Name of Student: Velarde__________________________ Section and Group number: _BN3F Group 4 (Case Scenario 3)_____

Assessment Nursing (Rationale) Desired Nursing Intervention Justification Evaluation

Cues Diagnosis Pathophysiologic / Outcome
Schematic Diagram
Predisposing Precipitating
Subjective: Activity Intolerance factors: factors: After 8 hours of Independent: After 8 hours of duty,
related to insufficient > Female > History of nursing intervention, the patient is able to:
“Gapang luya ko > 47 years old smoking and
physiologic energy as the patient is
> Family an alcohol
kag sakit akon evidenced by history of drinker for expected to: Assess the patient’s vital signs To help determine patient’s
lawas. Budlayan generalized body pulmonary the past 5 at least every 4 hours. current health status and
weakness. tuberculosis years
ko mag giho kag evaluate effectiveness of
on father's > Takes
nursing interventions
nalipong man ko side. garlic as a
herbal rendered.
sang ligad nga Increase serum
medicine
adlaw.” as calcium levels to 9-10 Achieve normal
verbalized by the mg/dl. laboratory values,
An extremely low calcium
especially calcium and
client. Activity Intolerance level may cause tingling,
Monitor calcium (normal 8.6 phosphorus levels.
muscle aches, spasms of the
Definition: to 10.0 mg/dL) and phosphate muscles in the throat, GOAL MET
levels (normal 2.7 to 4.5
State in which an ↓ mg/dL)
stiffening and spasms of
muscles (tetany), seizures, and
individual has no
Objective: Verbalize feelings of abnormal heart rhythms.
physiological or Decrease in gland function Verbalize comfort and
comfort and increased
Patient is awake, psychological energy absence of abdominal
activity participation
alert, and
enough to resist or
complete required or
↓ in toileting and
pain, weakness, and
perform self-care
responsive to hygiene.
activities with minimal
desired daily activities.
Resistance to PTH action Due to increased risk of tetany
both verbal and assistance.
and seizures. A trach tray
painful stimuli.

> GCS score= 15

↓ Evaluate the airway and have
needs to be easily accessible
for this.
GOAL MET

Source/Reference: Inadequate PTH secretion emergency equipment at

> Facial grimace Demonstrate decrease bedside. ensure that a trach Perform basic tasks
and increased reabsorption
Nurse’s Pocket Guide:
of Ca in GI tract in physiological signs tray is easily accessible. and maintain regular
> Abdominal Diagnoses, Prioritized of activity intolerance cardiovascular and
guarding Interventions, and as evidenced in vital
Nutritional needs are
respiratory functions
Rationales Edition 12 important because they
> Stiffening of signs within normal provide an energy source to during activity.
upper and lower ↓ range (pulse,
Assess nutritional status.
engage in activities.
respirations, BP).
extremities Increase in calcium level in
> Pallor blood ROM exercises increase
circulation and help prevent
contractures.

↓
Assist in performing range of Prolonged immobility may
Muscular hyper irritability
motion (ROM) as tolerated. lead to the development of
Vital signs: pressure ulcers.

BP- 110/80 mmHg

↓
Temp.- 37.1 Muscle cramps in To improve patient education
degrees Celsius extremities, hypocalcemic and medication adherence.
tetany After 3 days of nursing
RR- 18 cpm Monitor skin integrity several
Source/Refer interventions, the
times per day.
PR- 69 bpm ↓ patient will be able to:

Weight- 65 kgs en Activity Intolerance related

Exhibit an increased
ce to insufficient physiologic
tolerance to perform Educate patient on the impact
energy as evidenced by
NANDA ADL’s with no of hypoparathyroidism and Perform ADL’s without
Laboratory generalized body weakness
assistance. treatment on physiologic excessive exhaustion
values: functioning. or loss of energy.
To determine effectiveness of
Calcium=4 GOAL MET
therapy or presence of side
mg/dL
Reference: Verbalize to make
effects.
Phosphorous= 6.1 changes in diet and Collaborative:
mg/dL lifestyle to improve
and maintain health. Demonstrated
Michels, T. C., & Kelly, K. M.
behaviors to stop
(2013, August 15). Parathyroid Administer antibiotics as
disorders. American Family smoking and drinking
Strength: ordered after establishing that
by throwing stocks of
Physician. the patient has no drug
She has someone https://www.aafp.org/afp/2013 cigarettes and alcohol
allergies and note the client's Registered dietitian
 watching over response. nutritionists know how to and to improve diet by
/0815/p249.html. evaluate your nutritional increasing calcium
her, emotional
status based on your medical intake.
support Ratheesh R Follow. (n.d.).
Hypoparathyroidism. history, laboratory results, and
SlideShare. weight history. Thelp you with
https://www.slideshare.net/Rat Refer patient to your habits, and provide you
Weakness: heeshR9/hypoparathyroidism- dietitian/nutritionist to come with science-based dietary
88169324. up with the best diet plan to advice.
Patient lacks improve nutritional status.
knowledge on
hypoparathyroidi
sm or any
endocrine
disorder.

Name of CI: Ms. Maita Monfort RN, MN_______________________________ Area of Exposure: Medical Ward_____________________