Electrolyte Imbalance r/o

Subdural Hematoma r/o GBS r/o

Hypokalemic Periodic Paralysis

A Case Presentation Presented to

The Faculty of the College of Nursing and School of Midwifery
BAGUIO CENTRAL UNIVERSITY

In Partial Fulfillment
Of the Requirements for the
Degree of Bachelor of Science in Nursing

Liza M. Puroc

DECEMBER 2021
 I. PATIENTS PROFILE
Name: Morvy Tenias
Age: 15 years old
Sex: Male
Civil status: Single
Address: Km.5, La Trinidad, Benguet
Occupation: N/A
Nationality: Filipino
Religion: Pagans
Date and time of Admission: December 3, 2021 3:38 pm
Ward & Bed no: Medicine ward 402 A
Admitting Diagnosis: Electrolyte Imbalance r/o Subdural Hematoma r/o GBS
r/o Hypokalemic Periodic Paralysis
Chief complaints: body pain and headache

II. HISTORY OF PRESENT ILLNESS 

 The patient presented to the hospital with complaints of body pain specifically
to his abdomen upom slight external rotation. And has an on and off fever and
rashes is seen oh his upper extremities.

III. 13 AREAS OF ASSESSMENT/ REVIEW OF SYSTEM 

a. Psychosocial Status
Patient Morvy Tenias is 15 years old and from Km.5, La Trinidad, Benguet living
together with hisa family. He is a Filipino citizen and his religion is Pagans

b. Mental and Emotional Status

With regards to his level of consciousness, he is alert and responds a wide range
of stimuli. He has a good intellectual development. He can easily understand and
follow instructions and has the ability to comprehend.. He has a good emotional
intelligence as manifested an appropriate emotional response to stimuli or
situation. However, pain being felt made him restless, irritable and narrowed
focus.

c. Environmental status
He has an appropriate state of mobility to his age and aware of the potential
danger hazard. He has no sensory deficit and is properly oriented to time and
place. Patient and family members has no any history of any infectious disease as
evidenced of his negative RTC-PCT test. His resting moment is quite disturbed
duet to taking of his vutal signs. The water or side table is placed at the left side of
the patient it is accessible for his needs. Patient is in the medicine ward, together
with his father.
 d. Sensory Status
Vision: He has the ability to distinguished objects or persons wwihtout using
any correctibe device
Hearing : He can also distinguish voice even from a distance, loud or soft. No
corrective auditory deficits. And no auditory device noted being used by the
patient
Smell: The patient is able to discriminate an odor from the other
Taste: The patient is able to discriminate sweet, sour, salty and bitter tastes from
each other
Tactile: He was able to determine and discriminate sharp and dull, light and
firm touch, able to perceive heat, cold, pain in proportion to stimulus, able to
differentiate common objects by touch by doing necessary procedure

e. Motor status
In general, all body parts are well coordinated and he can move with ease, but
with limited movement especially in his abdomen was noted specially when in
pain

f. Nutritional Status
Prior to admission, patient consumes full meal 3x a day. He eats meals on time
and a balanced diet.
During hospitalization, he was instructed with a diet as tolerated.

g. Elimination Status
Before hospitalization, Patient L.M usually defecate one to two a day and voids 7
times a day. Duriing hospitalization,, Patient L.M defecated 2-3 times per day
with a characteristic of watery stool. She was put in IFC and voids 3 times in one
day and described it as amber in color and with an output of 700mL.

h. Fluid and Electrolytes Status

Prior to admission, he has a good skin turgor that indicates good hydration. He
usually consumes 3L of fluid a day. He has no signs of dehydration and fluid
overload.
He has an ongoing IVF of PNSS x 1L regulated at 31 to 32 gtts/min.

i. Circulatory Status
The cardiac rate of patient L.M ranges from 85-100 beats per minute. During the
rotation there is no abnormal cardiac rate noted. The normal cardiac rate of an
adult is 60-100 bpm.

December 6, 2021 Cardiac Rate

8 am 85 bpm NORMAL
12 pm 90 bpm NORMAL
December 7, 2021
8 am 100 bpm NORMAL
12 pm 88 bpm NORMAL

j. Respiratory Status
The table below shows the patient’s respiratory rate ranging from 13-20 cycles
per minute are all in normal as 12-20 cycles is the normal. The oxygen saturation
ranges from 96%-98% where the normal value for oxygen saturation is 95%-
100%.

December 6, 2021 Respiratory Oxygen

Rate saturation
8 am 21 cpm NORMAL 96% NORMAL
12 pm 19 cpm NORMAL 97% NORMAL
December 7, 2021
8 am 21 cpm NORMAL 96 % NORMAL
12 pm 20 cpm NORMAL 96% NORMAL

k. Temperature Status
During the rotation patient L.M has a low grade fever in the morning but has
decreased after taking paracetamol.. No sign of profuse sweating noted.

December 6, 2021 Temperature

8 am 36.7 NORMAL
12 pm 36.4 NORMAL
December 7, 2021
8 am 37.3 ABNORMAL
12 pm 36.8 NORMAL

l. Integumentary Status
The skin is warm to touch and upon physical assessment, there was a presence of
rashes on his upper extremities

m. Rest and Sleep Pattern

Due to the environmental factors the patient can’t sleep well due to the pain he is
experiencing. He experiences pain specifically on his abdomen upon slight
external rotation. He uses diversional activities such as conversing to his dad and
manages pain by finding a very much comfortable position.
ANATOMY AND PHYSIOLOGY
(AS BACKGROUND KNOWLEDGE)

An electrolyte
imbalance happens
when electrolyte levels
in the blood are too high
or too low. Such
imbalances can cause
health issues. In rare
cases, they can be fatal .

What Is
Hypokalemia?
Hypokalemia is
an electrolyte
imbalance and is
indicated by a low level
of potassium in the
blood. The normal adult
value for potassium is
3.5-5.3 mEq/L.
Potassium is one of
many electrolytes in
your body. It is found
inside of cells. Normal
levels of potassium are
important for the
maintenance of heart,
and nervous system
function.
Potassium helps carry
electrical signals to cells
in your body. It is
critical to the proper functioning of nerve and muscles cells, particularly heart muscle
cells.

What Causes Hypokalemia?

One way your body regulates blood potassium levels is by shifting potassium into and
out of cells. When there is a breakdown or destruction of cells, the electrolyte potassium
moves from inside of the cell to outside of the cell wall. This shift of potassium into the
cells causes hypokalemia. Trauma or insulin excess, especially if diabetic, can cause a
shift of potassium into cells (hypokalemia).
Potassium is excreted (or "flushed out" of your system) by your kidneys. Certain drugs or
conditions may cause your kidneys to excrete excess potassium. This is the most
common cause of hypokalemia.

Other causes of hypokalemia include:

Increased excretion (or loss) of potassium from your body.
Some medications may cause potassium loss which can lead to hypokalemia. Common
medications include loop diuretics (such as Furosemide). Other drugs include steroids,
licorice, sometimes aspirin, and certain antibiotics.
Renal (kidney) dysfunction - your kidneys may not work well due to a condition called
Renal Tubular Acidosis (RTA). Your kidneys will excrete too much potassium.
Medications that cause RTA include Cisplatin and Amphotericin B.
You may have hypokalemia from a loss of body fluids due to excessive vomiting,
diarrhea, or sweating.
Endocrine or hormonal problems (such as increased aldosterone levels) - aldosterone is
a hormone that regulates potassium levels. Certain diseases of the endocrine system,
such as Aldosteronism, or Cushing's syndrome, may cause potassium loss.
Poor dietary intake of potassium

Symptoms of Hypokalemia:
You may not have any symptoms unless your blood potassium levels are significantly
lowered.
You may have muscle weakness, fatigue, or cramps.
On exam, your healthcare provider may notice your reflexes to be lessened.
You may have changes on your electrocardiogram (ECG or EKG).
IV. PATHOPHYSIOLOGY
Modifiable Factors Non-modifiable Factors
-History of Appendicitis -Age
-History of Colonic Carcinoma
-NPO for 3 days
- Low sodium: 133.80mmol/L

Decreased sodium and bicarbonate serum

level

Decreased perfusion pressure in the renal arterioles

KIDNEYS Juxtaglomelular cells release RENIN

LIVER Converted ANGIOTENSIN I from ANGIOTENSIN

ANGIOTENSIN- Converted ANGIOTENSIN II from ANGIOTENSIN I

CONVERTING ENZYME

Release of the Constricts the

ADRENAL CORTEX
ALDOSTERONE arterioles

Acts on renal tubular and gastrointestinal epithelium Increased activity of the proximal
tubule Na+/H+ antiport transporter

Elevated distal tubule flow rate Increased H+ excretion and

bicarbonate reabsorption

Increased tubular lumen electronegativity

HYPOKALEMIA

Increased sodium reabsorbed from tubular urine

back to the bloodstream

Potassium moves from the bloodstream into the

tubule

Increased renal excretion of potassium

 V. LABORATORY FINDINGS 
LABORATORY TEST NORMAL VALUES ABNORMAL INTERPRETATION
FINDINGS
BLOOD TEST 4%-5.6% 3.1% NORMAL

TUBEX 0-2 (Negative) Positive Strong indication of

6-10 (Positive) current typhoid
fever infection

VI. DRUG STUDY 

I. She is on a maximum
dose of metformin 1 g
BD, insulin glargine
50 units at night,
Amlodipine
II. 5mg OD, Captopril
25 mg BD and
Simvastatin 40mg at
nigh
III. She is on a maximum
dose of metformin 1 g
BD, insulin glargine
50 units at night,
Amlodipine
IV. 5mg OD, Captopril
25 mg BD and
Simvastatin 40mg at
nigh
V. She is on a maximum
dose of metformin 1 g
BD, insulin glargine
 50 units at night,
Amlodipine
VI. 5mg OD, Captopril
25 mg BD and
Simvastatin 40mg at
nigh
VII. She is on a maximum
dose of metformin 1 g
BD, insulin glargine
50 units at night,
Amlodipine
VIII. 5mg OD, Captopril
25 mg BD and
Simvastatin 40mg at
nigh
NAME OF MECHANIS INDICATIO SIDE ADVERSE NURSING
THE DRUG M OF N/ EFFECTS EFFECTS IMPLICATION
ACTION CONTRAIND
ICATION:
GENERIC ACTION:  INDICATIO Gas or Body as a Be aware that patient
NAME:  NSAID that N: bloating. Whole: Back may be at increased risk
Celecoxib exhibits Acute and Sore throat. pain, for CV events, GI
antiinflammat long-term Cold peripheral bleeding; monitor
BRAND ory, analgesic, treatment of symptoms. edema. accordingly.
NAME: and antipyretic signs and Constipation. Increased risk Administer drug with
Celebrex activities. symptoms of Dizziness. of food or after meals if GI
Unlike rheumatoid Dysgeusia. cardiovascular upset occurs.
CLASSIFICA ibuprofen, arthritis and events.  Establish safety
TION inhibits osteoarthritis GI: Abdomina measures if CNS, visual
Anti- prostaglandin Reduction of l pain, disturbances occur.
inflammatory synthesis by the number of diarrhea, Arrange for periodic
NSAIDS inhibiting colorectal dyspepsia, ophthalmologic
cyclooxygenas polyps in flatulence, examination during
e-2 (COX-2), familial nausea.  long-term therapy.
but does not adenomatous CNS: Dizzines If overdose occurs,
inhibit polyposis s, headache, institute emergency
cyclooxygenas (FAP) insomnia.  procedures—gastric
e-1 (COX-1). Management Respiratory:  lavage, induction of
of acute pain Pharyngitis, emesis, supportive
FREQUENC Treatment of rhinitis, therapy.
Y/ DOSAGE/ primary sinusitis, URI.  Provide further comfort
ROUTES: dysmenorrhea Skin: Rash. measures to reduce pain
200 mg BID Relief of signs (eg, positioning,
PO and symptoms environmental control)
of anklylosing and to reduce
spondylitis inflammation (eg,
Relief of signs warmth, positioning, and
and symptoms rest).
 of juvenile Take drug with food or
rheumatoid meals if GI upset occurs.
arthritis Take only the prescribed
dosage; do not increase
CONTRAIND dosage.
ICATION: You may experience
Hypersensitivi these side effects:
ty including Dizziness, drowsiness
those in whom (avoid driving or the use
attacks of of dangerous machinery
angioedema, while taking this drug).
rhinitis and Report sore throat, fever,
urticaria have rash, itching, weight
been gain, swelling in ankles
precipitated by or fingers; changes in
aspirin, vision.
NSAIDs or
sulfonamides.
Severe hepatic
impairment;
severe heart
failure;
inflammatory
bowel disease;
peptic ulcer;
renal
impairment
(CrCl <30
ml/min);
pregnancy and
lactation.

GENERIC ACTION:  Indication: Minimal GI Body as a Monitor for S&S of:

NAME:  Produces Analgesic- upset. Whole: Negli hepatotoxicity, even with
Paracetamol analgesia by antipyretic in Methemoglo gible with moderate
unknown patients with binemia recommended acetaminophen doses,
BRAND mechanism, aspirin allergy, Hemolytic dosage; rash.  especially in individuals
NAME: perhaps by hemostatic Anemia Acute with poor nutrition or
Abenol , A'Cen action on disturbances, Neutropenia poisoning: A who have ingested
ol, Acephen, A peripheral bleeding Thrombocyto norexia, alcohol over prolonged
nacin-3, Anup nervous diatheses, penia nausea, periods; poisoning,
hen, APAP, At system. upper GI Pancytopenia vomiting, usually from accidental
asol , Campain  Reduces fever disease, gouty Leukopenia dizziness, ingestion or suicide
, Datril Extra by direct arthritis Urticaria lethargy, attempts; potential abuse
Strength, Dola action on Arthritis and CNS diaphoresis, from psychological
nex, Exdol , Ha hypothalamus rheumatic stimulation chills, dependence (withdrawal
lenol, Liquipri heat- disorders Hypoglycemi epigastric or has been associated with
n, Panadol, Pe regulating involving c coma abdominal restless and excited
dric, Robigesic  center with musculoskelet Jaundice pain, diarrhea; responses).
, Rounox , Tap consequent al pain (but Glissitis onset Do not take other
ar, Tempra, Ty peripheral lacks clinically Drowsiness of hepatotoxici medications (e.g., cold
lenol, Valadol vasodilation, significant Liver ty—elevation preparations) containing
sweating, and antirheumatic Damage of serum acetaminophen without
CLASSIFICA dissipation of and anti- transaminases medical advice;
TION:   heat. Unlike inflammatory (ALT, AST) overdosing and chronic
Central aspirin, effects) and bilirubin; use can cause liver
Nervous acetaminophe Common cold, hypoglycemia,  damage and other toxic
System n has little flu, other viral hepatic coma, effects.
Agent; Nonnar effect on and bacterial acute renal Do not self-medicate
cotic platelet infections with failure (rare).  adults for pain more
Analgesic, aggregation, pain and fever Chronic than 10 d (5 d in
Antipyretic does not affect Unlabeled use: ingestion: Ne children) without
bleeding time, Prophylactic utropenia, consulting a physician.
and generally for children pancytopenia, Do not use this
produces no receiving DPT leukopenia, medication without
gastric vaccination to thrombocytope medical direction for:
bleeding. reduce nic fever persisting longer
incidence of purpura, hepat than 3 d, fever over 39.5°
FREQUENC fever and pain otoxicity in C (103° F), or recurrent
Y/ DOSAGE/ alcoholics, ren fever.
ROUTES Contraindica al damage.
500 mg PRN tion:
for pain/fever Hypersensitivi
ty to
acetaminophe
n or
phenacetin;
use with
alcohol.
GENERIC ACTION:  INDICATIO dizziness or Body as a Determine history of
NAME:  Semisynthetic N: lightheadedn Whole: Prurit hypersensitivity
Ceftriaxone third- Infections ess us, fever, reactions to
generation caused by salty or chills, pain, cephalosporins and
BRAND cephalosporin susceptible metallic induration at penicillins and history of
NAME: antibiotic. organisms in taste, or IM injection other allergies,
Rocephin Preferentially lower decreased site; phlebitis particularly to drugs,
binds to one or respiratory ability to (IV site).  before therapy is
CLASSIFICA more of the tract, skin and taste GI: Diarrhea,  initiated.
TION penicillin- skin cough abdominal Lab tests: Perform
Antiinfective;  binding structures, fast heartbeat cramps, pseud culture and sensitivity
Antibiotic; Thi proteins (PBP) urinary tract, excessive omembranous tests before initiation of
rd-Generation located on cell bones and tiredness colitis, biliary therapy and periodically
Cephalosporin walls of joints; also sludge.  during therapy. Dosage
susceptible intra- Urogenital:  may be started pending
organisms. abdominal Genital test results. Periodic
This inhibits infections, pruritus; coagulation studies (PT
third and final pelvic moniliasis. and INR) should be
stage of inflammatory done.
bacterial cell disease, Inspect injection sites for
wall synthesis, uncomplicated induration and
thus killing the gonorrhea, inflammation. Rotate
bacterium. meningitis, sites. Note IV injection
 and surgical sites for signs of phlebitis
FREQUENC prophylaxis. (redness, swelling, pain).
Y/ DOSAGE/ Monitor for
ROUTES: CONTRAIND manifestations of
2g IV every 12 ICATION: hypersensitivity (see
hours Hypersensitivi Appendix F). Report
ty to their appearance
cephalosporins promptly and
and related discontinue drug.
antibiotics; Watch for and report
pregnancy signs: petechiae,
(category B). ecchymotic areas,
epistaxis, or any
unexplained bleeding.
Ceftriaxone appears to
alter vitamin K–
producing gut bacteria;
therefore,
hypoprothrombinemic
bleeding may occur.
Check for fever if
diarrhea occurs: Report
both promptly.
Report any signs of
bleeding.

IX. She is on a maximum

dose of metformin 1 g
BD, insulin glargine
50 units at night,
Amlodipine
X. 5mg OD, Captopril
25 mg BD and
Simvastatin 40mg at
nigh
VII. NCP PROPER
Time Chart
7:00- F> Acute pain related to muscle cramps/aches as evidenced by bdominal pain upon
3:00 slight external rotation with pain scale of 7/10
pm D> Receiver lying on bed. With intact IVF of PNSS 1L x 12 hours. “Nasakit daytoy
siket ko”. With pain sclae of 7/10. With VS of BP- 100/80; temp- 36.9 C; PR- 20 cpm;
PR- 113 bpm; SPO2- 97 %. With generalized weakness noted
A>Assessed and monitored VS every 4 hours. Assessed pain characteristics like
quality, severity, location, onset and duration. Provided rest periods to facilitate
comfort, sleep and relaxation. Administered NSAID medication. Replaced and
regulated IVF (PNSS)
R> Pain scale of 6/10 and feeling bettter.

Time Chart
7:00- F> Continuity of care
3:00 D> Received lying in bed with an intact IVF of PNSS 1L x 12 hours, infuing well
pm A>Assessed and monitored VS every 4 hours. Provided rest periods to facilitate
comfort, sleep and relaxation. Administered NSAID medication. Replaced and
regulated IVF. Instructed SO to report any untoward signs and symptoms to nurses or
press the call bell
R> Receptive to care