Name: Torio Mark Joseph A.

Course&year: BSN 3-B

Subject Code: RLE NCM-116

Case Scenario: Patient with Hypoparathyroidism

A twenty-six-year-old male was admitted to the emergency clinic with pain and cramps in the
legs, nausea, vomiting, and a decrease in the amount of urine. He had a head trauma due to a fall
from a height 15 years ago requiring treatment for 45 days in the intensive care unit and had been
treated for epilepsy for the last 10 years. He had no epileptic attack for the last eight months. He
was admitted to the emergency department for leg pain, cramping in the hands and legs, and
agitation at recurrent times within the last six months. He was prescribed antidepressant and
antipsychotic medications. He had trauma to various sites of the body during these episodes of
agitation and convulsions. He was using phenytoin, levetiracetam, sertraline, and olanzapine. He
had no history of smoking or alcohol use. Past medical and family histories were unremarkable.
He had a blood pressure of 80/50 mmHg, heart rate 150 bpm, and respiration rate 35 breath per
muinute, temperature 39.0C, with tachycardia, tachypnea diffuse abdominal tenderness, and
abdominal muscle rigidity on physical examination. Immediately attending physician order start
ivf of pnss 1l for 24 hours, start doubutamine drip at double concentration at 30 ugtts/min, if still
blood pressure is low start levophed drip at double concentration at 30 ugtts/min, give lanoxin ½
ampule stat now, paracetamol 300mg iv now then every 4 hours RTC, 
Major laboratory findings are presented in Table 1. 
He was diagnosed as primary hypoparathyroidism and AKI secondary to rhabdomyolysis. His
antipsychotic medication (olanzapine) was stopped and the dosage of antiepileptic drugs was
decreased. Because of continuing oliguria despite proper hydration, he required five sessions of
hemodialysis. Calcium was replaced parenterally due to nausea and vomiting, followed by oral
calcium and calcitriol treatment after resolution of these symptoms with the doses titrated
according to calcium levels and hypocalcemic symptoms. Within one week, symptoms of
hypocalcemia diminished and rhabdomyolysis recovered with CPK levels returning to normal
followed by polyuria and full recovery of renal functions. Nifedipine, metoprolol, and
spironolactone were administered for the treatment of hypertension. Creatinine, CPK, AST, and
ALT levels were within normal levels 15 days after admission to the hospital. The need for
antihypertensive agents was abolished with normalization of renal functions. He was discharged
with a treatment protocol of oral calcium (9 gr/day), calcitriol (2 μg/day), and the antiepileptic
agents and was advised to be followed up in the endocrinology outpatient clinic.
Table 1

Parameter (unit) Result at admission Result at discharge Normal range

Leucocyte (/mm3) 14300 8800 4400–11300
Hemoglobin (g/dL) 12.6 11.9 14–17.5
Hematocrit (%) 37 34 41–51
Platelet (/mm3) 155000 199000 152–362
Urine sediment 8–10 erythrocytes/field — <2
Proteinuria (mg/day) 435 210 <150
Urea (mg/dL) 181 38 17–48
Creatinine (mg/dL) 7.5 1.1 0.7–1.2
LDH (U/L) 19195 241 135–225
Sodium (mmol/L) 130 138 135–145
Potassium (mmol/L) 5.3 4.7 3.5–5.1
Calcium (mg/dL) 3.7 8.8 8.8–10.2
Phosphorus (mg/dL) 6.2 3.1 2.6–4.5
PTH (pg/mL) 0 2 15–65
CPK (U/L) 262000 299 39–308
ALT (U/L) 4349 24 <41
AST (U/L) 5237 35 <40
Albumin (g/dL) 2.8 3.6 3.5–5.2

Questions: 
a. Based from this case, what are your nursing priority assessment? (5 points)

Assessment of the patient with hypothyroidism should include:

 Assessment of the thyroid from an anterior or posterior position.
 Auscultation of the lobes of the thyroid gland using the diaphragm of the stethoscope if
there are abnormalities palpated.
 Based from the case, why patient need to have a dobutamine and levophed drip? (5
points)
b. based on expert opinion recommend dopamine or dobutamine as first-line agents with
moderate hypotension (systolic blood pressure 70 to 100 mm Hg) AND Norepinephrine
is similar to adrenaline.
c. Why patient need to undergo haemodialysis for 5x?  (5 points)
The patient needed dialysis if your kidneys is no longer remove enough wastes and fluid
from your blood to keep you healthy. This usually happens when you have only 10 to 15
percent of your kidney function left.

d. Make a drug study about the lanoxin, metoprolol, calcitriol? (5 points)

 Lanoxin- Lanoxin is the tablets contains the active substance digoxin, which
belongs to a group of medicines called cardiac glycosides. It is used to treat
arrhythmias and heart failure. An arrhythmia is an irregularity in the heart-beat,
which causes the heart to skip a beat, beat irregularly or beat at the wrong speed.
 Digoxin oral tablet is available as both a generic and brand-name drug. Brand
name: Lanoxin. Digoxin is also available as an oral solution. Digoxin oral tablet is
used to treat atrial fibrillation, mild to moderate heart failure in adults, and heart
failure in children.

 Metropolol- This medicine is a beta-blocker. It works by affecting the response to

nerve impulses in certain parts of the body, like the heart. As a result, the heart
beats slower and decreases the blood pressure. When the blood pressure is
lowered, the amount of blood and oxygen is increased to the heart.
 Brand names: Lopressor and Toprol XL

 Calcitriol-    is used to treat and prevent low levels of calcium and bone disease in
patients whose kidneys or parathyroid glands (glands in the neck that release
natural substances to control the amount of calcium in the blood) are not working
normally.

 Brand Name: Calcijex, Rocaltrol

 Generic Name: Calcitriol
 Drug Class: Vitamin D Analogs
 e. Create NCP based from this case scenario (20points)

ASSESSMENT NURSIN PLANNIN NURSNG EVAULATION

G G INTERVENTION
DIAGN
OSIS
Subjective: decrease After 10 Independent:  After 8 hours of
d hours of Monitor vital signs nursing
 pain and secretion nursing noting pulse rate at interventions,
cramps in or interventio rest and when active. the patient was
the legs decrease ns the able to display
  nausea, d activity patient  Encourage improved ability
vomiting of will patient to to participate in
 decrease in parathyro display restrict desired
the amount id improved activity and activities.
of urine hormone ability to rest in bed as
  head trauma (PTH). participate much as
desired possible..
V/S taken as activities.  Avoid topics
follows: that irritate or
upset the
T: 39. OC patient.
RR: 35 bpm Discuss ways
HR: 150 bpm to respond to
BP: 80/50 mmHg these feelings.