Hypokalemia Case Study

Author/s

Shawn Maskalick, Chinwe Okoro, Logan Simcox, Ali Hasnie

Bellarmine University

Doctor of Physical Therapy program

Class of 2016

Abstract

100 word limit, non-structured description

Patient Characteristics

• Demographic Information: 75 y/o white female retired high school teacher living in nursing home

• Medical diagnosis if applicable:
• Co-morbidities: PMH of Coronary Artery disease. S/P CABG, IDDM, HTN, CKD stage 3. 
• Previous care or treatment: Multiple hospital admissions for acute exacerbation of systolic heart failure and respiratory distress secondary to fluid overload.

Examination

• Subjective: 75 y/o white female, NH resident w/PMH of Coronary Artery disease. S/P CABG, CHF with EF 20% on diuretics, IDDM, HTN, CKD stage 3 presents to the ED with c/o dyspnea for 2 days. According to her caregiver and the family, she has had difficulty breathing on minimal exertion and appear winded at rest. She is unable to ambulate and has been lethargic for 3 days. According to the family, since her d/c from the hospital one month ago her respiratory status has not returned to her baseline health. She has been requiring 2L oxygen via nasal cannula and few days ago her lasix dose was doubled. Her quality of life has significantly decline in the last month and she requires 24 hour assistance.
• Self Report Outcome Measures: N/A
• Physical Performance Measures: N/A
• Objective : She appears chachectic, in respiratory distress using her accessory muscles, unable to complete her sentence. Tachycardia, tachypnea, hypotension, hypoxic, audible S1, S2, 3/6 ESM at the right sternal border. abd soft, non distended, pulses are+1 of lower extremities. She is alert to person, place and time, no focal neurologic deficit.

Clinical Impression:

1. Acute hypoxic respiratory failure secondary pulmonary edema
2. Acute on chronic CHF exacerbation
3. Hypokalemia and hypomagnesium secondary to loop diuretics

Summarization of Examination Findings

Targeted Intervention: Replace the potassium via IV, correct all the electrolyte abnormalities, and continue diuresis for fluid overload.

Intervention

• Phases of Interventions (e.g. protective phase, mobility phase, etc.)
• Dosage and Parameters
• Rationale for Progression
• Co-interventions if applicable (e.g. injection therapy, medications)

Outcomes

Findings Over time

Discussion

Summary Statement which should include related findings in the literature, potential impact on clinical practices

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