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Due to the constraints of modern life, we often have limited resources to prioritize the quality and nutritional value of our food. As a result, our focus tends to be on satisfying hunger rather than meeting nutrient requirements. While the term "diet" is commonly linked to restricting food intake for weight loss purposes, it can also encompass consuming nourishing foods that fulfill our body's nutritional needs and making wise choices in our eating habits.
Statistics show that in the United States, 20% of hospitalized patients experience hypokalemia.
However, only about 4-5% of these patients have clinically significant hypokalemia. Severe hypokalemia is not common. Mild hypokalemia is found in around 14% of outpatients who undergo laboratory testing. Approximately 80% of patients taking diuretics develop hypokalemia. The incidence of hypokalemia is equal for both males and females.
The researcher chose to study hypokalemia as a case study on acute adult diseases due to its potential lethality and frequent oversight by those unaware of its nature. By examining the entire progression of the illness, valuable knowledge and fresh insights can be gained to assist in managing hypokalemia.
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This can benefit students, nurses, and researchers studying this condition.
The researcher's goal is to apply the Neuman Systems Model to a client with hypokalemia. This theory was specifically designed to address the client's needs and the researcher aims to test its effectiveness by using it to treat the acute condition of hypokalemia. The Neuman Systems Model focuses on promoting the overall well-being of the client or client system in relation to environmental stress and their response to stress (Fawcett,1995).
According to the Neuman Systems Model and systemic perspective, health and wellness are defined as the coordination or degree of system stability. This refers to the condition in which all parts and subparts (variables) are in balance or harmony with the whole of the client/client system (Neuman,2002).
Betty Neuman’s Systems Model is based on the concept of stress and its response. The model incorporates physiological, psychological, sociocultural, developmental, and spiritual factors at all system levels (Neuman, 2002). The physiological factor pertains to mental relationships and processes. The sociocultural factor involves social and cultural interactions and expectations. The developmental factor encompasses processes and needs that change as the system develops. Lastly, the spiritual factor relates to the system’s beliefs, which are often undervalued despite their significance (Frisch, 2006).
The basic structure of a client consists of common survival factors and unique individual characteristics. It includes the energy resources of the overall system (Neuman, 2002). The client or client system is a combination of various variables, such as physiological, psychological, sociocultural, developmental, and spiritual factors. Each of these variables is a subpart of the whole client. The client as a system contains a core or basic structure that is made up of survival factors, along with protective concentric rings surrounding it.
The concentric rings have similar factors but serve different purposes, including retention, attainment, and maintenance of system stability and integrity. The client is seen as an open system that interacts with the environment. The client is viewed as a system and can be referred to interchangeably as the client/client system (Neuman, 2002). The entire client system consists of the variables of a person interacting with the internal and external environment (Neuman, 2002).
The degree of reaction refers to the amount of system instability caused by the invasion of stressors into the normal lines of defense. According to Neuman, the environment is defined as all factors that both affect and are affected by the system. It includes all internal and external factors or influences surrounding the identified client or client system. Neuman has identified three relevant environments: the internal environment, which consists of all forces or interactive influences within the boundaries of the client/client system; the external environment, which consists of all forces or influences outside the client/client system and can be interpersonal or extrapersonal in nature (Neuman, 2002). Feedback is the process in which system output, including matter, energy, and information, provides feedback to initiate corrective action and change, enhance, or stabilize the system.
As per Fawcett (1995), the client's state of normalcy or stability is safeguarded by flexible defense lines, serving as a buffer against stressors and aiming to prevent their intrusion. The objective of this system is to achieve stability for ensuring the survival and optimal wellness of the client. Conversely, health is a dynamic continuum that constantly fluctuates between illness and wellness. Optimal wellness or stability indicates fulfillment of all system needs, whereas reduced wellness signifies unmet needs. At any given moment, the client exists in a dynamic state with varying degrees of wellness or illness. The exchange of matter, energy, and information between the client and the environment is known as Input/Output, occurring continuously. Lines of resistance encompass both known and unknown internal and external resources that support the client's fundamental structure and normal defense line while maintaining system integrity.
An example is the body's mobilization of white blood cells or activation of immune system mechanisms. The effectiveness of the lines of resistance in reversing the reaction to stressors allows the system to reconstitute, while ineffectiveness leads to energy depletion (Neuman, 2002). The normal defense line is the solid boundary line that encircles the broken internal lines of resistance, representing the client's state of evolution over time or their usual wellness level. It serves as a standard to determine any deviation from the usual wellness state (Neuman, 2002). The prevention as intervention typology or modes for nursing action and determinants for entry into the health care system include primary prevention (before a reaction to stressors occurs), secondary prevention (treatment of symptoms following a reaction to stressors), and tertiary prevention (maintenance of optimal wellness following treatment).
Reconstitution refers to the restoration and maintenance of system stability after addressing a stressor reaction, which can lead to a higher or lower level of wellness compared to before. Stability is a state of balance or harmony that involves exchanging energy as the client effectively deals with stressors to achieve and sustain an optimal level of health, thereby preserving the integrity of the system. Stressors are environmental factors, as well as factors within oneself, between individuals, or external to individuals, that have the potential to disrupt system stability. A stress is any event that can affect both the adaptable and normal lines of defense, resulting in either a positive or negative outcome (Neuman, 2002).
Intrapersonal stressors are those that exist within an individual's internal environment, such as conditioned and autoimmune responses. Interpersonal stressors, on the other hand, are found in the external environment and occur at the boundary between the individual and their proximal external environment. These stressors include forces like role expectations and communication patterns. Extrapersonal stressors also exist in the external environment but occur at the boundary between the individual and their distal external environment. These stressors can include financial concerns or social policies (Fawcett, 1995).
Wellness refers to the state in which the entire system of the client is in harmony. It is characterized by the interrelationships of various variables that determine an individual's resistance to stressors. On the other hand, illness indicates a lack of harmony among the different parts and subparts of the client's system. A system is considered wholistic if its parts or subparts can be organized into an interrelated whole. Wholistic organization involves keeping all parts intact and stable within their intimate relationships. Individuals are seen as wholes with dynamic interdependence between their component parts.
The researcher in this study utilized the case study method, which involves conducting a comprehensive investigation of a single unit of study. This unit can be an individual, a small group of subjects, a family, a community, or an institution (Burns & Grove, 2003).
The research was conducted at Cebu City Medical Center (CCMC), which is located on N. Bacalso Avenue in Cebu City. CCMC is a government hospital that provides healthcare services to all city residents and has a total of 300 beds. The patient was admitted to the stroke ward on the third floor, which falls under the jurisdiction of the Internal Medicine (IM) department. This department specializes in treating cardiovascular problems. The stroke ward specifically has 10 beds and serves patients with cardiovascular issues.
The researcher used Gordons functional health pattern, which consists of 11 domains, as a research instrument. These domains include health perception management pattern, nutritional-metabolic pattern, elimination pattern, exercise-activity pattern, sleep-rest pattern, cognitive perceptual pattern, self-perception pattern, role-relationship pattern, sexuality-sexual functioning domain, coping-stress management pattern and values-belief system domain. Each of these domains focuses on different aspects of the client's health and well-being.
A transmittal letter was sent to the chief nurse of Cebu City Medical Center regarding an interview with a client who had an acute condition. Before the interview, the researcher communicated with the client to explain the purpose and goals of the interview. The client provided full consent and understanding. The researcher then conducted a chart review, performed a physical assessment, and utilized Gordon's Health pattern tool during the interview.
This chapter presents an evaluation using the Neuman Systems Model for assessing and managing clients with hypokalemia. Situational Appraisal The client is a 38-year old female currently residing in baranggay ylaya talamban Cebu City. She was born on March 10, 1975, identifies as Roman Catholic, and is the youngest of two daughters from her father's second family. She is now an orphan and a widow. She perceives her current condition as a consequence of her wrongdoings. According to the client's sister, the client used to experience epilepsy and seizures, but they stopped occurring over time. She is currently unemployed and only works as an extra. Despite having an unstable source of income, she manages to have three meals a day, although food intake is limited mainly to vegetables. Water is her primary beverage, which she consumes based on her needs or thirst.
The elimination pattern can happen daily or depend on the urge. The client's daily activities include waking up, sleeping, and going to work, which is a sedentary job. However, her sleep and rest patterns are disrupted as she sleeps for 6-9 hours each day but frequently wakes up at night and struggles to fall back asleep. Despite being a third year high school student, this did not prevent her from finding employment. Occasionally, the client sees herself as helpless and hopeless due to her illness. As the youngest daughter, she sought attention from her parents but did not rely on them. Instead, she worked hard to secure a job as a factory worker. Additionally, she has a strong bond with her elder sister's child whom she loves like her own. Eventually, she got married.
Despite not having any children of her own, she took on the role of a mother figure for her sister's son. She is currently single and abstaining from sexual activity, finding contentment in a life without obligations. After losing both of her parents, she fell into a state of depression and used work as a way to cope with her grief. The intensity of her depression escalated when her husband tragically died in an accident, leaving her struggling to accept his passing and leading to her quitting her job.
The most devastating moment in her life occurred when her nephew, whom she considered as if he were her own son, passed away. This event compelled her to turn to illegal drugs as a means of managing the overwhelming pain. Her only remaining family member is an older sister; they have no close relationships with their half-siblings from their father's previous marriage.
The client believes that neglecting responsibilities within the church has contributed to her current condition and considers being in debt as a sinful act for which she now feels repercussions.
Physiological loss of system stability is indicated by muscle weakness, resulting in difficulty in breathing and inability to ambulate.
Psychological loss of system stability is indicated by feelings of uselessness and helplessness.
The lack of financial support upon hospitalization and relative support indicates the sociocultural loss of system stability. Similarly, unemployment, dependence, and a decrease in competency in the current age bracket demonstrate the developmental loss of system stability. Additionally, feelings of uselessness signify the spiritual loss of system stability.
The first cause of hypokalemia is deficient intake, which is rarely a standalone reason but can be seen in older individuals who are unable to cook or have difficulty swallowing. This can lead to a significant deficiency over time. Another situation where poor intake can cause hypokalemia is in patients receiving total parenteral nutrition (TPN) where potassium supplementation may be inadequate for an extended period. The second cause is increased excretion, which is the most common reason for hypokalemia when combined with poor intake. The main factors leading to increased renal potassium losses include enhanced sodium delivery to the collecting duct through diuretics, excess mineralocorticoids from primary or secondary hyperaldosteronism, or increased urine flow due to osmotic diuresis.
Gastrointestinal losses, particularly diarrhea, are a common cause of hypokalemia. Vomiting, on the other hand, is also a typical cause of hypokalemia, but its pathogenesis is complex. The gastric fluid itself contains a small amount of potassium, approximately 10 mEq/L. Nonetheless, vomiting leads to a depletion of fluid volume and metabolic alkalosis. These two processes result in increased renal excretion of potassium. Depletion of fluid volume triggers secondary hyperaldosteronism, which subsequently causes the cortical collecting tubule to secrete more potassium in response to enhanced sodium reabsorption. Metabolic alkalosis also contributes to potassium secretion in the collecting tubule due to the reduced availability of hydrogen ions for secretion when sodium is absorbed. The third cause of hypokalemia is a shift of potassium from extracellular space to intracellular space.
The mechanism of this pathogenic process often accompanies increased excretion and enhances the hypokalemic effect of excessive loss. Changes in potassium levels in the cells occur episodically and are usually temporary, such as with acute insulin therapy for hyperglycemia. Regardless of the underlying cause, hypokalemia produces similar signs and symptoms. Since potassium is primarily found inside the cells and various factors can control the actual amount of potassium in the blood, a person can experience significant potassium losses without showing obvious hypokalemia. On the other hand, hypokalemia does not always indicate a true deficiency in the body's potassium reserves.
Variance from wellness| Nursing intervention| Reconstitution| Weak extremitiesSubjective cues: "dili nako malihok ako mga tiil" as verbalized by the client. Objective cues: * Client lying on bed * Foot plantar flexed. * Weak muscle strength and low muscle tone on extremities.Difficulty in breathingSubjective cues: "usahay mag lisod ko ug ginhawa" as verbalized by the client Objective cues: * Enlarged chest cavity. * Use of accessory muscles in breathing * Fast deep breaths * Presence of nasal prongs at the bedside.Risks for muscle atrophy and foot droppingSubjective cues: mura ug ning gamay akong mga bati-is" as verbalized by the client. Objective cues: * Client is lying on bed * Foot plantar flexed * Immobility of the lower extremities
No presence of foot board * No ROM exercises done. * Promote ROM exercises to prevent muscle atrophy on the affected limb * Provide foot board to support the foot and avoid plantarflexion which causes foot drop. * Encourage the client to eat a balanced diet paired with bananas for potassium replacement * Administer medications as prescribed * Monitor the client for any complications * Position the client on semi-fowlers position. * Instruct client to do abdominal breathing or pursed lip breathing. * Monitor for signs of hypoxia.
* Administer oxygen as prescribed, when needed. * Promote range of motion (ROM) exercises. * Provide a foot board. * Encourage the significant other (S.O.) to perform sponge bathing to improve circulation. * Encourage the client to move and exercise their foot toes. | Goal: Demonstrate techniques and lifestyle changes to meet physiological needs. Reconstitution: Building lines of resistance. Goal: Promote techniques and exercises to meet physiological needs. Reconstitution: Building lines of resistance. Goal: Promote techniques and exercises to prevent physiological problems. Reconstitution: Building and strengthening flexible lines of defense.
Feedback from the client regarding the interventions provided.
The client successfully identified and prioritized her problems with the help of the researcher. This allowed her to recover in treatment and find solutions that were important to her, such as achieving optimal functioning. As a result, she gained self-esteem, a positive outlook on life, and is currently working on strengthening her lines of defense. The client also realized that healing is not only physical but also involves the mind, spirit, society, and development in order to achieve holistic recovery.
The Neuman Systems Model proved to be effective and efficient in delivering comprehensive nursing care to a hypokalemic client. The assessment conducted was comprehensive and relied on the perceptions of both the client and the caregiver, enabling collaborative problem identification and effective solution development. While the model may be complex and challenging at times, practice in its implementation allows for familiarity and proficiency.
According to the research, the Neuman Systems Model has been found to be a valuable tool for improving nurses' critical and analytical thinking. This is achieved through the collection of data on the client's initial response and the nurse's judgment. As a result, it helps to reduce errors in problem identification and the provision of nursing care.
Using the Neuman Systems Model as an effective and holistic approach for clients with hypokalemia, the research findings, observations, and conclusion suggest the following recommendations:
Nurse practitioners should conduct a comprehensive assessment on their clients, which involves identifying the main issues as well as evaluating the individual as a whole. This can be achieved through utilizing the Neuman Systems assessment and evaluation tool.
The interventions required by clients may vary greatly, making it essential for nurses to assess each client's individual needs. There is no standardized intervention that can be applied universally.
Burns and Grove's Understanding Nursing research 3rd edition is published by W. B. Saunders, Elsevier Company.
Fawcett, Jacqueline (1995) Analysis and Evaluation of Conceptual Models of Nursing 3rd ed. F.A. Davis Company
Frisch N., Frisch L. (2006) Psychiatric Mental Health Nursing 3rd edition. Thomson Delmar Learning Company
Karch, Amy (2008) Lippincott's Nursing Drug Guide: Wolters Kluwer Lippincott Williams & Wilkins Company
Medical-Surgical Nursing Made Incredible Easy (2004) is a book published by Lippincott Williams & Wilkins Company Springhouse.
Neuman, Betty and Fawcett, Jacqueline. (2002). The Neuman Systems Model 4th edition. Prentice Hall Company.
Understanding Hypokalemia: Applying the Neuman Systems Model. (2016, Nov 21). Retrieved from https://studymoose.com/application-of-the-neuman-systems-essay
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