UNIVERSITY OF MINDANAO

COLLEGE OF HEALTH SCIENCES EDUCATION

Bachelor of Science in Nursing

A Mini Case Presentation on:

Hypokalemia

In Partial Fulfilment of the Requirements in Care

of Mother, Child at Risk or with Problems

Submitted to:
Prof. Mary Ann Guyot

Submitted by:
Mandin, Caren Joy R.
Manlino, Janice S.
Natad, Feonsa Olivyrra M.
Obeja, Josue Evan M.
Piquero, Mike Andree S.
Quilantang, Julia Clare O.
Remperas, Princess Ethel A.
Reyes, Lois Danielle C.
Rivera, Huey Aaron T.
Roba, Fred Mark B.

November, 2021
Description of the Disease
Potassium is a necessary electrolyte for the body to function properly, as it allows
muscles to move, cells to get nutrition, and nerves to convey signals. It’s very vital for
cardiac cells and aids in the prevention of excessive blood pressure. As a result, if you
have a low potassium level in your blood or if your blood potassium is less than 3.6
mmol/L, you have hypokalemia. Also, it is also known as hypokalemic syndrome, low
potassium syndrome and hypopotassemia syndrome.

Low potassium levels can be caused by a variety of factors. It's possible that you're losing
too much potassium through your digestive system. However, frequent vomiting,
diarrhea, excessive sweating, drugs such as diuretics, antibiotics, laxatives, and
corticosteroids, excessive alcohol use, poor diet, adrenal disorder, and kidney illness are
all common causes of hypokalemia.

Mild hypokalemia is frequently accompanied by no symptoms. Muscle spasms, muscle

cramps or weakness, paralysis, fatigue, abnormal heart rhythms, and kidney disorders
can all be symptoms of severe hypokalemia. Moreover, hypokalemia can also be
diagnosed using blood tests, urine tests, and an electrocardiogram.

Hypokalemia is common in patients undergoing peritoneal dialysis (PD). It is estimated

to affect one-third of all PD patients. It is associated with increased cardiovascular and
all-cause mortality. Furthermore, according to research, women tend to get hypokalemia
more often than men.

I. Definition of Terms
Hypokalemia refers to a decrease in plasma potassium levels below 3.5 mEq/L
(3.5 mmol/L). Because of transcellular shifts, temporary changes in plasma
potassium may occur as the result of movement between the ICF and ECF
compartments (Grossman and Porth, 2014). Patients commonly diagnosed with
this electrolyte imbalance include individuals who are on diuretics such as Lasix or
laxatives. Other common causes may include chronic diarrhea,
vomiting, malnourishment, alcoholism, burns, gastric suction-NG. Individuals
with Cushing's syndrome may experience hypokalemia, however those with Guillain
Barre syndrome may mimic the signs and symptoms of hypokalemia (Jackie et al.,
2013).
Inadequate potassium intake, excessive potassium excretion, or transfers of
potassium from the extracellular to the intracellular region can all cause hypokalemia.
The most prevalent mechanism is increased excretion. A single reason, such as poor
intake or an intracellular shift, is unusual, but many causes are frequently present at
the same time (Lederer, E., 2021).

II. Etiology
Hypokalemia can result from inadequate potassium intake, increased potassium
excretion, or a shift of potassium from the extracellular to the intracellular space.
Increased excretion is the most common mechanism. Poor intake or an intracellular shift
by itself is a distinctly uncommon cause, but several causes often are present
simultaneously (Lederer, E., 2021).

Hypokalemia is frequently caused by insufficient intake. A daily potassium intake

of at least 40 to 50 mEq is required. Inadequate dietary intake can be caused by a lack
of capacity to access or consume food, as well as a diet lacking in potassium-rich foods.
Potassium deficiency is common in those on fad diets and those with eating disorders.
Potassium deficiency is more common in senior individuals. Numerous people have bad
eating habits as a result of living alone; they may have a restricted budget, making it
difficult to purchase potassium-rich meals; they may have difficulties chewing many
potassium-rich foods due to dental issues; or they may have swallowing problems
(Grossman and Porth, 2014).

III. Signs and Symptoms

1. Muscle weakness owing to need for greater stimulation of cell due to low potassium
level
Muscle cramps Malaise and lethargy
2. Decrease in deep tendon reflex response because of lack of response of nerve
tissue to
normal stimuli

3. Anorexia and constipation as a result of decrease in peristaltic activity

4. Palpitations due to cardiac arrhythmias caused by excitability of cardiac muscle
Rhabdomyolysis (destruction or degeneration of muscle tissue) in severe hypokalemia
Cardiac
arrest in severe hypokalemia
“7 L’s (low)”

1. Lethargy
2. Low, shallow respiratory
3. Lethargy cardiac dysrhythmias
4. Lot of urine
5. Leg cramps
6. Limp muscle
7. Low blood pressure (sever)

IV. Anatomy and Physiology

Potassium is an essential mineral and a major electrolyte found in the human body. It plays an
important role in electrolyte regulation, nerve function, muscle control and blood pressure. It is
important that people get sufficient potassium from the diet, as an imbalance can cause
problems in the body.

Hypokalemia, or decreased potassium, can arise due to kidney diseases; excessive losses due to
heavy sweating, vomiting, diarrhea, eating disorders, certain medications, or other causes. Our
kidneys control our body’s potassium levels, allowing for excess potassium to leave the body
through urine or sweat. In some cases, low potassium levels can lead to arrhythmia, or
abnormal heart rhythms, as well as severe muscle weakness.
The Kidneys

The kidneys are two bean-shaped organs that are located on either side of the spine, in the
retroperitoneal space. The left kidney is situated a little higher than the right one, because of
the liver on the right side of the abdominal cavity, above the right kidney. It is extremely
important in filtering minerals from the blood, removing waste products, regulating blood
volume, and maintaining a healthy balance of water, salts, and minerals, such as potassium, in
the blood. Without this balance, nerves, muscles, and other tissues in the body may not work
normally.

The kidney is the main organ that controls the balance of potassium by removing excess
potassium into the urine. When potassium levels are low (hypokalemia), you can become weak
as cellular processes are impaired. And also, if hypokalemia occurs, there is an imbalance
resulting from a dysfunction in this normal process, or the rapid loss of urine or sweat without
replacement of sufficient potassium.

The Nervous System

The nervous system is the major controlling, regulatory, and communicating system in the
body. It is the center of all mental activity including thought, learning, and memory. Together
with the endocrine system, the nervous system is responsible for regulating and maintaining
homeostasis. The nervous system relays messages between your brain and body via the
nerves. The function of nerves and muscles is dependent on potassium and calcium ions. In
case of potassium deficiency, the nerves supplying the limbs may not function, causing
paralysis-like symptoms.

The nervous system controls the muscle contractions. Nerve signals are generated when
sodium enters the cells while potassium exits the cells. Both low and high potassium levels can
affect nerve signals creating irregular heart rhythm (arrhythmia) that can be life-threatening.
The muscles of the gut are also affected when potassium levels are low, causing ballooning of
the intestines.
The Muscular System

The muscular system is composed of specialized cells called muscle fibers. Their predominant
function is contractibility. Muscles, attached to bones or internal organs and blood vessels, are
responsible for movement. Nearly all movement in the body is the result of muscle
contraction.

Our muscles need the right balance of potassium inside their cells and sodium outside of them.
When that balance gets out of whack, it makes it harder for your muscles to work. Our most
important muscle, the heart, needs potassium. It helps cells send the right electrical signals so
that the heart pumps correctly. Potassium is involved in the electrical signals sent by muscles.
It lets them contract properly. If you’re low on potassium, you can get muscle weakness and
cramps.

The Cardiovascular System

The human cardiovascular system is composed of a heart which pumps blood through a closed
system of blood vessels. The heart is composed mostly of cardiac muscle, or myocardium. Its
primary function is to transport nutrients, water, gases, wastes, and chemical signals
throughout the body.

Potassium is a vital mineral that aids in nerve function, including the nerves that control heart
rhythm. Potassium’s most important role involves regulating the heart’s rhythm and
contractions, which is why one of the dangers of low potassium is an arrhythmia, even a heart
attack or sudden cardiac arrest. If a person does not receive treatment, these conditions can be
life-threatening.

The Digestive System

The gastrointestinal tract plays an important role in the maintenance of fluid and electrolyte
balance, and its diseases cause disturbances in that balance. Conversely, fluid and electrolyte
disorders may disturb gastrointestinal function. Digestive problems have many causes, one of
which may be potassium deficiency. Potassium helps relay signals from the brain to muscles
located in the digestive system. These signals stimulate contractions that help the digestive
system churn and propel food so it can be digested .

When blood potassium levels are low, the brain cannot relay signals as effectively. Thus,
contractions in the digestive system may become weaker and slow the movement of food. This
may cause digestive problems like bloating and constipation . Additionally, some studies have
suggested that a severe deficiency may cause the gut to become completely paralyzed.
The Respiratory System

The respiratory system and especially the lungs play an important role in maintaining
homeostasis in the body. Gas exchange in the lungs is one of the ways that the respiratory
system helps maintain homeostasis.

A severe potassium deficiency can cause breathing difficulties. This is because potassium helps
relay signals that stimulate the lungs to contract and expand. When blood potassium levels are
severely low, your lungs may not expand and contract properly. This results in shortness of
breath. Low blood potassium can make you short of breath, as it can cause the heart to beat
abnormally. This means less blood is pumped from your heart to the rest of your body. Blood
delivers oxygen to the body, so an altered blood flow may cause shortness of breath. Also, a
severe potassium deficiency may stop the lungs from working, which is fatal.
V. Pathophysiology
Hypokalemia

Internal K+ Balance External K+ Balance

Low K+ Intake
K+ movement into the cell
External K+ Consumption

• Anorexia
Body finds a way to • Fasting
Internal Balance Shift excrete excess K+
• Specific Diets

External Balance Shift

Excess Insulin Alkalosis

Kidney Sweat GI Tract

Increase Glucose after
meal Low H+ concentration

Exercising a lot in hot climate

 Insulin release Urination Defecation

Increase activity of K+ are moved into the Primary

Increase excretion Vomiting
Diuretics of K+ Diarrhea
Na+/K+ pump cell in exchange for H+ Hyperaldosteronism
through sweating

Abnormal secretion of Inhibit Na+ Loss of gastric • Infections

K+ are moved into the aldosterone reabsorption secretions(HCl)
cell • Bowel

Increase HCO3 in inflammation

Increase reabsorption of Increase Na+
Na+ at DCT reabsorption extracellular spcae • Laxative abuse

Increase secretion of K+ Increase K+ Metabolic Alkalosis Chronic Diarrhea

at collecting ducts secretion to CD

Increase K+
secretion in the
Increase excretion of K+
collecting ducts
through urine

Increase excretion
of K+

Hypokalemia
 Hyperpolarization of
membrane potential
IF LEFT UNTREATED

Muscles become less

reactiveSEVERE
to stimulation
HYPOKALEMIA

Decreased smooth Decreased skeletal Decreased respiratory Decreased cardiac

muscle contraction muscle contraction muslce contraction muscle contraction

Constipation Weakness Respiratory depression Cardiac arrhythmias

Cramps Cardiac arrest

Flaccid Paralysis
 VI. Diagnostic Test

Serum Potassium Test, this test will measure the potassium of the client. The sample to
get would be either blood or urine of the patient. This test will be provided if signs and
symptoms of the health problem of the client occurred. The result of this test would be
high or low potassium level.
➢ Hypokalemia or low in potassium level the test would show < 3.5 mEq/L (3.5
mmol/L)
Electrocardiographic (ECG) test, this is a painless procedure where it is noninvasive
this is to help diagnose many common heart problems in client of all ages, this
procedure will be done to detect the following:

• Arrhythmias (Abnormal Health Rhythm)

• Coronary Artery Disease or a blocked or narrowed arteries in the heart
• Previous heart attack
The following Symptoms that indicated that you need ECG test would be:

• Chest pain
• Dizziness
• Lightheadedness
• Confusion
• Heart palpations
• Rapid palpation
• Rapid pulse
• Shortness of breath
• Weakness
• Fatigue
• Decline in ability to exercise

➢ For patient having a low potassium level or hypokalemia the ECG test would
show change in T waves or it could be inverted T waves or both, suggesting
ischemia and depressed ST segment. In addition, an elevated U wave will also
indicate that the patient is having a low potassium level or Hypokalemia.

VII. Medical Management: Pharmacology

 DRUG / ACTION ADMINISTRATION/DOSA ADVERSE INDICATIONS/CONTRA NURSING
CLASSIFICA GE REACTIONS INDICATIONS/CAUTIO CONSIDERATION
TION NS S

Generic - Inhibition of PO (Adults) - Allergic reactions Indications - Monitor

name sodium intake and
- Edema – 25-200 - It counteracts
reabsorption output
Spironolacton mg/day in 1-2 potassium loss
in the kidney CNS rations and
e divided doses caused by other
while saving daily weight
- Dizziness diuretics
potassium - HTN – 50-100 during
and mg/day in 1-2 - Clumsiness - Used with other therapy
Brand name
hydrogen divided doses agents (thiazides)
- Headache - Assess
Aldactone ions; to treat edema or
- Diuretic-induced patient
spironolacto hypertension
Hypokalemia – 25- frequently for
ne achieves
100 mg/day in 1-2 CV - Primary development
this effect by
divided doses hyperaldosteronis of
antagonizing - arrhythmias
Classificatio m hyperkalmei
aldosterone - Diagnosis of primary
n a
receptors hyperaldosteronism
Diuretics – 100-400 mg/day in GU - Assess
Unlabeled use
1-2 divided doses patient for
Potassium- - Erectile
Therapeutic - Management of skin rash
sparing - Heart failure – 12.5- dysfunction
Effects heart failure (low frequently
diuretics 25 mg/day
doses) during
- Weak (unlabeled use)
therapy
diuretic and Derm
anti-
 hypertensive PO (Children 1-17 yrs) - Stevens- - Discontinue
response Johnson diuretic at
- Diuretic/HTN – 1 Contraindications
when Syndrome first sign of
mg/kg/day in 1-2
compared - Hypersensitivity rash
divided doses - Toxic Epidermal
with other
(should not exceed Necrolysis - Hyperkalemia
diuretics
3.3 mg/kg/day or
- Anuria Laboratory Test
- Conservatio 100 mg/day)
Conditions
n of (unlabeled use) Endo - Acute renal
potassium insufficiency - Evaluate
- Diagnosis of primary - Breast
serum
hyperaldosteronism tenderness - Significant renal
potassium
– 125-375 dysfunction
- Gynecomastia levels before
mg/m2/day in 1-2
and routinely
divided doses - Irregular menses
during
(unlabeled use) Use cautiously in
- Voice deepening therapy
- Hepatic
- Withhold
dysfunction
PO (Neonates) drug and
Hemat
- Presence of age- notify
- 1-3 mg/kg/day in 1-2
- Agranulocytosis related renal physician if
divided doses
dysfunction may patient
lead to risk of becomes
MS hyperkalemia hyperkalemi
c
- Muscle Cramps - Diabetes
- Discontinue
- Concurrent use of
potassium-
potassium
sparing
supplements or
diuretics 3
potassium-
 containing salt days before
substitutes a glucose
tolerance
- OB
test because
- Lactation of risk of
severe
hyperkalemi
a.

Generic - This PO (Adults) - Irritation at IV Indications - Assess for

name medication site signs and
- 40-100 mEq/day in - PO, IV:
maintains symptoms of
Potassium divided doses treatment/prevetio
the acid- hypokalemia
Chloride n of potassium
base CNS (weakness,
depletion
balance, fatigue,
PO (Neonates, Infants, - Confusion
isotonicity, - IV: arrhythmias polyuria,
Brand name and Children)
and electro- - Restlessness due to digoxin polydipsiya)
Klor-Con physiologic - 2-5 mEq/kg/day in toxicity and
- Weakness
balance of divided doses hyperkalemi
the cell. It is a
Classificatio the activator Contraindications
CV - Monitor
n in many IV (Adults)
- Hyperkalemia pulse, blood
enzymatic - Arrhythmias
Mineral and - Serum potassium > pressure,
reactions - Severe renal
electrolyte 2.5 mEq/L – up to - ECG changes and ECG
and are impairment
replacements/ 20 mEq/day as an periodically
essentials to
supplements infusion (not to - Hyperkalemic during IV
the
exceed 10 mEq/hr) GI familial periodic therapy.
transmission
or a concentration of paralysis
of nerve - Abdominal Pain
40 mEq/L via
 impulses, peripheral line (up to - Diarrhea - Hypersensitivity/in Laboratory Test
contraction 100 mEq/L have tolerance Considerations
- Flatulence
of cardiac, been used via
- Monitor
skeletal, and central line) - Nausea
serum
smooth (unlabeled) Use cautiously in
- Vomiting potassium
muscle;
- Serum potassium <2 - Cardiac disease before and
gastric
mEq/L with periodically
secretion; - Renal impairment
symptoms – up to Neuro during
renal
40 mEq/day as an - Diabetes mellitus therapy.
function; - Paralysis
infusion (rate should
tissue - Hypomagnesemia - Monitor renal
generally not - Paresthesia
synthesis function,
exceed 20 mEq/hr) - GI hypomotility
and also serum
including
carbohydrate bicarbonate,
dysphagia/esoph
metabolism. and pH.
IV (Neonates, Infants, and ageal
Children) compression from - Monitor
left atrial serum
Therapeutic - 0.5-1 mEq/kg/dose
enlargement chloride
Effects (maximum 30
because
mEq/dose) as an - Patients receiving
- Replacemen hypochlorem
infusion to infuse at potassium-
t ia may occur
0.3-0.5 mEq/kg/hr sparing drugs
if replacing
- Prevention (maximum infusion
potassium
of deficiency rate 1 mEq/kg/hr).
without
concurrent
chloride.

- Toxicity and
Overdose:
 symptoms of
toxicity are
those of
hyperkalemi
a (slow,
irregular
heartbeat,
fatigue,
muscle
weakness,
paresthesia,
confusion,
dyspnea,
etc.)

Generic The cell membrane Potassium Acetate Assessment

Cardiovascular: Indications
name potential created by Injection, USP, 40 mEq is
Cardiac arrhythmia,
potassium and administered intravenously Treatment and
Potassi heart block,
sodium ions allows only after dilution in a prevention of - History:
um hypotension, paralysis,
the cell generate an larger volume of fluid. hypokalemia when it is Allergy to
acetate paresthesia
action potential—a necessary to avoid tartrazine,
The dose and rate of
- "spike" of electrical Central nervous chloride or acid/base aspirin;
administration are
discharge. The system: Abnormal status requires an severe renal
Brand name dependent upon the
ability of cells to electroencephalogram, additional source of impairment;
individual needs of the
Hyperlyte, produce electrical confusion, lethargy bicarbonate. untreated
patient.
Normosol-M discharge is critical Addison’s
for body functions disease;
Contraindications
such as hyperkalemi
Normal daily requirements:
neurotransmission, a; adynamia
Classificatio muscle contraction, Newborn: 2-6 mEq/kg/24 Local: Local tissue Severe renal impairment episodica
n and heart function. hr. necrosis (with or adrenal insufficiency; hereditaria;
Potassium is also extravasation) hyperkalemia acute
Electrolyte Children: 2-3
an essential dehydration;
supplement mEq/kg/24 hr. Neuromuscular &
mineral needed to heat cramps,
regulate water Adult: 40-80 mEq/24 skeletal: Weakness GI disorders
balance, blood hr. that cause
pressure and levels delay in
of acidity. passage in
the GI tract,
cardiac
disorders,
lactation

-Physical:
Skin color,
lesions,
turgor;
injection
sites; P,
baseline
ECG; bowel
sounds,
abdominal
examination;
urinary
output;
 serum
electrolytes,
serum
bicarbonate

Intervention
s

- Agitate
prepared IV
solution to
prevent
“layering” of
potassium;
do not add
potassium to
an IV bottle
in the
hanging
position.

- Monitor IV
injection
sites
regularly for
necrosis,
 tissue
sloughing,
phlebitis.

- Monitor
cardiac
rhythm
carefully
during IV
administratio
n.
- Caution
patient not to
use salt
substitutes.
- You may
experience
these side
effects:
Nausea,
vomiting,
diarrhea
(taking the
drugs with
meals,
diluting them
further may
help).
- Report
tingling of
the hands or
feet, unusual
tiredness or
weakness,
feeling of
heaviness in
the legs,
severe
nausea,
vomiting,
abdominal
pain, black
or tarry
stools, pain
at IV
injection site.
 VIII. Nutritional Therapy

Regular Diet
2,000 kcal – 300 CHO – 75 CHON – 56 FAT

Food Exchange No. of CHO g CHON g FAT Energy

exchange Kcal
allowance
I. Vegetable 5 15 5 - 80
II. Fruits 5 50 - 200
III. Milk 2 24 16 20 340
whole
Low Fat
Non-Fat -
IV. Rice A 1 23 - - 92
(Low
Protein)
Rice B 1 23 2 - 100
(Medium
Protein)
Rice C 6 138 24 - 648
(High
Protein)
V. Meat Low 1 - 8 1 41
Fat
 Medium 2 - 16 12 172
Fat
High Fat 1 - 8 10 122
VI. Fat 3 - - 15 135
VII. Sugars 5 25 100
Total 298 79 58 2,030

Sunday Calories
Breakfast 1 cup of Whole Grain 159
Cereals
1 glass of Skimmed Milk 85
2 Banana 242

Lunch 1 cup of Brown Rice 150

Chicken Breast with 390
Broccoli
1 serving of Spinach Salad 120
Grapefruit Juice 100

Snack 1 oz. of Roasted Peanut 160

1 glass of Grapefruit Juice 100

Dinner 1 cup of Brown Rice 150

 Grilled Tuna Panga 120
1 cup Mashed Potato 179
1 Orange 62

Total 2,017

Monday Calories
Breakfast 2 pieces of Avocado Toast 368
1 Sweet Potato 144
1 glass of Chocolate Milk 180

Lunch 1 cup of Brown Rice 150

1 serving of Kinilaw na 40
Talaba
1 cup of Green Salad 138
1 Banana 121

Snack 1 piece of Banana Que 160

1 glass of Orange Juice 110

Dinner 1 cup of Brown Rice 150

Fried Tilapia 190
1 serving of Law-Uy 80
1 slice of Watermelon 86

Total 1,917

Tuesday Calories
Breakfast 1 cup of Brown Rice 150
1 serving of Ginisang 230
Munggo
1 Banana 121
1 glass of Skimmed Milk 85

Lunch 1 cup of Brown Rice 150

1 serving of Adobong 293
Sitaw
Avocado Milkshake 300

Snack 1 piece of Turon 180

1 glass of Orange Juice 110

Dinner 1 cup of Brown Rice 150

1 serving of Sinigang 185
Tilapia
1 Orange 62

Total 2,016

Wednesday Calories
Breakfast 1 cup of Arroz Caldo 173
1 glass of Skimmed Milk 85
1 Banana 121

Lunch 1 cup of Brown Rice 150

1 cup of Adobong Pusit 270
 1 cup of kale Salad 150
1 Orange 62

Snack 1 oz. of Roasted Peanut 160

1 glass of Chocolate Milk 180

Dinner 1 cup of Brown Rice 150

1 cup of Ginisang 214
ampalaya
Fried tilapia 190
1 slice of watermelon 86

Total 1,991

Thursday Calories
Breakfast 1 cup of Whole Grain 159
Cereals
1 glass of Chocolate Milk 180
2 Banana 242

Lunch 1 cup of Brown Rice 150

1 serving of Ensaladang 95
Guso
1 fried Chicken breast 180
2 slices of watermelon 172

Snack Avocado Milkshake 300

Dinner 1 cup of Brown Rice 150
1 serving of Sinigang na 168
Bangus
1 sweet potato 144

Total 1,940
Friday Calories
Breakfast 1 cup of Arroz Caldo 173
1 sweet Potato 144
1 glass of Chocolate Milk 180
1 Orange 62

Lunch 1 cup of Brown Rice 150

1 serving of Ginisang 213
Alugbati
Grilled Tuna Belly 156
1 glass of Pineapple Juice 100

Snack 1 cup of Ginataang Bilo- 239

bilo
Buko Juice 72

Dinner 1 cup of Brown Rice 150

1 cup of Adobong Sitaw 242
1 Banana 121

Total 2,002
 Saturday Calories
Breakfast 1 cup of Brown Rice 150
1 serving of Ginisang 230
Munggo
1 glass of Skimmed Milk 85

Lunch 1 cup of Brown Rice 150

1 serving of Pinakbet 175
1 serving of Chicken 220
Breast with Mushrooms
1 Banana 121

Snack 1 oz of Pumpkin Seed 161

Dinner 1 cup of Brown Rice 150

1 cup of Chop Suey 200
1 Grilled Salmon 220
1 Orange 62

Total 1,924

VIII. Nursing Management: essential nursing interventions

Cues and Evidences Nursing Diagnosis Objective Intervention Rationale Evaluation

Subjective: Altered electrolyte After 3 days of Goal met

• “Parang balance related to nursing 1. Establish rapport 1. This will help gain the
nahihilo po active fluid loss as intervention the with the patient trust of the patient as After 3 days of nursing
ako”, as evidenced by patient’s serum well as his trust and intervention, the patient’s
verbalized by diarrhea and potassium cooperation serum potassium levels
the patient. vomiting levels will be were within normal levels
within normal 2. Take the 2. This will serve as and has shown no signs
Objective: ranges. patient’s vital baseline data to and symptoms of
• Diarrhea signs. monitor any hypokalemia.
episodes alterations in the
were noted. patient’s vital signs.
• Vomiting of
patient was 3. Encourage the 3. This will help bring
noted. patient to eat the patient’s serum
• Upon foods rich in potassium levels
admission potassium within normal range.
patient
displayed 4. Encourage the 4. This will aid in
muscle patient to drink replenishing the fluids
weakness of plenty of water. lost.
the lower
extremities 5. Encourage the 5. Doing so will facilitate
patient to moving of stone
frequently stand through the urinary
V/S: if possible. tract.
 BP: 90/ 60 6. Monitor heart 6. Potassium deficits
mmHg rate and rhythm. can weaken cardiac
T: 36.8 ˚C muscle contractility.
P: 115 bpm 7. Monitor signs of 7. Early detection of
RR: 18 cpm symptoms of alterations of the
hypokalemia. patient’s condition
can prevent life
threatening events.

8. Closely monitor 8. Monitoring the

intake and output patients input and
of the patient. output would give
you an idea how
much potassium the
patient losses.

Cues and Evidences Nursing Diagnosis Objective Intervention Rationale Evaluation

Subjective: Risk of fall related After 3 days of Goal met

• “Nauubusan to decreased nursing 9. Establish rapport 9. This will help gain the
ng lakas muscle strength of intervention the with the patient trust of the patient as After 3 days of nursing
aking mga the lower patient will not well as his trust and intervention, there was no
paa sa tuwing extremities experience fall cooperation noted injury caused by
naglalakad falling during his hospital
ako”, as 10. Provide sign to 10. If the healthcare stay.
verbalized by identify and have providers are notified,
the patient. healthcare the patient will have
 providers to lower chances of fall
Objective: observe fall during nursing care.
• Upon precaution
assessment, behavior.
muscle
weakness 11. Review 11. Certain drugs have
was noted. medication, certain side effects
• Serum determine and which can possibly
potassium monitor the drugs cause nausea,
level of side effects to vomiting, weakness,
2.8mEq/L the patient. confusion, etc.

V/S: 12. Move the 12. Items far from the

BP: 90/ 60 patient’s items patient have
mmHg and needs near tendencies of making
T: 36.8 ˚C them, enough for them reach, risking
P: 115 bpm them to easily them of falling.
RR: 18 cpm reach.

13. Set the patient’s 13. Lower beds will help

bed as low as patient take less
possible. injury in the event that
the patient
accidentally falls.

14. Always raise the 14. Side rails serves as

bed’s side rails. barriers that prevent
 the patient from
falling.

15. Provide 15. Rooms that are too

adequate room dim would can result
lighting to stumbling and
especially at falling of patient.
night.

16. Teach the patient 16. This will promote

how to use exercise and client
assistive devices independence.
if necessary.

17. Instruct the 17. This is so that the

family to never patient can be
leave the patient monitored all the time
unattended. and be observed.
 IX. Prognosis

After adequate treatment for hypokalemia with potassium, symptoms from this
metabolic imbalance will go away. Hypokalemia doesn’t cause long-term problems for
the patients with this imbalance. Patients diagnosed with hypokalemia and experiences
arrhythmia are at risk of dying. Patients who have an underlying heart condition such as
congestive heart failure (CHF) and with hypokalemia should be treated promptly. Patients
with such conditions are at risk of death

X. Discharge/ Home instructions or teachings

• Take potassium supplements as prescribed by physician

• Educate the client about the purpose and side effects of each drug.
• Instruct the client to take her medicine in prescribed dosage at the exact time and
never self-medicate.
• Educate the client to take prescribed medicines with the prescribed duration.
• Notify the physician immediately in case of severe reaction and side effects
• Instruct the client to carry her medicine list with him to have it prepared in case
needed.
Exercises:

• After exercise or doing something that causes sweating, drink potassium rich
beverages.
• Instruct the client to watch out for signs of hypokalemia during strenuous activities.
• Educate the client the importance of rest for faster recovery from the disease.
• Encourage the client to drink adequate amount of water especially when doing his
or her exercise.

Treatment:

• Encourage foods and fluids rich in potassium if experiencing diarrhea or vomiting.

• Have potassium levels checked regularly
• Recommend to the patient to drink larger amounts of fluid at least 8-12 glasses
per day.
• Instruct foods or fluids that contain high amounts of salt contents.
• inform the client about the potential side effects as well as the adverse effects he
should expect to happen upon having the medicine he takes.

• Instruct the client to follow drinking the prescribed medicine of the physician and
avoid using over the counter drugs if possible.

Out-Client Follow up:

• Explain to the client to follow up with the doctor as directed and return for a
scheduled check-up and consultation after 1 week of being discharged.

• Instruct the patient when to have his follow up checkup and have him note what
questions he would like to ask or verify from the physician.

• Instruct the client to seek immediate consultation if discomfort and the adverse
reaction of the drug occurs
Health Teachings

Purpose: The purpose for this is to help the client to have a better nutrition.

Goal: The primary goal of this teaching is to reduce the risk of fluid imbalance and nutrition deficient.

Objectives: Content outline: Method of Time allotment: Resources Methods of

instructions: (instruction evaluation
materials)
After 30 minutes of
discussion the client
will.
1. Understand how 1. Discuss
important to prevention and 1. Discussion 1. 10 1. Visual aids 1. Question and
have a better control of foods minutes Answer
nutrition. that are taken.
.
2. Identify basic 2. Discuss what are
kinds of the foods rich in
potassium-rich potassium:
foods. a. Bananas
b. Oranges and
3. Discuss the orange juice 2. Discussion 2. 10 2. Visual aids 2. Question and
preventive c. Tomatoes, minutes Answer.
measurement. tomato sauce,
and tomato juice
d. Leafy green
vegetables, such
as spinach, kale,
salad greens,
collards, and
chard 3. Discussion 3. 10 3. Visual aids 3. Question and
e. Melons (all kinds) minutes Answer.
f. Pomegranates
g. Peas
h. Beans
i. Potatoes
j. Sweet potatoes
k. Avocados,
including
guacamole
l. Vegetable juices,
such as V8
m. Fruit juices
n. All nuts and
seeds
o. Fish, including
tuna, halibut,
salmon, cod,
snapper,
haddock,
swordfish, and
perch
p. Milk, including
fat-free, low-fat,
 whole, chocolate,
and buttermilk
Soy milk

3. Preventive
measurement.
a. Good
quality of
foods.
b. Includes
low-salt
diet rich in
potassium,
magnesiu
m, and
chloride
c. Stop or
reduce the
dosages of
any
medicines
that can
cause low
potassium.
d. Avoid
foods that
are high in
salt. Salty
canned
 and
prepared
foods
should be
avoided.

References:

1. Grossman, S. and Porth, C., 2014. Porth's pathophysiology: Concepts of altered health states. 9th ed. Philadelphia: Lippincott Williams & Wilkins.

2. Jackie et al. (2013) 'Hypokalemic Periodic Paralysis: Two Cases of Profound Weakness', Air Medical Journal, 32(4), pp. 181 -183. Retrieved from:

http://www.airmedicaljournal.com/article/S1067-991X(13)00079-5/abstract?showall=true= on November 11, 2021

3. Testing.com. (2021, November 9). Potassium. Retrieved November 12, 2021, from https://www.testing.com/tests/potassium/

4. What Is Hypokalemia? (2016, October 12). WebMD. Retrieved November 12, 2021, from https://www.webmd.com/digestive-disorders/hypokalemia

5. Hinkle, J., & Cheever, K. (2018). Medical Surgical Nursing (14th ed., Vol. 1). Wolters Kluwer.