTION : The chest skin is intact and

the temperature is uniform The ratio of anteroposterior

to transverse diameter is 1:2

PALPATION : No presence of tenderness

or masses on area of posterior thorax when palpated

The thoracic expansion of the posterior chest is full and symmetric

PERCUSSION :

Vibration is heard on the posterior chest wall starting from the upper part of the lungs ( at the base of the neck ) to the lower part of the lungs



Resonate sound heard from the 1 ICS down to the last

Flat sound heard over the scapula

AUSCULTATION: A “gentle sighing “ sound

was heard at the base of the lungs during inspiration

A “blowing” sound heard at the upper part of the lungs between the scapula

ANTERIOR THORAX

INSPECTION : The chest skin is intact The client ‘s respiratory

rate is 20 cpm Effortless inspiration noted

PALPATION : No presence of tenderness

or masses on area of anterior thorax

The respiratory excursion is full and symmetric

PERCUSSION :

Vibration was heard on the anterior chest wall from the upper part of the lungs ( above the clavicle ) to the loer part of the lungs

Resonate sound was heard down to the 6th ICS; Dull sounds on areas over the heart

AUSCULTATION: Harsh sound heard over the

trachea “gentle sighing” sounds

heard on the lower part of the lungs

“blowing “ sound was heard on the area between sternum and clavicle



CARDIOVASCULAR SYSTEM

INSPECTION : No visible pulsations noted

on aortic, pulmonic, tricuspid and apical area of precordium

PALPATION: Apical pulsation is felt by

palpation

AUSCULTATION: Pulsation of heart is heard

in four anatomical area but more audible in apical area upon ausculatation

Peripheral pulses :- Carotid arteries has a

full pulsations- Jugular veins are visible

ABDOMEN INSPECTION : The client’s skin is light

brown in color ; no lesions noted

Abdominal distention was observed

Abdominal movementAUSCULTATION:

Hyperactive bowel sounds was heard on the four quadrants of the abdomen

PALPATION: Slight tenderness present

on the hypogastric area

MUSCULOSKELETAL SYSTEM

INSPECTION: Muscle size is equal on both

sides of the body No tremors present

PALPATION : Muscle tone at rest is firm Presence of muscle

weakness

Muscle strength : LUE – 1/5 RUE – 1/5 LLE – 1/5 RLE – 1/5



INTERPRETATION-

1- 10% of normal strength ; no movement, contraction of muscle is palpable or visible

Bones : No deformities noted No tenderness or swelling

present

Joints : No swelling of joints noted No tenderness or swelling

present upon palpation

NEUROLOGIC SYSTEM LEVEL OF CONSCIOUSNESS:- Conscious and coherent.- Alert and responsive.

MOTOR FUNCTION:- The client wasn’t able to

perform the tests because of the muscle weakness present on the Upper and Lower Extremities

SENSORY FUNCTION:- Numbness and tingling

sensation felt at the lower leg and feet

- The client was able to identify pain sensation

- The client reflex responses is hypoactives

Glassgow Coma Scale- Eye opening=4- Verbal= 5- Motor= 2- Total of 11

Patient name: Patient RPB



Date: AUG. 29, 2011

Test: electrolytes

Result Reference range Analysissodium 139.8 135-148mmol/L NormalPotassium 3.80 3.5-5.3mmol/L NormalChloride 104.5 98-107mmol/L Normal


Date: AUG. 28, 2011

Test: electrolytes

Result Reference range Analysissodium 139.8 135-148mmol/L NormalPotassium 2.91 3.5-5.3mmol/L Below Normal

rangeChloride 102.3 98-107mmol/L Normal




Date: AUG. 27, 2011

Test: Urinalysis (test determines the content of the urine because urine because urine removes toxins and excess liquids from the body it can contain important clues)

Physical examination Reference Analysis

Color = Light yellowTransparency = Slightly Turbid

NormalNormal

chemicalProtein = +1(plasma)Sugar = negativeSpecific gravity = 1.010

pH= 6.0

+

-1.002-1.030

4.5-8.0

Normal

NormalNormal

NormalMicroscopicWBC = 0-2/huff

RBC = 0.2/huff

Epithelial cells

Mucus threads

Amorphous

Bacteria

0-2/hpf

0.2/hpf

+2

+3

(-)

0

Normal

Normal

Normal

Normal

Normal

normal




Date: AUG. 26, 2011

Test: electrolytes

Result Reference range Analysissodium 139 135-148mmol/L NormalPotassium 1.64 3.5-5.3mmol/L Below Normal

rangeChloride 101.4 98-107mmol/L Normal


Date: AUG. 26, 2011

Test: Hematology

(The study of the blood, the blood- forming organs and blood disease

Component Result Reference AnalysisHemoglobin 166g/L 130-180g/L Within normal

rangeHematocrit 0.46 0.42-0.48 Within normal

rangeWBC count 30.6x109/L 5-10x109/L Above normal

rangePlatelet 502x109/L 150-400x109/L Above normal

rangeDifferential countNeutrophil 0.85 0.36-0.66 Above normal

rangeLymphocyte 0.15 0.22-0.40 Below normal

rangeMonocyte - 0.04-0.08Eosinophil - 0.01-0.04Stab - 0.0-0.01



Course in the ward

08/26/11

Upon admission, patient complains of muscle weakness all over

his body. Client was conscious and coherent but his vital signs

are unstable, BP: 90/60mmHg, RR: 20bpm, PR: 77bpm, Temp:

36.5 °C . Upon receiving the patient from ER, venocyclysis was

already started (D5 NM 1L x KVO) with side drip of PNSS 80cc +

40meq KCl x 25cc/hr, on 1st cycle to run for 3 cycles. Patient was

on DAT, High K+ diet. Laboratory examination was requested

CBC, Na, K it was done at the ER and now waiting for the results.

ABG & Urinalysis were requested. At 1:25pm patient was

transferred safely to bed. He was conscious and coherent. At

3:00pm, another cycle of KCl drip was administered via soluset

with 80cc of PNSS+40mEq KCl. Around 4am, urine specimen was

collected and submitted to the laboratory for urinalysis. Input

and output noted for continuity of care.

August 26, 2011

On the 1st day, the patient was conscious and not in distress. He

was received from ER ward via stretcher with ongoing IVF of

D5NM 1L x KVO and side dip of PNSS 80cc + 40mEq KCl x

25cc/hr on its right arm 1st cycle, to run for 3 cycles. Vital signs

were taken and recorded hourly. The patient’s vital signs were

ranging from BP 90/60mmHg, PR 75-80cpm, RR 20-21bpm and T

36.4-36.6 degree centigrade. The patient was instructed on DAT,

high K diet. The CBC, Na, K and UA was done at the ER ward

reminded to be secured. He was requested for ABG, TSH and

FT4. He was encouraged to rest and sleep and was kept safe and



comfortable. Due medications were given. Intake and output

were noted. His intake for 24 hours was 3960mL IVF and oral. For

the patient’s output he defecated only once between 2-10pm

shift and was urinated only a total of 2200mL for 24 hours.

August 27, 2011

On the 2nd day, the patient was received sitting on bed, still

conscious and not in distress with ongoing IVF of PNSS 1L +

80mEq KCl to run for 10 hours at the level of 600cc, infusing well

at the right arm. Vital signs were taken and recorded hourly. The

patient’s vital signs were ranging from BP 90/60-100/60mmHg,

PR 76-90cpm, RR 20-22bpm and T 36.2-36.8 degree centigrade.

He was seen and examined by Dr. Villegas at around 9am with

orders noted and carried out. The patient was still instructed on

DAT, high K diet for maintenance. He was still requested for ABG,

TSH and FT4 to secure the result of K. The patient was still

encouraged to rest and sleep and was kept safe and

comfortable. He was also encouraged deep breathing. His BP

reached 80/80mmHg and was referred to Dr. Cordova at 12am.

The result of K-2.91 was relayed to Dr. Cordova. At 12:15am fast

drip of PNSS 200cc was given then the remaining 300cc was

incorporated with 40mEq KCl PNSS to run for 10 hours. Due

medications were given. Intake and output were noted. His

intake for 24 hours was 5450mL IVF and oral. For the patient’s

output, he was urinated only a total of 2600mL for 24 hours.

August 28, 2011

On the 3rd day, the patient was still conscious and not in distress

with ongoing IVF of PNSS 1L + 80mEq KCl at 750cc level to run

for 8 hours. Vital signs were taken and recorded every 4 hours.



The patient’s vital signs were ranging from BP 80/50-

100/70mmHg, PR 70-92cpm, RR 20-22bpm and T 36-36.7 degree

centigrade. The patient was still instructed on DAT, high K diet.

He was still requested for ABG, TSH and FT4. Due medications

were given. The patient was also seen and examined by Dr. De

Sagun at 9:10am with orders noted, for report serum K after the

3rd cycle due at 8am. The patient was provided with safety

measures. The IVF of PLR was consumed and hooked-up PLR 1L

to run for 12 hours. No signs of nausea and vomiting were shown

by the patient. The patient was still encouraged to rest and sleep

and was kept safe and comfortable. Due medications were given.

Intake and output were noted. His intake for 24 hours was

4660mL IVF and oral. For the patient’s output he defecated twice

for this day and urinates for about a total of 2600mL for 24

hours.

Chapter III

CLINICAL DISCUSSION OF THE DISEASE

Description of disease



Hypokalemic periodic paralysis is a disorder related to periodic

problems with muscle weakness and, occasionally, mild

paralysis. Individuals are generally born with the disorder,

although symptoms may not manifest until much later in life.

Most cases are inherited, and it only takes one parent with the

faulty gene to pass the disorder on to the child. Hypokalemic

periodic paralysis is very uncommon, affecting only about one in

every 100,000 individuals.

EPIDEMIOLOGY

Hypokalemic periodic paralysis (PP) is the most common of the

periodic paralyses, but is still quite rare, with an estimated

prevalence of 1 in 100,000. Hypokalemic PP may be familial with

autosomal dominant inheritance or may be acquired in patients

with thyrotoxicosis .

Clinical penetrance is often incomplete, especially in women [8].

The disorder is three to four times more commonly clinically

expressed in men. Approximately one-third of cases represent

new mutations.

Age



The age of onset of the first attack ranges from one to 20 years;

the frequency of attacks is highest between ages 15 and 35 and

then decreases with age.

Anatomy and physiology

Potassium is present in a fluid form in the body cells and acts as

an electrolyte along with other minerals like sodium, chloride,

calcium, and magnesium. It is helps in maintaining the heart,

brain, kidney, muscles tissues and other organs of the body in a

healthy condition. It plays a key role in sending nerve signals and

increases the body metabolism to use proteins, fat and

carbohydrates for energy.

Benefits of Potassium

The health benefits of potassium to the body are as follows:

It plays a key role in regular contraction and relaxation of the

muscles, hence, maintains muscle functions and optimal nerve.It

helps in preventing the possibilities of muscle cramps or

hypokalemia in the body.Since it functions as an electrolyte, it

maintains the electrical conductivity of the brain, and impacts

the brain function. It is also plays a vital role in enhancing the

higher brain functions like memory and learning.Unlike sodium,

potassium helps in balancing normal blood pressure and

minimizes the possibilities of heart diseases and hypertension. It

is also considered as a best stress and anxiety buster.It plays a



significant role in regulating water balance in the human body,

and also assists the kidneys to remove the waste products from

the body through excretion.Potassium boosts the spirit of nerve

reflexes to send messages from one body part to another, which

in turn helps in muscle contraction to perform daily activities.

Absorption of potassium from the diet is passive and does not

require any specific mechanism. Absorption takes place in the

small intestine as long as the concentration in gut contents is

higher than that in the blood. If food moves rapidly through the

bowel then absorption will not be sufficient.The kidneys are the

main regulators of body potassium, maintaining blood levels by

controlling excretion, even as intake varies. Some potassium is

excreted in sweat. Digestive juices contain significant amounts of

potassium but most of this is re-absorbed in the lower gut.

Symptoms of severe potassium deficiency include fatigue,

vomiting, abdominal distention, acute muscular weakness,

paralysis, pins and needles, loss of appetite, low blood pressure,

intense thirst, drowsiness, confusion and eventually coma.

Muscle spasms, tetany, heart arrhythmias and muscle weakness

can also be caused by increased nerve excitability associated

with inadequate intake of potassium.

Causes of potassium deficiency include high sodium diets,

surgical operations involving the bowel, extensive burns and

injuries, diabetes, Cushing's syndrome, excessive excretion of

aldosterone, chronic diarrhea which limits gut re-absorption of

potassium, persistent vomiting, influenza, inflammatory bowel



disease, anemia, ulcerative colitis, kidney disease, heart disease,

chronic respiratory failure, prolonged fasting, therapeutic

starvation, bizarre diets, anorexia nervosa, alcoholism and cystic

fibrosis.

Maximal voluntary exercise followed by rest caused a transient

potentiation and then a depression of the action potential and of

the twitch tension in the patient and in healthy subjects, but the

patient's response was at times quantitatively greater. The

deviation from normal tended to be greatest when the patient

was weakest. Excessive accumulation of lactic and pyruvic acids

in the blood occurred after a standard work load. This may

indicate a greater than normal release of these metabolites from

muscle or an impaired metabolism by muscle, or both. There

appears to be no impairment in glycogenolysis or glycolysis in

muscle during exercise.

A close relationship was again observed between carbohydrate

metabolism and primary hypokalemic periodic paralysis. The

present study points to a possible metabolic lesion, or a

contributing mechanism, that can be activated by rapidly

induced glycolysis.



Pathophysiology

Hypokalemic periodic paralysis is a condition in which a person

has episodes of muscle weakness and sometimes severe

paralysis.

The condition is congenital, which means it is present from birth.

In most cases, it is passed down through families (inherited) as

an autosomal dominant disorder. That means only one parent

needs to pass the gene related to this condition onto you in order

for you to be affected.

Occasionally, the condition may be the result of a genetic

problem that is not inherited.Unlike other forms of periodic

paralysis, persons with congenital hypokalemic periodic paralysis

have normal thyroid function and very low blood levels of

potassium during episodes of weakness. This results from

potassium moving from the blood into muscle cells in an

abnormal way.Risks include having other family members with

periodic paralysis. The risk is slightly higher in Asian men who

also have thyroid disorders.

Hypokalemic periodic paralysis causes attacks of muscle

weakness or paralysis when the level of potassium in the blood

drops. During severe attacks the patient may be unable to move

and even appear unconscious. Even during paralysis the patient

is awake and completely aware of their surroundings. Abortive

attacks become more common in patients as they enter their



40’s. Some patients over 40 who had paralysis when younger

quit having attacks of paralysis but have abortive attacks

instead. Abortive attacks can be more trouble than paralytic

attacks, because young patients usually feel strong between

attacks of paralysis and patients with abortive attacks rarely feel

strong.

Weakness most often affects the muscles of the arms and legs

but may cause weakness of the the trunk/back muscles as well.

A few patients have trouble breathing and swallowing during

severe episodes. The low potassium level during attacks may

cause irregular or weak heartbeat. Most patients have good

muscle strength between attacks, but in some patients muscle

tissue is damaged over time. Some patients have reduced

muscle strength by the time they are 50-60 years old.

There are several types of Periodic Paralysis associated with

metabolic and electrolyte abnormalities. Of these, Hypokalemic

Periodic Paralysis (HPP) is the most common with a prevalence of

1 in 100,000. The clinical features of the syndrome vary

somewhat depending on the underlying etiology but the most

striking feature is the sudden onset of weakness ranging in

severity from mild, transient weakness to severe disability

resulting in life-threatening respiratory failure. Attacks may be

provoked by stress such as a viral illness or fatigue, or certain

medications such as beta-agonists, insulin or steroids. A

perturbation of sodium and calcium ion channels results in low

potassium levels and muscle dysfunction. As this is primarily a

problem with muscle contraction rather than nerve conduction,

tendon reflexes may be decreased or absent but sensation is 38



generally intact. Although the serum potassium level is often

alarmingly low, other electrolytes are usually normal. Indeed,

total body potassium is actually normal with the change in the

serum level reflecting a shift of potassium into cells.

Electrocardiographic changes are common, but unlike patients

who are truly potassium depleted, the changes do not correlate

well with the measured serum level . Diagnosis between

paralytic episodes is difficult as the patient may have normal

strength and potassium levels. Electromyography reveals

abnormalities in some patients but is often normal, especially

between episodes when no clinically detectable weakness is

present.

HPP occurs in several settings and the diagnosis may require an

extensive search for the underlying etiology since the treatment

varies according to the cause. HPP may occur sporadically in the

form of Familial Hypokalmic Paralysis (FHP), a poorly understood

disorder which may occur spontaneously or as the result of

autosomal dominant inheritance .This form of Periodic Paralysis

is felt to be the result of disordered cellular potassium regulation

perhaps due to sodium or calcium channel abnormalities.

Mutations of the CACNA1S and SCN4A genes have been

identified that cause abnormalities in sodium channels resulting

in abnormal potassium ion flux. Acute paralytic episodes are

treated with potassium replacement and close monitoring of the

cardiac rhythm and serum potassium levels.

Potassium is essential for many body functions, including muscle

and nerve activity. The electrochemical gradient of potassium

between the intracellular and extracellular space is essential for



nerve function; in particular, potassium is needed to repolarize

the cell membrane to a resting state after an action potential has

passed. Decreased potassium levels in the extracellular space

will cause hyperpolarization of the resting membrane potential.

This hyperpolarization is caused by the effect of the altered

potassium gradient on resting membran potential as defined by

the Goldman equation. As a result, a greater than normal

stimulus is required for depolarization of the membrane in order

to initiate an action potential.

In certain conditions, this will make cells less excitable. However,

in the heart, it causes myocytes to become hyperexcitable.

Lower membrane potentials in the atrium may cause

arrhythmias because of more complete recovery from sodium-

channel inactivation, making the triggering of an action potential

more likely. In addition, the reduced extracellular potassium

(paradoxically) inhibits the activity of the IKr potassium current

and delays ventricular repolarization. This delayed repolarization

may promote reentrant arrythmias.





Drug study

Generic name

Classification Mechanism of action

Dosage & route

Indication Contraindication Adverse effect

Side effects Nursing responsibilities

Brand name:Zantac

Generic name:Ranitidine

Histamine H2 antagonist

Antiulcer

-inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells.-inhibits gastric secretion

Po: 150mg tablet BID at bed time

-Prophylaxis & treatment of elevated acidity of stomach.-Treatment of gastroesophageal reflux

-Hypersensitivity-Cirrhosis of the liver-Impaired renal or hepatic function

CNS Malaise insomnia agitation somnolence Hallucination

-headache-abdominal pain-constipation-diarrhea-N&V

1. do not smoke interferes with healing and drug effectiveness2. Avoid alcohol aspirin- containing products and beverages that contain caffeine (tea, cola, coffee) these increase stomach acid.3. Do not drive or operate machinery until drug effects are realized; dizziness or drowsiness may occur.



Generic name Classification Mode of action Dosage & route

Indication Contraindication Adverse effects

Nursing responsibilities

Metoclopramide Anti-emetics,GI Stimulants

-blocks dopamine receptors in chemoreceptor trigger zone of the CNS-Stimulates motility of the upper GI tract and accelerates gastric emptying-decreased nausea and vomiting-decreased symptoms of gastric stasis

150 mg1ampTIV q 8

-prevention of chemotherapy-induced emesis-treatment of post-surgical and diabetic gastric stasis-facilitation of small bowel intubation in radiographic procedures-treatment and procedures of post-operative nausea and vomiting when nasogastric suctioning is undesirable.

-hypersensitivity-possible GI obstruction or hemorrhage-history of seizure disorders-pheochromocytoma-parkinson’s disease

CNS-restlessness-drowsiness-fatigue-extrapyramidalReactions-irritability-anxietyCV-arrhythmiaGI-constipation-diarrhea-nausea-dry mouthENDO-gynecomastia

IM: for prevention of postoperative nausea and vomiting.Inject near the end of surgery-assess for nausea, and vomiting, abdominal distention, and bowel sounds prior to and following administration-Inject slowly over 1-2min to prevent transient feeling of anxiety.



Generic name


Dosage & route



Brand name:Reglan Reclomide

Generic name: Metoclopramide

Antiemetic, GI stimulant

-Blocks dopamine receptors in chemoreceptor trigger zone of the CNS-Stimulates motility of the upper GI tract and accelerates gastric emptying.-Decreased nausea and vomiting-Decreased symptoms of gastric static.

150mg 1 amp TIV q8

-Facilitation of small bowel intubation in radiographic procedures.-Treatment and prevention of postoperative nausea & vomiting when nasogastric suctioning is undesirable.

-Gastrointestinal hemorrhage-Obstruction or perforation-History of seizure disorder-Parkinson’s disease

CNS-Anxiety-Depression-IrritabilityCVHypo/Hypertension arrhythmiasBradycardiaGI-Bowel disturbances

-Restlessness-Drowsiness-Fatigue-Akathisia-Dizziness-Nausea-Diarrhea

1. Take as directed; may dilute syrup in water, juice or carbonated beverage just before taking.2. Teach pt. that drug increases the movements or contractions of the stomach and intestines.3. Avoid alcohol and CNS depressants.4. Extrapyramidal effects should be reporter; may be treated w/ parenteral diphenhydramine.5. Do not operate a car or hazardous machinery until drug effect realized drug has a sedative effect up to 2hr. after dosing.



Generic name


Dosage & route



Brand name: Kalium Durule

Generic Name: Potassium Chloride

-Electrolyte (Potassium Supplement)

-Serve as an activator in many enzymatic reactions and is essential to many processes including:*Gastric Secretion*Transmission of nerve impulses*Carbohydrate metabolism*renal function

PO: 20mg tablet TID

PO: Treatment or prevention of potassium depletion in patient who are unable to ingest adequate dietary potassium.

-Severe renal impairment-Untreated Addison’s disease-Severe tissue trauma-Hyperkalemic familial periodic paralysis.-Know alcohol intolerance (elixirs)

-GI bleedingCNS-Paresthesia-paralysis-confusion-weakness-restlessnessCV-Arrhytmias-ECG changes

-Nausea & Vomiting-Diarrhea-Flatulence-Abdominal discomfort

1. Dilute or dissolve PO or soluble powders in cold water, fruit or vegetable juice or other suitable liquid and drink slowly take it w/ plenty of H2O

2. If GI upset occurs products can be taken after meals or with food with a full glass of water.

3. Swallow tablets or capsules; do not chew or dissolve in the mouth.

4. Identify high potassium sources in the diet: spinach, potatoes, collards, tomato juice.



Name of Drug

ClassificationMode of Action

Dosage route

Indication ContraindicationSide

effectAdverse

effectNursing

Responsibilities

Brand name: Kalium Durule

Generic Name: Potassium Chloride

Electrolyte ( potassium supplement)

Maintains the following cell characteristics: *acid base balance*Isotonicity

IV: PNSS 1L 80cc + 40 mEqs KCL x 10 hrs

Prophylaxis and treatment of moderate to severe potassium loss when PO therapy is not feasible.

Severe renal function impairment with oliguria.-

GI bleedingGI obstruction

-Fever-Infection at injection site-Venous thrombosis-Phlebitis extending to the injection site

Do not administer potassium IV undiluted. Usual method is to administer by slow IV infusion in dextrose solution.

Check site of administration frequently for pain and redness because drug is extremely irritating.



Name of drug

Classification

Mechanism of

action

Dosage &

Route

Indication Contraindication

Side effect

NSG.RESP.

PNSS 0.9NaCl Na+=154mEq/LCl+=154mEq/LAlso available with varying concentration of dextrose.

Isotonic solution

Electrolyte

Maintain body fluid osmolalityHelp regulate acid-base balanceRegulate distribution of body fluids

1L TIV Often to correct an extracellular volume deficit.

Heart failurePulmonary edemaRenal impairmentSodium retention

hypotention

Always check IV site for infection

Check IV site for blood clotting



Name of drug

Classification

Mechanism of action

Dosage &

Route

Indication

Contraindication

Side effectNSG.RE

SP.

D5W

No electrolyte

50g of dextrose

Hypotonic solution

provides needed glucose to patients who are either diabetic or require constant sugar replacement. Dextrose in water also replenishes the body's supply of carbohydrates while facilitating re-hydration.

1L TIV Used mainly to supply water and to correct increase serum osmolality.

-head injury-should not be used for fluid resuscitation-should not use solely in treatment of fluid volume deficit.-should not be used in excessive volume in the early post-operative period

vomiting

ADV.effect:

acute hyponatremia

Always check IV site for infection

Check IV site for blood clotting





Medical Management & Surgical Management

Medical Management

Asymptomatic or mild hypokalemia may be treated with enteral

potassium supplements in the form of pills. This is the safest and most

effective treatment for hypokalemia. Symptomatic or severe

hypokalemia should be corrected with a solution of intravenous

potassium. For people taking diuretics, potassium supplements are not

necessary as long as they eat a balanced diet containing foods rich in

potassium. But if hypokalemia has already occurred, use of the high

potassium diet alone may not reverse hypokalemia. The treatment of

the patient’s hypokalemia consisted of kalium durule (C: mineral and

electrolyte replacement or supplement; A: replaces potassium and

maintains potassium level, 2 durules TID per NGT.

Surgical Management

Management is nonsurgical. Medical therapy is aimed at potassium

supplementation by the enteral (ie, oral or through feeding tubes) or

parenteral route. Potassium supplements restore body potassium

storage. Electrolytes are used to correct disturbances in fluid and

electrolyte homoeostasis or acid-base balance and to reestablish

osmotic equilibrium of specific ion. .



Chapter IV

Prioritized nursing problem

Ineffective breathing pattern

Deficient fluid volume

Imbalance nutrition

Activity intolerance

Risk for injury



ASSESSMENT DIAGNOSIS INTERFERENCE PLANNING INTERVENTION RATIONALE EVALUATION“ mediyo Nahihirapan akong huminga as verbalized by the patient”

Vital signs:Temp: 36.6CRR:30cpmPR:77bpmBP:90/60mmHg

Ineffective breathing pattern related to muscle weakness

Inspiration and expiration doesn’t provide adequate cause by muscle weakness

After 1hour of nursing intervention patient will be able to breathe normally

-Assess patients breath sound and respiration

-monitor vital sign

Elevate the bed of the patient to a high fowler’s position

-position patient’s head appropriate for age

-Encourage deep breathing exercise.

*assessing breathing pattern is a good indication for respiratory distress or accumulation of secretion.*monitoring vital signs will serve as the baseline data for the intervention to the patient Elevating the bed and positioning of the pt. will help better lung expansion*positioning the head of the patient will help the patient open and maintain airwayThis exercise help patient to breath easily and provide comfort.

After nursing intervention the goal was meet, , patient can now breathe normally.

NURSING CARE PLAN




ASSESSMENT DIAGNOSIS INTERFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective“.madalas akong magsusuka at matubig ang dumi ko”as verbalized by the patient.

ObjectiveVital signsTemp: 36.5CBP:90/60mmHgRR:35 cpmPR:77bpm

-dry oral mucosa-furrowed tongue-cracked lips-poor skin turgor- dry skin

Deficient Fluid Volume relatedto, vomiting.

A decrease in the intravascular, interstials, and/or intracellular fluid due to vomiting and diarrhea that may affect the acid /base balance of the body and may result to a fluid volume deficit.

After 6 hours of nursing intervention the patient will be able to maintain electrolyte and acid/base balanced as evidenced by not compromised serum electrolytes and muscle strength.

-monitor vital signs

-Monitor for neurologic and neuromuscular manifestations of hypokalemia(e.g., muscle weakness, lethargy, altered level of consciousness) -Offer the client ice chips followed by clear liquids

-Encouraged fluid intake and monitoring of daily fluid intake and output

-Administer medications(antiemetics) if the doctor ordered.

-Provides baseline for assessing and evaluating interventions*Potassium is a vital electrolyte for skeletal and smooth muscleActivity.

*Fluid electrolyte replacement provides oral replacement therapy*To detect early signs of dehydration

*To limit gastric/intestinal losses; to treat bacteria

After 6 hours of nursing intervention the goal was met as evidenced by not compromised serum electrolytes and muscle strength.


ASSESSMENT DIAGNOSIS INTERFERENCE PLANNING INTERVENTION RATIONALE EVALUATION“ nangangayayat na ako kasi wala akong ganang kumain dahil sa pagsusuka ko” as verbalized by the patient

Desired body weight: 54.18 kg

PRESENT:Height: 5’3”Weight: 44 kg.BMI:17.18

PAST:Height: 5’3”Weight: 49 kg.BMI:19

Vital signs:

Temp:RR:30

Imbalalance nutrition less than body requirements related to decrease appetite secondary to vomiting.

Due to vomiting there are not sufficient nutrients absorbed and utilize by the body that result to weight loss due to cellular starvation.

Source:-Brunner, medical surgical nursing pathphysiological concept, vol.1

Short term:After 2 hours of nursing intervention, the client will be able to learn different ways to regain weight appropriately.

Long term:After 4 weeks of nursing intervention, the patient will be able to attain its desirable body weight.

Independent:-determine client’s ability to chew, swallow, and taste of food.

-assess the tooth for decay.

-assess weight.

-note age, body build, strength and activity/rest level.

-provide diet modification, as indicated.

-advice to use flavoring agent.

*this may be a factor of decrease appetite of the patient.

-tooth decay may cause a difficulty to chew thus limiting the intake of foods.

*to establish baseline parameter.

*help to determine nutritional needs.

* To enhance food satisfaction to stimulate

Short term:After 2 hours of nursing intervention, the goal was met as manifested by the verbalization of the client as he was able to identify ways to regain weight appropriately.

Long term:After 4 weeks of nursing intervention, the goal was partially met, as manifested by a change in its weight from 44 kg to 45.6 kg.



PR:77BP:90/60

-limit fibrous foods.

-prevent/minimize unpleasant odors/sight.

-weight regularly or graph the results.

-emphasize importance of well-balanced and nutritious intake.

-Provide information regarding individual nutritional needs and ways.

appetite.

*it may lead to early satiety.

*may have a negative effect on appetite/eating.

*to monitor effectiveness of dietary plan.

*intake of nutritious foods may help the client gain weight appropriately and to stay fit and healthy.

*to meet these needs it should be with in financial constraints of the client.



-encourage increase fluid intake.

-encourage to increase intake of potassium rich foods such as tomato, spinach, avocado, dried fruits, nuts, oranges, sunflower seeds, and potatoes.

Dependent:-administer anti-emetic drug as prescribe by the physician.

Collaborative:-consult a dietitian/nutritionist team, as indicated.

*fluids may aid in normal digestion.

*foods high in potassium helps to increase potassium level the body.

*to lessen vomiting thus improving its appetite.

*to implement interdisciplinary management and to make appropriate meal plan for the client.

ASSESSMENT DIAGNOSIS INTERFERENCE PLANNING INTERVENTION RATIONALE EVALUATIONSubjective“hindi ko

Activity After 1week of asses client’s actual Assessment of After 1week



magalaw ang mga kamay at binti ko”as verbalized by the patient

Objective-difficulty in ambulation.

LUE=1/5KUE=1/5LEE=2/5RLE=2/5

Potassium level:=1.64

Vital signsTemp: 36.5CBP:90/60mmHgRR:30cpmPR:77bpm.

intolerance related to skeletal muscle weakness secondary to decreased serum potassium level.

Due to severe muscle weakness a person will be able to haveInsufficient physiological or psychological energy to endure or complete required or desired daily activities

nursing intervention the patient will be able to:-increase activity tolerance thru the signs expressed primarily:-verbalization-demonstration of well tolerated activities (ADL)

and perceived limitations/degree of action deficits thru:a. test for muscle resistance

- assists client to ADL’s till ability becomes dependent to independent

- assign client simple activities and continuously add the difficulty according to the capability of the client per session.Encourage patient to eat food high in potassium like banana and appleOr administer Kalium durule as ordered by the doctor.

actual limitations can give us a thorough picture about client’s capability for activity.- assisting client to ADL’s can help improve actual tolerance.-Simple activities will be able muscles to react and perceived well from weakness

-potassium will be able to improve skeletal and cardiac muscle activity

of nursing intervention the patient was able to:Meet its goal and can perform his simple ADLs



Assessment Diagnosis Interference Planning Intervention Rationale EvaluationSubjective:“Nanghihina ang katawan ko at paa ko”as verbalized by the client-Fatigue-numbness-TinglingAge: 21y.o.

Objective:V/SBP:90/60mmHgT:36.6PR:79RR:20

Muscle strength:LUE: - 1/5RUE: – 1/5LLE: - 2/5RLE: - 2/5GCS=

Risk for injury related to muscle weakness.

Due to loss of potassium in the cell, the muscle loses its capability to contract that causes muscle weakness, loss of balance, flexibility and coordination, which can contribute to difficulty in doing its activities of daily living that closely linked to injury and fall.

-Bruno, medical surgical nursing with pathophysiological concepts, vol.1

After 4 hours of nursing intervention, the patient will be able to verbalize understanding on what are the ways to reduce/prevent injury to happen with the help of his family and attain muscle strength of:LUE: 4/5RUE: 4/5LLE: 5/5RLE: 5/5

Independent:-Ascertain knowledge of safety needs/injury prevention and motivation.-Assess client’s muscle strength, gross & fine motor coordination.-Assess the level of consciousness

-encourage the client to increase intake of potassium rich foods such as tomato, spinach, avocado, dried fruits, nuts, oranges, sunflower seeds, and potatoes.

-To prevent injury to occur in any setting.

-To identify risk for falls.

-This affects the ability of the client’s ability to protect self or others, and influences choice of interventions and teaching.-This will increase the K level to reach normal serum level of K that will result to normalization of body function thus improving muscle strength.

After 4hrs. ofNursing intervention, goal was partially met, as manifested by verbalization on understanding by enumerating to prevent or reduce occurrence of injury and he was able to increase his muscle strength from LUE: - 1/5RUE: – 1/5LLE: - 2/5RLE: - 2/5To: LUE: - 3/5RUE: – 3/5LLE: - 4/5RLE: - 4/5



Dependent:-Administer 40mEq KCl intravenously incorporated to 1000cc of PNSS as prescribed by the doctor.

Collaborative:-Assist with identification or treatment for underlying cause.

Monitor laboratory studies:*Serum K

-This will increase the K level to reach normal serum level of K that will result to normalization of body function thus improving muscle strength.

- refer to listing of predisposing or contributing factors

-levels should be checked frequently during replacement therapy, especially in the



*Serum Magnesium.

presence of insufficient renal function sudden excess elevation may cause cardiac dysrhythmias

-Hypomagnesemia may impair potassium retention.



Discharge plan

Medication: -Instruct the client to take his

medications on time. Prescribed by

the doctor.

-Kalium Durule 20mg/tab for 3

days

Exercise : -Encourage the client to ambulate

-Encourage the client to take mild

exercise only

Treatment : -Instruct the client to take Kalium

durule and to increase intake of

potassium rich foods to increase

his serum potassium level.

Health teaching : : Encourage the client to avoid

strenuous activities/exercises.

: Encourage to lessen carbohydrate

intake and to avoid carbonic &

alcoholic beverages.

: Encourage to increase intake of

potassium rich foods

: Encourage to take his medicines

on time.

OPD : Instruct the client to go back to the

hospital for his follow up check-up

at OPD department on Sept. 6,

2011, 8-11am.

Diet : -Instruct the patient to increase

potassium intake such as apple,

avocado, carrot, kiwi, orange

tomatoes, peanut butter,



watermelon & milk.

-Instruct the patient to lessen

intake of carbohydrate rich foods

and to avoid carbonic and alcoholic

beverages.

Signs and symptoms : -Advice the patient to go to the

clinic or hospital if he experiences

any signs and symptoms of

hypokalemia such as muscle

cramps, frequent vomiting and

muscle fatigue or weakness.


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