1

I. INTRODUCTION

The patient Mrs. N.L is a 73 years old female who has been experiencing general body
weakness three weeks prior to admission. After a series of laboratory works, it shows that Mrs.
N.L. has low potassium level which indicates an electrolyte imbalance specifically hypokalemia.

Electrolyte imbalances can be caused by a deficiency or an overabundance of minerals in

the body. There are many causes for an electrolyte imbalance. Causes for an electrolyte
imbalance may include loss of body fluids from prolonged vomiting, diarrhea, sweating or high
fever, inadequate diet and lack of vitamins from food, malabsorption - Hormonal or endocrine
disorders, kidney disease.

As described, an electrolyte imbalance may create a number of symptoms. The

symptoms of electrolyte imbalance are based on which of the electrolyte levels are affected. If
the blood test results indicate an altered potassium, magnesium, sodium, or calcium levels, it
may lead to muscle spasm, weakness, twitching, or convulsions. Blood test results showing low
levels may lead to: irregular heartbeat, confusion, blood pressure changes, nervous system or
bone disorders. Blood test results showing high levels may lead to: weakness or twitching of the
muscles, numbness, fatigue, irregular heartbeat and blood pressure changes.

Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5
mmol/L). Severe hypokalemia is a level of less than 2.5 mEq/L. Hypokalemia is a potentially
life-threatening imbalance that may be iatrogenically induced Signs and symptoms

Potassium, the most abundant intracellular cation, is essential for the life of an organism.
Potassium homeostasis is integral to normal cellular function, particularly of nerve and muscle
cells, and is tightly regulated by specific ion-exchange pumps, primarily by cellular, membrane-
bound, sodium-potassium adenosine triphosphatase (ATPase) pumps.

Potassium is obtained through the diet and excreted principally via the kidney. Potassium
homeostasis is maintained predominantly through the regulation of renal excretion; the adrenal
gland and pancreas also play significant roles. Hypokalemia may 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.

The frequency of hypokalemia in the general population is difficult to estimate; however,

probably fewer than 1% of people who are not taking medication have a serum potassium level
lower than 3.5 mEq/L. Potassium intake varies according to age, sex, ethnic background, and
socioeconomic status. Whether these differences in intake produce different degrees of
hypokalemia or different sensitivities to hypokalemic insults is not known.
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Up to 21% of hospitalized patients have serum potassium levels lower than 3.5 mEq/L,
with 5% of patients exhibiting potassium levels lower than 3 mEq/L. Among elderly patients, 5%
demonstrate potassium levels lower than 3 mEq/L.

Of patients taking non–potassium-sparing diuretics, 20-50% develop hypokalemia.

African Americans and women are more susceptible. The higher frequency of hypokalemia in
the former group may be from lower intake of potassium in African-American men
(approximately 25 mEq/day) than in their white counterparts (70-100 mEq/day). Risk of
hypokalemia in patients taking diuretics is enhanced by concomitant illness, such as heart failure
or nephrotic syndrome.

Other factors associated with a high incidence of hypokalemia include the following:
 Eating disorders (incidence of 4.6-19.7% in an outpatient setting)
 AIDS (23.1% of hospitalized patients)
 Alcoholism (incidence reportedly as high as 12.6% in the inpatient setting), likely from a
hypomagnesemia-induced decrease in tubular reabsorption of potassium
 Bariatric surgery

The frequency of hypokalemia increases with age because of increased use of diuretics
and potassium-poor diets. However, infants and younger children are more susceptible to viral
GI infections; emesis or diarrhea from such infections places them at increased risk for
hypokalemia because the depletion of fluid volume and electrolytes from GI loss is relatively
higher than that in older children and adults.

Hypokalemia generally is associated with higher morbidity and mortality, especially from
cardiac arrhythmias or sudden cardiac death. However, an independent contribution of
hypokalemia to increased morbidity/mortality has not been conclusively established. Patients
who develop hypokalemia often have multiple medical problems, making the separation and
quantitation of the contribution by hypokalemia, per se, difficult.

II. BIOGRAPHICAL DATA

Name: Mrs.N.L.

Age: 73 years old

Gender: Female

Address: Sta.Catalina Village Salawag, Dasmarinas, Cavite

Marital Status: Married

Occupation: None

Religion: Catholic
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Date of Admission: February 21,2017

Attending Physician: Dr. Josefino Rebancos

Chief Complaint: General Body Weakness

GENOGRAM

FATHER FATHER 97 MOTHER 93

Deceased Deceased Deceased

MOTHER 73

(Patient)

Youngest
2nd to the eldest
Female
Eldest Female
46 years old
45 years old
51 years old
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III. NURSING HISTORY

HISTORY OF PRESENT ILLNESS

Mrs. N.L is on known care of Rheumatoid Arthritis maintained currently on Prednisone 5mg ½
tab once a day, she was apparently well until 3 weeks when she experienced general body
weakness and a slight decrease in appetite.

Potassium Level upon Admission:

Potassium – 2.9 L

PAST MEDICAL HISTORY

The patient has undergone operation on the right eye, removal of cataract and is previously
admitted to same institution with acute peptic ulcer disease, electrolyte imbalance – hypokalemia
secondary to poor intake.

FAMILY MEDICAL HISTORY

The patient’s family has no history of DM and HPN.

IV. GORDON’S FUNCTIONAL PATTERN

Gordon’s Before During Analysis

Assessment Hospitalization Hospitalization
Health Perception Prior to Patient stated that Patient needs a
hospitalization during her stay she heath teaching
Patient’s states that feel comfortable regarding to her
in the past week her and safe. condition and
body feel weak. must ensure that
patient values
guided to
improved health
perception during
hospitalization.
(Krumholz, 2010)
Nutritional/Metabolic Patient ‘s Patient stated that The doctor
Pattern Height: 5’3 Ft she mostly eat fruits ordered low salt
Weight: 55kg such as banana that ,low fat and low
BMI: 22.5 (Normal) rich in potassium prone diet.
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eats three times a and she been To the patient and

day, states that she drinking a 1 bottled increase fluid
loves to eat of 350ml of water. intake and needs
vegetable, 1 cup of follow –up health
rice and fruits, teaching regarding
Patient drink on her diet.
usually 8 glasses of Nutrition is the
water in a day. intake of food,
considered in
relation to the
body’s dietary
needs.
( WHO )Second
International
Conference on
Nutrition (ICN2)

Elimination Pattern Patient is able to Patient states that she Her condition
urinate (3x a day) and usually defecate 3 x a doesn’t affect her
defecate (1x a day) day with soft, light elimination pattern.
with soft, light brown brown color and Elimination patterns
color normally every urinates white or describe the
day. She usually yellow urine on a regulation, control,
defecate early in the usual basis. and removal of by-
morning without any products and wastes
problem in the body(Kozier’s
& Erb’s)
Activity/Exercise Patients states that Patient states that Patients will
Pattern in the past weeks she lessens the follow the advice
before she movement on her to do some
hospitalized, she body. stretching
can do activities activities. An
such as zumba activity and
exercise in the exercise pattern
morning. refers to a
person’s routine of
exercise, activity,
leisure, and
recreation. It
includes activity
of daily living that
require energy
expenditure.
(Kozier’s & Erb’s
Sleep-Rest Pattern Patient stated that Patient stated that Patient will follow
he sleeps 8 hours at she has a good sleep the advice in
night. in the hospital and important of
 6

he nap during 12 sleeping; It

noon. includes activity
of daily living that
requires energy
expenditure.
(Kozier’s & Erb’s)
Cognitive Perceptual Patient can Patient can follow Patient
Pattern comprehended and simple commands comprehension
follow simple and can and following
commands. comprehend simple command
has not change,
Any alterations in
people’s sensory
functions can
affect their ability
to function within
their environment
Adapted from:
Gordon, M.
(1994) Nursing
Diagnosis:
Process and
Application, 3d
Ed. St. Loui
Self-Perception-Self Patient stated that Patient stated that Patient feels that
Concept she feels old, but she feels week , she is older than
strong person and overweight and old the usual feeling.
always safe. ugly woman that image is
she has been influenced
hospitalized strongly by self-
esteem and self-
evaluation, more
so than by external
evaluation by
others
.( Stang J, Story M
(eds)
Role-Relationship Patient stated that Patient stated that She must have
Pattern that she lives with he will be happy time for her
hir husband and bonding together relatives Role
family each member of the performance
family. relates what a
person in a
particular role
does to the
behaviors meet
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social expectation.
.(Kozier’s & Erb’s
)
Sexuality Patient is still Patient reports his Patient has a good
Reproductive Pattern sexually inactive and her wife is not relationship with
with his husband sexual active. his husband. Role
because of her age. performance
relates what a
person in a
particular role
does to the
behaviors meet
social expectation.
(Kozier’s & Erb’s)

Coping Stress Patient stated that Patient stated that The patient usual
Pattern she’s watching T.V she watching ‘coco manner of
when She got stress martin as her idol handling stress
as her coping on T.V program that she perceived
mechanism whenever she feel ability to manage
stress at the her condition. A
hospital. coping mechanism
is a natural or
learned way of
responding to a
changing
environment or
specific problem
or
situation(Kozier)
Value-Belief Pattern Patient stated that Patient states she The patient
she is a Roman prey when she perceives the
Catholic; she prays woke up in the important in life
every Sunday she morning and before and has special
goes to church. she sleep. religious practice,
That provides
guidance for
believers in
responding to
lives. (Adele
Pillitteri Maternal
and Child Health
Nursing)
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V. PHYSICAL ASSESSMENT

Patient is cooperative and answers to questions during the interview.

PATIENT NAME: Mrs. NL AGE: 73 y/o GENDER: Female

DIAGNOSIS: Hypokalemia

VITAL SIGNS

TEMPERATURE 36.4°C  Axillary  Oral  Rectal  Tympanic

HEART RATE 90 bpm  Regular  Irregular  Strong  Bounding

 Thready

RESPIRATORY RATE 20 cpm  Regular  Irregular  Deep  Shallow

BLOOD PRESSURE 110/80  Sitting  Lying  Standing

Assessment Actual Findings Analysis

Integumentary

 Skin Sagged, wrinkled skin Normal Findings

 Hair Hair is graying. Hair is Normal Findings

unevenly distributed
 Nails Nails are smooth and intact Normal Findings
epidermis. Short and clean
fingernails and toenail.
Normal capillary refill of
<3secs.
Head Round in shape. Absence of Normal Findings
nodules or masses. Scalp is
clean, no lice or dandruff
seen
Eyes and Vision Intact and symmetrical. Normal Findings
Eyelids close symmetrically
and blinks involuntarily.
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Conjunctivae is pink in color.

Use of glasses when reading.
Ears and Hearing

Auricles Color of the auricles is same Normal Findings

as facial skin, symmetrical;
auricle is aligned with the
outer canthus of the eye,
mobile, firm, non-tender
External ear canal Without impacted cerumen Normal Findings

Nose and sinuses Symmetric and straight, no Normal Findings

nasal flaring. Air moves
freely as he clients breathes
through both nares. Mucosa is
pink, no lesions and nasal
septum intact and in middle
with no tenderness.
Mouth Symmetrical with pink lips. Normal Findings
Able to purse lips. Incomplete
set of teeth, patient can move
tongue without difficulty.
Tongue is normal in color
(pink and white) with
prominent veins seen in floor
of mouth.
Throat and Neck Patient is able to swallow Lumps on neck due to
without difficulty. Voice is Prednisone. Supraclavical
normal. Can flex neck easily.“fat pads” are collections of
Lump on neck present. No fat at the base of the neck,
pain or tenderness reported. just above the collarbones,
which are common in patients
on steroids. They sometimes
cause concern among patients
if mistaken for lymph nodes
or other causes for worry, but
will gradually subside as the
prednisone dose is tapered to
below 10 milligrams/day.
(www.hopkinsvaculitis.org)
Chest and Lungs Normal lung sounds heard on Presence of U-wave on ECG.
both lung field. No pain
present upon inhalation or
exhalation. Can speak
without difficulty in
breathing. Heart rate of 90
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bpm apical pulse, no chest

pain reported. Presence of U-
wave on ECG
Abdomen Color is same with the rest of Normal Findings
the body. With striae seen.
No distention noted.
Peristalsis heard in all four
quadrants. Abdominal girth
of 28 inches. No pain
reported.
Upper Extremities Soft, warm, and dry to touch. Edema on right side due to IV
Full ROM on both sides. infiltration, tremors
Edema on Right side of the
hand. Fine hand tremors.
Lower Extremities Soft, warm, and dry to touch. Right foot is weak
No lesions seen. Right foot is
weak, without walker.
Genitalia and Rectal Not performed N/A

Bones and Joints No deformities of bones Normal Findings

Mental Status Able to express himself by Normal Findings

speech. Oriented to person,
date, time and place. GCS15
Cranial Nerves

 I Able to distinguish odor in Normal Findings

each nostril (orange)
 II Able to see near and far with Normal Findings
the help of reading glasses.
 III, IV, VI Follows moving object Normal Findings
correctly and vertically;
demonstrates normal facial
sensation, moves eyes
laterally
 VII Elevates eyebrows; puff Normal Findings
cheeks; recognizes tastes
 IX: Impaired of hearing due to Presbycusis
aging
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VI. LABORATORY WORKS

Patient was sent to the hospital for general weakness including her lower extremities.
Blood investigation was done for the basis of the complaint and proper diagnostic
procedure.

DATE EXAMINATION RESULTS NORMAL SIGNIFICANCE/RELEVANCE TO

DONE VALUES THE PATIENT CONDITION
Feb. CBC: Is most ordered request blood
21 screening test, as basis for the
General Health Condition of the
Hb 137 120-160g/L patient symptoms.
neutrophil 0.83 0.55-0.65
lymphocytes 0.15 0.25-0.35 Normal
High indicates for an acute
infection, especially a bacterial
infection
monocytes 0.02 0.03-0.06 Low indicates viral infections and
undernutrition.

Low represents an alarm signal

for an increased risk of infection
and blood disorder
Feb. SODIUM (Na) 124 136.0-149.0 Low it decreases the function of
muscles and nerve.
21 umol/L
Feb. POTASSIUM 2.9 3.80-5.00 Low potassium levels in the blood
stream, the chemical for proper
21 (K) umol/L functioning of nerve and muscle.
ECG + U shape - signifies that the patient has
low K level.
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VII. PATHOPHYSIOLOGY

MODIFIABLE FACTORS: NON-MODIFIABLE FACTORS:

-LIFESTYLE -AGE
-DIET (Poor intake of -GENDER
Potassium Rich foods)

Decreased potassium
extracellular fluid

Decreased depolarization

Decreased action potential

Slowed Slowed Decreased neuronal

smooth smooth excitability
muscle muscle
contraction contraction

Potassium outside HYPOKALEMIA

Body Fatigue
weakness
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IX. NURSING CARE PLAN

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective Activity After 8 hours Dependent: A After 8 hours

Data: Intolerance r/t to of nursing Prednisone 5.5mg OD glucocorticoid of nursing
“Mahina Right foot intervention, for her arthritis. is a cortisol and
intervention,
ang numbness the patient is used
the patient
kaliwang secondary to will verbalize Potassium Tablet (K- especially as an verbalized
paa ko, di muscle weakness leg comforts. Lyte) for muscle inflammatory comfort and
ako due to low spasm, and cramps. drug. legs are
makalakad potassium level elevated by
pag walang as manifested in Independent: Potassium is using
walker.” laboratory results Advised patient to used for nerve pillows.
have mild exercises in impulses and
her lower extremities muscle
by doing the flexion weakness.
Objective and extension exercise
Data:
Potassium Encouraged patient to
Level of: walk around the room
2.9 mmol/L if tolerated.

Assessment Nursing Inference Planning Nursing Rationale Evaluation

Diagnosis Intervention
Hypokalemia is Short term goal: Dependent:
Fluid deficit generally defined After 1 hour of
Subjective: related to as a serum health teaching Administer Administer After 6
‘Nanghihina ang hypokelmia potassium level patient will be the prescribe when hours of
katawan ko” excessive loss of less than 3.5 able to identify drugs potassium nursing
As verbalized by of potassium, mEq/L (3.5 to prevent levels need interventi
the patient. evidenced by mmol/L). Severe hypokelmia to be on, client
generalized hypokalemia is a restored is able to
Objective : body level of less than Long term goal: verbalize
weakness 2.5 mEq/L. Monitor ECG The ECG can understan
 Muscle Hypokalemia is a After 4-6 hours provide ding of
weakness potentially life- of nursing useful interventi
at the threatening intervention the information ons and
lower imbalance patient will be for medicatio
extremitie able to maintain hypokelmia ns
s serum potassium
levels within Monitor vs To obtain
normal range baseline
. data
Independent:
 14

Assist client Potassium-

in selecting rich foods in
foods rich in the diet
potassium as help
such as maintain
banana, fruit potassium
juices and balance
fresh
vegetables

X. DRUG STUDY

Drugs Classification Indication Contraindication Side Effect Adverse Nursing

Effects Responsibility

Generic Nitrates are drugs Prevention The presence of (CNS) Instruct patient
Name: that act directly and treatment any allergies to Headache, to take
Isosorbide on the smooth of angina nitrates. These dizziness, medication as
 15

Mononitrate muscle to cause pectoris in drugs are also and directed, even if
(ISMN) relaxation and to adults contraindicated in myasthenia. feeling better.
depress muscle the following (GI) N & V Take missed
tone. condition: severe and doses as soon as
Brand Name: anemia, head incontinenc remembered;
IMDUR trauma or e. (CV) doses of
60mg hemorrhage, hypotension isosorbide
pregnancy and . (SKIN) dinitrate should
Dosage & lactation. flushing be taken at least
Route: pallor 2 tended hr
sweating apart (6hr with
½ tab / PO and extended-
increased release
perspiration. preparations);
daily doses of
isosorbide
mononitrate
should be taken
7 hour apart. Do
not double
doses. Do not
discontinue
abruptly.

Drugs Classification Indication Contraindicattion Side Effect Adverse Nursing

Effects Responsibility
Generic Anti- Anginal Long MAOI’s Dizziness, Use cautiously
Name: drugs treatment of (monomine low blood in patients with
Trimetazidine coronary oxidine pressure with heart failure or
insufficiency, inhibitors) change of hypertension
angina position, and in elderly
Brand Name: pectortis itching of patients.
Vastarel MR skin, allergic
 16

skin reaction,
nausea and
Dosage & vomiting.
Route:
1 tab morning
& evening

Drugs Classification Indication Contraindication Side Effect Adverse Nursing

Effects Responsibility
Generic Name: Electrolyte and Management Anuria, Fluid or
Spirinolactone water balance of edema hyperkalemia, electrolytes
agent, associated acute or imbalance,
Potassium with progressive renal gynecomasti
Brand Name: sparing excessive insufficiency. a, GI upset,
Aldactone diuretic, aldosterone drowsiness,
Aldosterone excretion, headache,
antagonist hypertension, hyponatremi
Dossage & primary a;
Route: hyperaldoster tachycardia,h
25mg tablet onism, ypotension,
hypokalemia, oliguria,
treatment of hyperkalemia
hirsutism, ; confusion,
cirrhosis of weakness,
liver paresthesia,
accompanied hirsutism,
by edema or mental
ascites drug. disturbance.

Drugs Classification Indication Contraindication Side Effect Adverse Nursing

Effects Responsibility
Generic electrolyte Fluid and Congestive Hypernatre Metabolic: Monitor
Name: electrolyte heart failure, mia, hypernatre electrolyte
Sodium replacement severely hypopotas mia, levels.
chloride in impaired renal semia, aggravation
 17

hyponatremia function,hypern acidosis. of existing

caused by atremia, fluid Fluid and metabolic
electrolyte retention. solute acidosis
loss or in overload with
severe salt leading to excessive
depletion. dilution of infusion.
serum
electrolyte
level, CHF,
overhydrati
on, acute
pulmonary
edema.

Drugs Classification Indication Contraindication Side Effect Adverse Nursing

Effects Responsibility
Generic Potassium Drug- Contraindicated Nausea, Paresthesia Monitor fluid
Name: chloride ; induced in patients with vomiting, of limbs, intake and
Potassium Belongs to the hypokalemi severe renal abdominal listlessness output and
bicarbonate class of a, liver impairment with pain & of legs, BUN,
potassium- cirrhosis, oliguria, anuria, diarrhea; flaccid potassium,
Brand containing nausea, or azotemia; hyperkale paralysis. and creatinine
Name: preparations. vomiting, untreated mia. levels.
K-Lyte Used as dietary cholera, Addison
supplements. diarrhea, disease; or
Dosage & muscular acute
Route: weakness, dehydration,
3-6 tab/day paralysis, heat cramps,
in divided cardiac & hyperkalemia,
doses. CHF, hyperkalemic
diabetic form of familial
ketoacidosis periodic
, ulcerative paralysis, or
colitis, other condition
weakness, linked to
anorexia, extensive tissue
drowsiness, breakdown.
Cushing's
syndrome,
pyloric
stenosis,
low BP.
 18

XI. Discharge Planning

Medications

 Instructed patient regarding home medication such as Isosorbide Mononitrate (30mg

oral, once a day), Trimetazidine (35mg oral, twice a day), and Aldactone (50mg oral,
twice a day).
 Encouraged the patient to comply with the medications.

Exercise

 Advised the patient to exercise using her walker.

 Instructed the patient to rest in between activities.

To Come Back

 Instructed to follow up check-up to Dr. Evelyn S. Osio after one week at around 8am.
 Stressed the importance of the follow-up check-up.

Health Teaching

 Emphasized the importance of the medications.

 Advised the patient to take all medications exactly as directed.
 Explained the uses, doses, frequency and side effects of the medications.
 Informed the patient to drink a beverage high in potassium after exercise or any activity
that causes to sweat a lot. This includes chocolate milk, coconut water, orange juice, or
low-sodium vegetable juices.
 Instructed the patient and family regarding the home care including activity limitations,
diet restrictions and medications.

Observe for untoward signs and symptoms

 Advised to observe pink-colored urine as this would indicate blood in the urine.
 19

 Instructed the patient to watch out for any signs of complication such as; Dry mouth,
blurred vision, tachycardia, nausea and vomiting, abdominal pain, diarrhea and
dizziness.

Diet

 Advised the patient to eat a diet rich in potassium to prevent and treat low blood
potassium. Such as: Avocados, Bananas, Oranges, Tomatoes, Spinach, Milk, Peas and
Beans, and Peanut Butter.
 Instructed the patient to avoid caffeine.
 Advised patient to avoid foods high in salt such as canned foods.

Spiritual Counseling

 Determined client’s support system.

 Provided an information regarding spiritual support system if possible.
 Encouraged patient to express any negative feelings to family or friends.