De La Salle Health Sciences Institute

Dasmariñas, Cavite
College of Nursing and School of Midwifery
Level III

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

 NURSING CASE STUDY

HYPOKALEMIC PERIODIC PARALYSIS

I. HEALTH HISTORY

A. DEMOGRAPHIC DATA

Client’s Name or Initial: E.D.V

Gender: Male
Age: 19
Birthdate: July 28, 1990
Birthplace: Manila
Marital Status: Single
Nationality: Filipino
Religion: Roman Catholic
Address: Blk. D2 Lot 6 San Nicholas, City of Dasmariñas, Cavite
Educational Attainment: College Graduate
Occupation: Factory Worker
Usual Source of Medical Care: Hospital
Date of Admission: March 2, 2010, 6:33pm

B. SOURCE AND REALIABILITY OF INFORMATION

 Client himself who seems reliable because he can verbalize the
discomfort and pain that he feels.
 Client’s auntie, R.E, 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. REASONS FOR SEEKING CARE OR CHIEF COMPLAINTS

“Knee pain for 2 days”
“Body weakness for 2 days”
“Difficulty of urinating for 8 hours”

D. HISTORY OF PRESENT ILLNESS

Four years before confinement, 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. It was not associated with

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any activity, easy fatigability, dizziness or syncope. His grandfather had similar
episodes of periodic paralysis during early adulthood.
On the following years, the patient had another episode of weakness of
lower extremities. It is noted that it happened once a year. Patient did not seek
medical consultation.
One day before confinement, 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 was accompanied with weakness of both lower extremities and difficulty of
walking. After a while, he was not able to stand up without support. He
complained of nausea and dizziness but there were no other associated
symptoms such as cough, colds, fever, dyspnea and diarrhea. This patient had
no history of gastrointestinal or renal losses of potassium.
Morning prior to confinement, upon waking up, the patient had intense
lower extremities. He then sought consultation at the out patient department and
the laboratory results revealed a decrease level of potassium. Patient was
subsequently admitted.

E. PAST MEDICAL HISTORY

Patient E.D.V had no known allergies to food and medications. He does

not have any history of serious childhood illness and diseases. Patient was
never been hospitalized before and never undergone any surgical operation.
Most of the time, the patient do self-medication and take over-the-counter
medicines whenever he feels sick.

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F. FAMILY HISTORY

D.V F.D
I.S.V A.D
Heart disease Heart disease
Heart disease, Old age
63 yrs. old 59 yrs. old
cardiac arrest, 89 yrs. old
Episodes of
periodic paralysis
73 yrs. old

L.D.V
Alive and healthy
L.D.V 47 yrs. old
Heart attack
58 yrs old

E.D.V. A.D.V. B.D.V. R.D.V. E.D.V. C.D.V.

Hypokalemia periodic 17 yrs. Old 9 yrs. Old
16 yrs. Old 14 yrs. Old 10 yrs. Old
paralysis Alive and Well Alive and
Alive and Well Alive and Well Alive and Well
19 yrs. old Well

Synthesis: Legend:
According to Mr. E.D.V her grandfather on her
father side has a disease history of heart disease. He = deceased (male)
died at the age of 73 due to cardiac arrest while her
grandmother has also a history of heart disease and = deceased (female)
died at the age of 63. His father had known history of
heart disease and died last January at the age of 58 = male
due to heart attack. Meanwhile, on her mother side,
His grandfather had a history of heart disease and = female
died at the age of 59 due to the same reason. His
grandmother died at the age of 89 due to old age. = patient
Subsequently, her mother has not been diagnosed to
any disease that is presently alive and healthy. The patient has 5 siblings and
none of them have been diagnosed to any disease or illnesses.

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G. SOCIO-ECONOMIC

At present, patient E.D.V. is currently working as an employee in Yazaki

earning more or less than P 2,000 a month. He is allotting half of his earnings in
their daily household expenditures. Since his father has passed away, her
mother is the one who is sustaining their family needs as a businesswoman.
They are also receiving a quantity of financial support from his uncle who is
working abroad.
The estimated monthly income of the family is P 9,000 which is sufficient
enough to sustain their basic needs.

H. DEVELOPMENTAL HISTORY

Based on Erik Erikson’s Developmental theory, patient E.D.V. belongs to

young adulthood (19-40 yrs. old) wherein the central task for this age group is
“Intimacy vs. Isolation”. In this stage, the most important event is love
relationships. Intimacy refers to one's ability to relate to another human being on
a deep, personal level. An individual who has not developed a sense of identity
usually will fear a committed relationship and may retreat into isolation. It is
important to mention that having a sexual relationship does not indicate intimacy.
People can be sexually intimate without being committed and open with another.
True intimacy requires personal commitment. However, mutual satisfaction will
increase the closeness of people in a true intimate relationship. The young adult
must develop intimate relationships with others. Not resolving this conflict leaves
the young adult feeling isolated. The young adult must be willing to be open and
committed to another individual. An individual may retreat into isolation if a sense
of identity is not developed and will fear a committed relationship.
In the case of Mr. E.D.V, he had a present relationship with opposite sex that
is needed for him to fulfill his sense of belonging. The patient also mentioned
about his “barkadas” or group of friends that he used to hang-out with
occasionally. The patient expressed his satisfaction and contentment about on
what he has right now. According to the patient, he does not experience any
sense of rejection from the past to the present as what he can remember.
Although he was not too sociable person as what he had mention, he feels
contented on what he have right now and is certainly satisfied in his present
status.

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I. REVIEW OF SYSTEM AND PHYSICAL EXAMINATION

1. ROS AND PE Date of Assessment: March 3, 2010

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 SYSTEM ROS PE
a. General/ Overall “Wala naman akong  Client is sitting on bed, awake,
Health Status masakit na coherent, oriented to time,
nararamdaman.” place and person
 With ongoing IVF # 1 PNSS 1L
+ 60 mEq/L KCl x 12 hours
inserted at left metacarpal
vein, 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,
PR = 63 bpm, RR = 16 cpm,
and Temp = 36 oC
b. Integument
SKIN
Inspection
 (-) pallor
 (+) birthmark on left biceps
approximately 8x4 cm. 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
 (- ) hair loss

NAILS AND NAILBED

Inspection and Palpation
 (-) brittle, dry
 (+) dirty and untrimmed
fingernails
c. Head  (+) capillary refill of < 2 seconds
Inspection
 (+) proportionate to the body
size
 (-) lesions and swelling
Palpation
 Normocephalic (round,
symmetric skull, appropriately
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related to body size)
 (+) symmetrical
 (-) tenderness and crepitation
2. LABORATORY STUDIES

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 Procedure Indication Normal Actual Nursing
and Values/ Findings Responsibilities/
Date Findings Implications (PRE,
INTRA, POST)

1. Urinalysis Performed to Color: light Color: yellow PRE:

March 3, 2010 -Explain the test
determine the yellow
purpose and
various Character: Character: procedure and the
need to follow
properties of Clear Clear
appropriate urine
urine, as well Spec. Spec. Gravity: collection
procedures
as any Gravity: 1.010
INTRA:
abnormal 1.005-1.030 -Provide privacy
during urine
constituents It pH 4.8 – 7.7 pH: 7.0
collection
is used as Albumin: (-) Albumin : trace POST:
-Evaluate patient
screening Sugar: (-) Sugar: (-)
compliance in
routine in specimen collection
and outcomes
physical
IMPLICATIONS:
examination. -Cloudy urine may
indicate presence of
pus (WBC), RBCs
or bacteria
-Abnormal color of
urine may be due to
presence of RBCs
(smoky), bilirubin
(brownish yellow to
yellow green);
melanotic tumor or
Addison’s (black)
-Acid urine (pH less
than 7.0) occurs in
metabolic acidosis,
diarrhea, starvation,
UTI caused by E.
coli

2.
Hematology PRE:
It consists of a Hgb= 140- Hgb= 153 g/L -Explain the blood
March 2, 2010 count purpose and
series of test 175 g/L
procedure
that determine Hct= 0.41- Hct= 0.46 -No fasting is
required
the number, 0.50
POST:
variety, RBC= 4.0- RBC= 4.3 x 10 -Monitor
12 venipuncture sites
percentage, 6.0 /L
for signs of bleeding
concentration x 10 12/L /infection
-Evaluate the
s and quality Platelet= Platelet=
outcome and
of blood cells. 150-400 x adequate counsel the patient
appropriately about
109/L WBC= 13.1 x
anemia,
WBC= 5.0- 109/L polycythemia, risk
of infections and
10.0 x 109/L
related blood
Differential disorders
9 -Monitor patient’s
count:
with prolonged,
-Segmenters -Segmenters = severely decreased
J. FUNCTIONAL ASSESSMENT

A. Health Perception/Health Management

The patient’s condition improved after being admitted in the hospital for
several days. Medications and the adequate rest is thought to be the reasons for
the improvement. The patient reported no colds in the past. The client is also
confident that he will easily get better. The client and his family are compliant to
all of the doctor’s orders, stating that being in a healthy condition is necessary
because he needs to come back to work as soon as possible.
B. Self-Esteem, Self-Concept/Self Perception Pattern
The patient always think in a positive way. He always feels good about
himself and he is open in talking about his problems and what he feels inside to
other people. Since the illness started, it does not change the patient’s
perception of himself. He has a strong belief that he will recover from his illness
easily.
C. Activity/Exercise Pattern
The patient has enough strength and energy in doing activities of daily
living. The client verbalized that his work requires a lot of energy. To keep his
body fit, the client once jogged regularly. However, he now opts to do brisk
walking every morning as his exercise routine. Patient is able to perform all
activities dependently.
D. Sleep-Rest Pattern
The client usually sleeps for 10 hours. He feels good and rested upon
waking up. 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. Daytime naps are not enjoyed by the client, stating his
work as the reason.
E. Nutritional/Elimination
The patient has a strong appetite. His regular diet is composed of rice and
beef, chicken or pork. The client does not eat vegetables, citing personal
preference as the reason. She has no known allergies to food. He consumes
about 5 glasses of water per day. The client urinates about 4 times a day in
moderate amount, yellowish in color. It is not associated with discomfort. The
patient passes out stool once a day, in moderate amount, formed and brownish
in color. The patient complains of occasional constipation.
F. Sexuality-Reproductive Pattern
The patient has a girlfriend but they are not engaging in premarital sex
because he love and respects her girlfriend.

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G. Interpersonal Relationships/Resources
As an eldest child, the patient knows that he has many responsibilities to
his family especially now that his father already passed away. He always set
himself as a good example to his younger siblings. He has a good relationship
with his co-workers and he is at easy when working with them. Sometimes, he
open up his problems to his co-workers but most of the time, with his family.
H. Coping and Stress Management/Tolerance Pattern
The client has regular contact with his family members, emphasizing that
they are the reason why he works hard. He also hangs out with his peers to relax
and relieve stress. They usually go out to play basketball and play computer
games.
I. Personal Habits
The patient does not smoke and occasionally drinks alcohol. He usually
drinks 3 glasses of liquor when he drinks with his peers. The client do not use
any prohibited drugs.
J. Environment Hazards
Their house is far from the streets, which would mean a lesser chance for
vehicular accidents. They know all their neighbors and they have a good
relationship with them. The client also does not drive cars or motorcycles.

II. PROBLEM LIST

A. ACTUAL or Active
Date Resolved/
Problem No. Problem Date Identified
Remarks

Loss of appetite March 3, 2010 March 3, 2010

Goal Met; was able
to eat foods required
(1) according to
metabolic needs and
activity as manifested
by frequent eating of
banana in the
afternoon
(2) Inability to do daily March 3, 2010 March 3, 2010
activities Goal Met; was able
to sit and ambulate
as manifested by

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 going to CR and
willingness to
participate in self-
care

B. HIGH RISK or Potential

Problem No. Problem Date Indentified

(1) Risk for Falls March 3, 2010

IV. ANATOMY AND PHYSIOLOGY

V. PATHOPHYSIOLOGY
Modifiable Factors Non-Modifiable Factors
- Diet - Gender
- Excessive - Genetics
Exercise - Idiopathic
- Diuretics - Race
- Diarrhea
- Vomiting

Failure of the kidney to

regulate potassium
level

Potassium Decreased potassium

level
KUB levels

Cells cannot repolarize

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 Cells become less
excitable

Slow neural
transmission

Impaired function of
the skeletal and
smooth muscle.
localized
weakness in
lower and
Decreased bowel
upper
motility
extremities
Fatigue
Muscle
tiredness
Hypokalemia Periodic muscle
Paralysis spasms
muscle
tenderness
Constipation

Potassium is essential for many body functions, including muscle and

nerve activity. More than 98% of the body's potassium is intracellular; measuring
it from a blood sample is relatively insensitive, with small fluctuations in the blood
corresponding to very large changes in the total bodily reservoir of potassium.

The osmotic gradient of potassium between 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. As a result, a greater than
normal stimulus is required for depolarization of the membrane in order to initiate
an action potential. Potassium is also essential to the normal muscular function,
in both voluntary muscle (e.g. the arms and hands) and involuntary muscle (e.g.
the heart and intestines).

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 During episodes of muscle weakness, potassium flows from the
bloodstream into muscle cells, affecting the ability of the cell to contract properly.
Potassium levels usually fall during attacks but are normal between attacks.
Episodes may last anywhere from an hour or two to days, and may vary in
intensity from episode to episode, with mild localized weakness in a hand, foot,
jaw or limbs one time and generalized paralysis the next. Episodes may be
accompanied by extreme muscle tenderness and aching or be entirely painless.
Patients may also have what are called abortive attacks - fluctuating daily
weakness which lasts for extended periods and has even been mistaken for
permanent weakness by physicians. Weakness most commonly affects the
muscles of the arms and legs but may affect the trunk as well. Weakness
occasionally affects the eyelid muscles (causing droopy lids). In a few patients
the muscles involved in breathing and swallowing can be affected during severe
episodes. 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.

VI. MEDICAL-SURGICAL MANAGEMENT

1. Pharmacotherapeutics
GN (BN) Indication Nursing
Classification Dosage and Responsibilities/
Stock Frequency Implications
(PRE, INTRA, POST)
1. Potassium chloride I: Potassium is critical for PRE
C: Potassium supplement, the normal functioning of - observe the 10 rights of
Antihypokalemic the muscles, heart, and drug administration
S: 1 tab nerves. It plays an
-assess patient’s medical
important role in controlling
history and
activity of smooth muscles
hypersensitivity to drug.
& skeletal muscles.
-advise the patient to take
Potassium supplement
this medicine immediately
provides replacement of
after meals or with food to
potassium in the body.
lessen possible stomach
It may be needed by
upset or laxative action
patients who do not have
-take this medicine only as
enough potassium in their
directed by your doctor
regular diet or have lost too
-do not use salt substitutes,
much potassium because
eat low-sodium foods,
of illness or treatment with
especially some breads and
certain medicines.
canned foods, or drink low-
D: 1 tab 750mg

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 F: TID sodium milk
(8am, 2pm, 8pm)
POST
-monitor for side effects of
the drug such as Diarrhea;
nausea; stomach pain and
vomiting
-assess for signs and
symptoms of hyperkalemia,
which include muscle
weakness, tingling
sensations and fatigue.
-monitor laboratory results
of the patient regarding
serum electrolyte levels

VII. PROGRESS NOTES

Received patient awake, coherent

and oriented to time, place and person,
in sitting position. Upon observation,
Day # 1 Mr. EV was clenching his hands and
March 03, 2010 tried to slightly rise up his both legs. He
had no appetite for food. There is an
IVF of PNSS 1L + 60 mEq/L KCL at
900 level, inserted at Left metacarpal
vein, infusing well.

Patient exhibited general

weakness as manifested by inability to
sit on his own. He also complained of
dysuria. He had no manifestations any
respiratory or cardiac problems (e.g.
DOB, abnormal lung and bronchial
sounds, elevated BP) except weak
pulse. He also manifested normoactive
BS (BS = 19/min on all quadrant)
without BM, UO = 300 cc, and poor
ROM. Recorded V/S; BP =

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 120/70mmHg, PR = 63 bpm, RR = 16
cpm, and T = 36 oC

Received patient awake, coherent

and oriented to time, place and person,
in sitting position. Upon observation,
Day #2 Mr. EV did some activities on his own
March 4, 2010 and ambulatory. There was still an IVF
of PNSS 1L + 60 mEq/L KCL at 600
level, inserted at left metacarpal vein,
infusing well. Recorded V/S; BP =
110/80, PR = 65 bpm, RR = 18 cpm,
and T = 36.1 oC

Patient exhibited good muscle

control. He lost his body weakness and
became ambulatory. He did not
manifest any signs of deviation in his
respiratory and cardiovascular system
(e.g. DOB, abnormal lung and bronchial
sounds, elevated BP, etc.).
Normoactive BS (BS = 17/min on all
quadrants) with 1x BM, soft, yellowish-
brown, formed stool, UO = 450 cc for
5x. Removed IVF and 24 hour urine
was collected with 300 cc urine.

VIII. DISCHARGE HEALTH TEACHING PLANS

Content Strategy

1. Compliance -Take all Health Teaching

Medication medications • Monitor Signs of Hyperkalemia (e.g.
as generalized fatigue, weakness, paresthesia,
prescribed paralysis, palpitations, nausea)
by the Medicine Dose AM PM ROUTE

doctor
Kalium Durule 750mg, 8:00 2:00
-Have a list
1 tab 8:00 PO
of

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 medications
with the
time of
intake,
dosage and
route.
Diet -Eat foods Health Teaching
reach in  Discussed foods rich in potassium (e.g.
Potassium banana, tomato, potato, sardines,
-Moderate eggplant, cabbage, orange, etc)
use of  Discuss preventable cause of hypokalemia
laxative (e.g. proper use of laxative and nutritional
management)
Exercise -Do not Health Teaching
Activity/Lifestyle over exert  Have a rest period. Increase perspiration
Changes may increase excretion of Potassium

4. Follow-up/Check- March 21, Health Teaching:

up 2010  To evaluate or assess the
Dr. effectiveness of therapeutic management
Cantada  Reassess the function of the
Rm 1226 bladder and condition of urine
 Be sure to bring the result of repeat
urinalysis

IX. SUMMARY OF CLIENT’S STATUS OR CONDITION AS OF LAST DAY OF

CONTACT

Date: March 4, 2010

On the last day of handling Mr. EV, there is an obvious change in his
activity. He regained his energy and he can do things easily unlike when he was
admitted. He can also ambulate to anywhere he wanted. He also improved in
excreting urine, from scanty, often urination to frequent urination of 5x a day in
large amount. Mr. EV was finally withdrawn his IV and he was asked to collect a
urine for 24 hour collection. There was 300 cc collected in his urine and
characterized as within normal color and gravity. The client is afebrile during the
whole course of admission.

Sara Ester Joy L. Ariza

Lady Sunshine B. Cuenca

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 Brenda T. Dagdag

Rhym Arwin P. Gamat

Rose Michaela G. Mactal

Maan Cheska D. Otrera

John Lester P. Ramos

Chrismark A. Reyes

Zaldy M. Tagulao, Jr.

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