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NURSING CASE STUDY:
HYPOKALEMIC PERIODIC PARALYSIS
Submitted By: Group IV BSN 3-8 Ariza, Sara Ester Joy L. Cuenca, Lady Sunshine B. Dagdag, Brenda T. Gamat, Rhym Arwin P. Mactal, Rose Michaela G. Otrera, Maan Cheska D. Ramos, John Lester P. Reyes, Chrismark A. Tagulao, Zaldy M. Submitted to: Prof. Ma. Rodalyn T. Giron Prof. Jeffilyn A. Anicete Prof. Khrizhna S. Laurizas Prof. Ramon R. Zabala March 15, 2010
It was not associated with 2 .D. HEALTH HISTORY A. R.NURSING CASE STUDY HYPOKALEMIC PERIODIC PARALYSIS I. SOURCE AND REALIABILITY OF INFORMATION Client himself who seems reliable because he can verbalize the discomfort and pain that he feels. Cavite Educational Attainment: College Graduate Occupation: Factory Worker Usual Source of Medical Care: Hospital Date of Admission: March 2. HISTORY OF PRESENT ILLNESS Four years before confinement. 6:33pm B. Client’s auntie. the patient began to experience weakness of the muscles and difficulty of standing up which lasts for a few hours that was less severe and resolve spontaneously within one day. D2 Lot 6 San Nicholas. City of Dasmariñas. DEMOGRAPHIC DATA Client’s Name or Initial: E.E. 1990 Birthplace: Manila Marital Status: Single Nationality: Filipino Religion: Roman Catholic Address: Blk. REASONS FOR SEEKING CARE OR CHIEF COMPLAINTS “Knee pain for 2 days” “Body weakness for 2 days” “Difficulty of urinating for 8 hours” D. 2010. who seems reliable because she is the one who is taking care of her nephew Patient’s chart as a secondary source of information C.V Gender: Male Age: 19 Birthdate: July 28.
fever. After a while. he was not able to stand up without support. colds. the patient do self-medication and take over-the-counter medicines whenever he feels sick. On the following years. Morning prior to confinement. dyspnea and diarrhea. easy fatigability. the patient had another episode of weakness of lower extremities. Patient did not seek medical consultation. upon waking up. 3 . E.any activity. It was accompanied with weakness of both lower extremities and difficulty of walking. One day before confinement. the patient had intense lower extremities. the patient started to complain of sudden onset of pain of both knees in the morning with a scale of 5/10 on the pain scale. It is noted that it happened once a year. He complained of nausea and dizziness but there were no other associated symptoms such as cough.V had no known allergies to food and medications. PAST MEDICAL HISTORY Patient E. Most of the time. He then sought consultation at the out patient department and the laboratory results revealed a decrease level of potassium. He does not have any history of serious childhood illness and diseases. This patient had no history of gastrointestinal or renal losses of potassium. His grandfather had similar episodes of periodic paralysis during early adulthood. Patient was subsequently admitted. dizziness or syncope.D. Patient was never been hospitalized before and never undergone any surgical operation.
S. Hypokalemia periodic paralysis 19 yrs. on her mother side.D. old F. Old Alive and Well B. His grandfather had a history of heart disease and died at the age of 59 due to the same reason. E.V. FAMILY HISTORY I. Old Alive and Well E. her mother has not been diagnosed to Legend: = deceased (male) = deceased (female) = male = female = patient any disease that is presently alive and healthy. old A.F.V Heart attack 58 yrs old Alive and healthy 47 yrs. Old Alive and Well R. Subsequently.V Heart disease 63 yrs.D.V L. old D.V.D. 14 yrs. The patient has 5 siblings and none of them have been diagnosed to any disease or illnesses.V. 16 yrs. cardiac arrest. Old Alive and Well Synthesis: According to Mr.D.D. 9 yrs. 17 yrs. His grandmother died at the age of 89 due to old age. old E.V Heart disease.V.V.D. old A.D.D. old L.D.D Heart disease 59 yrs.V her grandfather on her father side has a disease history of heart disease. Meanwhile. 10 yrs.D Old age 89 yrs. He died at the age of 73 due to cardiac arrest while her grandmother has also a history of heart disease and died at the age of 63.V. His father had known history of heart disease and died last January at the age of 58 due to heart attack. Old Alive and Well C. 4 . Episodes of periodic paralysis 73 yrs.
The young adult must be willing to be open and committed to another individual. H. Since his father has passed away. 5 . True intimacy requires personal commitment.D. The patient expressed his satisfaction and contentment about on what he has right now. People can be sexually intimate without being committed and open with another.000 a month. he feels contented on what he have right now and is certainly satisfied in his present status. They are also receiving a quantity of financial support from his uncle who is working abroad.000 which is sufficient enough to sustain their basic needs. DEVELOPMENTAL HISTORY Based on Erik Erikson’s Developmental theory. The patient also mentioned about his “barkadas” or group of friends that he used to hang-out with occasionally.D. her mother is the one who is sustaining their family needs as a businesswoman. It is important to mention that having a sexual relationship does not indicate intimacy. mutual satisfaction will increase the closeness of people in a true intimate relationship. Isolation”. The young adult must develop intimate relationships with others. An individual who has not developed a sense of identity usually will fear a committed relationship and may retreat into isolation. the most important event is love relationships. personal level. patient E. old) wherein the central task for this age group is “Intimacy vs. Although he was not too sociable person as what he had mention. he does not experience any sense of rejection from the past to the present as what he can remember. The estimated monthly income of the family is P 9.V. However. E.V. patient E. Not resolving this conflict leaves the young adult feeling isolated.G. According to the patient. In the case of Mr. is currently working as an employee in Yazaki earning more or less than P 2. belongs to young adulthood (19-40 yrs. An individual may retreat into isolation if a sense of identity is not developed and will fear a committed relationship. SOCIO-ECONOMIC At present.V. Intimacy refers to one's ability to relate to another human being on a deep. He is allotting half of his earnings in their daily household expenditures.D. In this stage. he had a present relationship with opposite sex that is needed for him to fulfill his sense of belonging.
REVIEW OF SYSTEM AND PHYSICAL EXAMINATION 1. 2010 6 .I. ROS AND PE Date of Assessment: March 3.
” b. oriented to time. RR = 16 cpm. PR = 63 bpm.) hair loss NAILS AND NAILBED Inspection and Palpation (-) brittle. awake. in size and with hair (+) mole on the LLQ of the abdomen (-) edema Palpation (+) warm to touch (+) good skin turgor (+) smooth and even skin on upper extremities (-) dry and rough skin HAIR AND SCALP Inspection and Palpation (-) flakes on scalp (+) black colored hair evenly distributed (. symmetric skull. General/ Overall Health Status ROS “Wala naman akong masakit na nararamdaman. Head 7 .SYSTEM a. Integument PE Client is sitting on bed. infusing well Client appears to be his stated chronologic age Skin color is even with visible birthmark on left biceps Dress is appropriate for occasion and weather Client has long and dirty fingernails Posture is erect and comfortable with age Client is cooperative and purposeful in his interaction with others Facial features are symmetric with movement Speech is clear Client has the following vital signs: BP = 120/70mmHg. place and person With ongoing IVF # 1 PNSS 1L + 60 mEq/L KCl x 12 hours inserted at left metacarpal vein. and Temp = 36 oC SKIN Inspection (-) pallor (+) birthmark on left biceps approximately 8x4 cm. coherent. dry (+) dirty and untrimmed fingernails (+) capillary refill of < 2 seconds Inspection (+) proportionate to the body size (-) lesions and swelling Palpation Normocephalic (round. appropriately related to body size) (+) symmetrical (-) tenderness and crepitation c.
2. LABORATORY STUDIES 8 .
concentration s and quality of blood cells. Hgb= 140175 g/L Hct= 0.030 pH 4.005-1.3 x 10 -Monitor venipuncture sites 12 /L for signs of bleeding /infection -Evaluate the Platelet= outcome and adequate counsel the patient appropriately about WBC= 13. POST) 1. starvation.010 INTRA: -Provide privacy during urine pH: 7.7 Albumin: (-) Sugar: (-) Color: yellow PRE: -Explain the test purpose and Character: procedure and the need to follow Clear appropriate urine Spec. Urinalysis March 3.06.46 -No fasting is required POST: RBC= 4. Hematology March 2. 2010 It consists of a series of test that determine the number.0) occurs in metabolic acidosis. as well as any abnormal constituents It is used as screening routine in physical examination. RBCs or bacteria -Abnormal color of urine may be due to presence of RBCs (smoky).010.0 collection Albumin : trace POST: -Evaluate patient Sugar: (-) compliance in specimen collection and outcomes IMPLICATIONS: -Cloudy urine may indicate presence of pus (WBC). coli PRE: -Explain the blood count purpose and procedure Hct= 0. diarrhea. 2010 Performed to determine the various properties of urine. percentage. melanotic tumor or Addison’s (black) -Acid urine (pH less than 7. Gravity: collection procedures 1.0 x 109/L Differential 9 count: -Segmenters . 109/L polycythemia.50 RBC= 4.8 – 7.410. Color: light yellow Character: Clear Spec.0 x 10 12/L Platelet= 150-400 x 109/L WBC= 5. variety. -Segmenters = severely decreased Hgb= 153 g/L 2.Procedure and Date Indication Normal Values/ Findings Actual Findings Nursing Responsibilities/ Implications (PRE. Gravity: 1.1 x anemia. risk of infections and related blood disorders -Monitor patient’s with prolonged. INTRA. UTI caused by E. bilirubin (brownish yellow to yellow green).
The patient passes out stool once a day. 10 . Self-Concept/Self Perception Pattern The patient always think in a positive way. Since the illness started. He has a strong belief that he will recover from his illness easily. yellowish in color. He consumes about 5 glasses of water per day. The client urinates about 4 times a day in moderate amount. The client and his family are compliant to all of the doctor’s orders. citing personal preference as the reason. he now opts to do brisk walking every morning as his exercise routine. The client does not eat vegetables. To keep his body fit. Self-Esteem. Medications and the adequate rest is thought to be the reasons for the improvement. it does not change the patient’s perception of himself. He watches television before going to sleep. The patient do not use any form of sleeping aids and is not experiencing episodes of insomnia and any other related disorders. chicken or pork. formed and brownish in color. F. It is not associated with discomfort. C. Nutritional/Elimination The patient has a strong appetite. FUNCTIONAL ASSESSMENT A. D. His regular diet is composed of rice and beef. Sexuality-Reproductive Pattern The patient has a girlfriend but they are not engaging in premarital sex because he love and respects her girlfriend. E. He always feels good about himself and he is open in talking about his problems and what he feels inside to other people. Patient is able to perform all activities dependently.J. The patient reported no colds in the past. stating his work as the reason. She has no known allergies to food. However. B. Sleep-Rest Pattern The client usually sleeps for 10 hours. The client is also confident that he will easily get better. The patient complains of occasional constipation. in moderate amount. Daytime naps are not enjoyed by the client. He feels good and rested upon waking up. Health Perception/Health Management The patient’s condition improved after being admitted in the hospital for several days. the client once jogged regularly. Activity/Exercise Pattern The patient has enough strength and energy in doing activities of daily living. stating that being in a healthy condition is necessary because he needs to come back to work as soon as possible. The client verbalized that his work requires a lot of energy.
The client do not use any prohibited drugs. Interpersonal Relationships/Resources As an eldest child. They know all their neighbors and they have a good relationship with them. 2010 11 .G. was able to sit and ambulate as manifested by Loss of appetite March 3. Coping and Stress Management/Tolerance Pattern The client has regular contact with his family members. ACTUAL or Active Problem No. 2010 Goal Met. PROBLEM LIST A. H. They usually go out to play basketball and play computer games. with his family. Sometimes. The client also does not drive cars or motorcycles. the patient knows that he has many responsibilities to his family especially now that his father already passed away. J. 2010 afternoon March 3. He has a good relationship with his co-workers and he is at easy when working with them. II. emphasizing that they are the reason why he works hard. which would mean a lesser chance for vehicular accidents. Problem Date Identified Date Resolved/ Remarks March 3. Personal Habits The patient does not smoke and occasionally drinks alcohol. was able to eat foods required (1) according to metabolic needs and activity as manifested by frequent eating of banana in the (2) Inability to do daily activities March 3. I. He usually drinks 3 glasses of liquor when he drinks with his peers. he open up his problems to his co-workers but most of the time. 2010 Goal Met. He always set himself as a good example to his younger siblings. He also hangs out with his peers to relax and relieve stress. Environment Hazards Their house is far from the streets.
PATHOPHYSIOLOGY Modifiable Factors . 2010 IV.Excessive Exercise .Idiopathic . (1) Problem Risk for Falls Date Indentified March 3.Vomiting Non-Modifiable Factors .Genetics .Gender .Diuretics . ANATOMY AND PHYSIOLOGY V.going to CR and willingness to participate in selfcare B.Diarrhea . HIGH RISK or Potential Problem No.Race Failure of the kidney to regulate potassium level Potassium level KUB Decreased potassium levels Cells cannot repolarize 12 .Diet .
potassium is needed to repolarize the cell membrane to a resting state after an action potential has passed. including muscle and nerve activity. the heart and intestines). the arms and hands) and involuntary muscle (e.g. with small fluctuations in the blood corresponding to very large changes in the total bodily reservoir of potassium. Potassium is also essential to the normal muscular function. a greater than normal stimulus is required for depolarization of the membrane in order to initiate an action potential.Cells become less excitable Slow neural transmission Impaired function of the skeletal and smooth muscle. measuring it from a blood sample is relatively insensitive. in both voluntary muscle (e.g. As a result. Decreased potassium levels in the extracellular space will cause hyperpolarization of the resting membrane potential. in particular. 13 . Decreased bowel motility Hypokalemia Periodic Paralysis localized weakness in lower and upper extremities Fatigue Muscle tiredness muscle spasms muscle tenderness Constipation Potassium is essential for many body functions. The osmotic gradient of potassium between intracellular and extracellular space is essential for nerve function. More than 98% of the body's potassium is intracellular.
Antihypokalemic S: 1 tab Nursing Responsibilities/ Implications Dosage and Frequency (PRE. affecting the ability of the cell to contract properly. D: 1 tab 750mg 14 . patients who do not have enough potassium in their regular diet or have lost too much potassium because of illness or treatment with certain medicines. Potassium chloride C: Potassium supplement. Episodes may be accompanied by extreme muscle tenderness and aching or be entirely painless. and drug administration nerves. Potassium levels usually fall during attacks but are normal between attacks. Pharmacotherapeutics GN (BN) Indication Classification Stock 1. with mild localized weakness in a hand. In a few patients the muscles involved in breathing and swallowing can be affected during severe episodes. Weakness most commonly affects the muscles of the arms and legs but may affect the trunk as well.observe the 10 rights of -assess patient’s medical the muscles. It plays an important role in controlling activity of smooth muscles & skeletal muscles.During episodes of muscle weakness. or drink low- potassium in the body.fluctuating daily weakness which lasts for extended periods and has even been mistaken for permanent weakness by physicians. and may vary in intensity from episode to episode. VI. MEDICAL-SURGICAL MANAGEMENT 1. potassium flows from the bloodstream into muscle cells. jaw or limbs one time and generalized paralysis the next. Weakness occasionally affects the eyelid muscles (causing droopy lids). Patients may also have what are called abortive attacks . POST) I: Potassium is critical for PRE the normal functioning of . INTRA. heart. Potassium provides It may supplement replacement be needed of by history and hypersensitivity to drug. -advise the patient to take this medicine immediately after meals or with food to lessen possible stomach upset or laxative action -take this medicine only as directed by your doctor -do not use salt substitutes. eat low-sodium foods. Episodes may last anywhere from an hour or two to days. foot. The laboratory exam to confirm hypokalemia is through potassium level in the blood and other renal diagnostics and laboratory exam for further evaluation of the condition. especially some breads and canned foods.
PROGRESS NOTES Received patient awake. There is an IVF of PNSS 1L + 60 mEq/L KCL at 900 level. UO = 300 cc. 2010 Mr. -monitor laboratory results of the patient regarding serum electrolyte levels VII. infusing well. inserted at Left metacarpal vein. EV was clenching his hands and tried to slightly rise up his both legs. tingling sensations and fatigue. Patient exhibited general weakness as manifested by inability to sit on his own. Recorded V/S. 8pm) sodium milk POST -monitor for side effects of the drug such as Diarrhea. He also manifested normoactive BS (BS = 19/min on all quadrant) without BM. stomach pain and vomiting -assess for signs and symptoms of hyperkalemia. elevated BP) except weak pulse. in sitting position. BP = 15 . and poor ROM. He also complained of dysuria.F: TID (8am. coherent and oriented to time. Upon observation. Day # 1 March 03. He had no appetite for food. DOB. nausea. abnormal lung and bronchial sounds. 2pm. place and person. which include muscle weakness.g. He had no manifestations any respiratory or cardiac problems (e.
abnormal lung and bronchial sounds. in sitting position. Upon observation. DISCHARGE HEALTH TEACHING PLANS Content 1. yellowishbrown. and T = 36 oC Received patient awake. coherent and oriented to time. Recorded V/S. There was still an IVF of PNSS 1L + 60 mEq/L KCL at 600 level.). UO = 450 cc for 5x. Removed IVF and 24 hour urine was collected with 300 cc urine. etc. Compliance Medication -Take all as prescribed by the doctor -Have a list of Strategy Health Teaching Monitor Signs of Hyperkalemia (e.1 oC Patient exhibited good muscle control. place and person. 8:00 2:00 1 tab 8:00 PO ROUTE medications • 16 . inserted at left metacarpal vein. Normoactive BS (BS = 17/min on all quadrants) with 1x BM. and T = 36.120/70mmHg. infusing well. nausea) Medicine Dose AM PM Kalium Durule 750mg. PR = 63 bpm. He did not manifest any signs of deviation in his respiratory and cardiovascular system (e. 2010 Mr. BP = 110/80. weakness. elevated BP. PR = 65 bpm. DOB. formed stool. EV did some activities on his own and ambulatory. RR = 16 cpm. soft. Day #2 March 4.g. generalized fatigue. He lost his body weakness and became ambulatory. RR = 18 cpm. palpitations. VIII. paresthesia. paralysis.g.
Ariza Lady Sunshine B. EV was finally withdrawn his IV and he was asked to collect a urine for 24 hour collection. proper use of laxative and nutritional management) Health Teaching Have a rest period. potato. cabbage. SUMMARY OF CLIENT’S STATUS OR CONDITION AS OF LAST DAY OF CONTACT Date: March 4. dosage and Diet route. He can also ambulate to anywhere he wanted. -Eat foods reach in Potassium -Moderate use of laxative Exercise Activity/Lifestyle Changes 4. He regained his energy and he can do things easily unlike when he was admitted. 2010 On the last day of handling Mr. sardines. There was 300 cc collected in his urine and characterized as within normal color and gravity. EV. Sara Ester Joy L. banana.medications with the time of intake. Increase perspiration may increase excretion of Potassium Health Teaching: To evaluate or assess the Reassess the function of the Be sure to bring the result of repeat effectiveness of therapeutic management bladder and condition of urine urinalysis IX. eggplant. tomato. orange. Cantada Rm 1226 -Do not over exert Health Teaching Discussed foods rich in potassium (e. etc) Discuss preventable cause of hypokalemia (e. He also improved in excreting urine. Mr. from scanty. there is an obvious change in his activity.g.g. The client is afebrile during the whole course of admission. 2010 Dr. often urination to frequent urination of 5x a day in large amount. Follow-up/Checkup March 21. Cuenca 17 .
Tagulao. Gamat Rose Michaela G. Ramos Chrismark A. Reyes Zaldy M. Jr.Brenda T. 18 . Mactal Maan Cheska D. Otrera John Lester P. Dagdag Rhym Arwin P.
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