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annie morel
hypocalcemia and hypercalcemia #2
| Question | Answer |
|---|---|
| What happens when the chelation (binding) of calcium to non-protein substances like citrate? | causes loss ionized Ca. |
| What is a citrate? | anticoagulant in stored blood |
| When patients receive a large number of transfusions what should you do? | monitor for signs of hypocalcemia |
| Absorptive alterations play a role in hypocalcemia...what happens to some of the body systems? | there is reduced oral calcium---primary effects on bone stores, renal disease-inability of the kidney to change provit.D to vit. D, diseases of the small intestine/pancreas can alter the normal absorption of Ca from the GI tract |
| What is the use of vit D? | helps absorb Ca |
| what happens in renal disease and renal failure and Ca? | the kidneys lose the ability to change the provit D to vit D |
| What happens to the Na in the cell with hypocalcemia? | hypocalcemia causes Na to move more easily into the cell |
| what happens when Na is more easily moved into the cell? | depolarization of neurons takes place more readily |
| What muscles are affected by over stimulationin hypocalcemia? | skeletal, smooth and cardiac |
| What do the severity of the clinical manifestations depend on? | pH (acidosis and alkalosis) and other electrolyte disorders |
| Will loW Ca blood clot? | no |
| Ca is involved in what functions? | heart contractions, muscle cotractions, nerve contractions, and is involved in blood clotting |
| When one has problems with Ca what other problems are eveident with electrolytes? | Na, Mg, and K |
| What nursing actions and assessments need to be done with a pt with hypocalcemia? | history of risk factors (recent blood transfusions, loop diuretics, chronic diarrhea, thyroid surgery, alcoholism, acute alkalosis, amlnutrition, lethargy, anxiety, depression, numbness, tingling, muscle cramps |
| do pancreatitis pt.s have hypocalcemia? | yes |
| What do loop diuretics do to Ca levels? | decrease |
| What else needs to be assessed with a pt with hypocalcemia? | ECG changes including prolonged QT interval |
| What are two things to look for upon physical examination for hypocalcemia? | Trousseau's or Chvostek's signs hyperactive reflexes |
| With Trousseau's sign what do you look for? | hand curl with BP taken |
| What do you look for with Chvostek's sign? | when you tap the face, the mouth twitches |
| What are some nursing interventions for hypocalcemia? | seizure precautions, encourage foods high in Ca and Ca supp. with Vit D.administer supp 1-1 1/2 hours after food and give with milk for Gi upset. GIVE ON EMPTY STOMACH |
| Why should you give Ca supp with VitD? | Helps with absorption in GI tract |
| How should you givE IV Ca? | 0.5 to 1 ml/min cautiously. Ca Cl and Ca gluconate are provided in 10 ml amp. but contain different amounts of Ca--13.6 meq of Cacl and 4.65 of Ca gluconate |
| Is Ca gluconate more concentrated? | yes |
| What should you do when giveing Ca IV? | monitor the IV site as Ca solutions can cause tissure cloughing and necrosis |
| When giving IV Ca what other things need to be considered? | dilute IV Ca in dextrose 5% in water-neccer dilute in solutions containing bicarb..will precipitate-avoid NS solutions as can cause ^renal Ca loss-do not give rapid IVP as causes syncope =, hypotension, and cardiac arrythmias-monitor for hypercalcemia |
| What are some activities of hypocalcemia that need to be documented? | S/S of hypoclacemia, VS esp. cardiac rhythm, I&O, seizure precautions and seizure activity, admin and monitor of IV Ca, labs esp Ca and after 1 hor of giving, pt. teaching, important info relayed back to dr if levels do not improve, cardiac monitor |
| What are the lab values for hypercalcemia? | serum concentrations greater than 10.5 |
| How is hypercalcemia determined? | it is the result of conditions that promote release of calcium from bone, excess intake, and decreased urinary excretion |
| what happens when there is an excess? | the thyroid releases calcitonin and causes ^Caand also renal problems |
| etiology of hypercalcemia? | result from excess Ca, milk and Ca containing antacids (milk alkali syndrome) and excess vit d intake |
| What happens to renal system with hypercalcemia? | renal failure decreases urinary excretion of Ca |
| What happens when thiazide diuretics are used? | they are a precipitate for hypo and hypercalcemia |
| what happens to the calcium in the bone with hyper Ca? | loss of Ca |
| can malignant tumors destroy the bone? | yes |
| Other tumors can secrete parathyroid-like hormones or agents that stimulate osteoclastic activity what happens to Ca? | This osteoclastic activity releases Ca salts into the blood |
| what happens to the bone with immobilization? | demineralization of the bone and that is why you get people up ASAP after surgerY!!! |
| What exactly does immobilation do? | it causes the Ca to leave the bone and concentrate in the ECF |
| what happens when there are high levels of Ca in the urine? | it impairs the concentrating ability of the kidneys by interfering with ADH and causing diuresis |
| If there is excess ca excreted in the urine, what does this predispose the person to? | calcium precipitation and stone formation |
| In hypercalcemia the excitability of the nerve tissue and muscle does what to the body? | causes weakness and flaccidity to the muscles |
| what are some GI symptoms of too much Ca? | constipation, n/v, due to decreased smooth muscle activity in the GI tract |
| Too much Ca slows the.... | GI tract... |
| The body needs Ca in normal.... | balance!!! |
| What are the cardiac effects of ^Ca levels? | Ventricular dysrhythmias, ^risk for dig toxicity and frequent PVC's |
| What should the nurse assess for with hypercalcemia? | S/S of hypercalcemia, altered OC, confusion, stupor, personality changes, hallucinations, paranoia, constipation,nausea, anorexia, thirst |
| What are some high risk factors for hypercalcemia? | cancer history, prolonged immobilization, thiazide diuretic therapy, steroid therapy, multiple fractures |
| What should the nurse assess for upon physical examination? | S/S of flabby muscles, reduces deep tendon reflexes,dysuria, (renal calculi), bone-related pain, (pathologic fractures), ECG changes,(including shortened QT interval, and cardiac dysrhythmias |
| In hypocalcemia do you have a prolonged Qt interval? | yes |
| In hypercalcemia do you have a shortened QT interval? | yes |
| What are some nursing interventions for hypercalcemia? | monitor pt LOC and safety precautions as necessary, encourage ambulationwith assistance, wt bearing forces on the skeleton promote mvmt of calcium into the bones, and handle gently to reduse the risk of pathologic fracture, OT and PT consults |
| What are some other nursing interventions for hypercalcemia? | assure family the pt LOC is temporary and will subside with treatment, admmin, ordered IV saline and loop diuretics and evaluate pt. response, ecourage hydration to dilute Ca and prevent renal calculiformation, 3000-4000ml fluid per day unless CHf pt |
| What can cause hypercalcemic crisis? | hyperparathyroidism, when the increase in Ca is acute |
| S/S of hypercalcemia include...? | excessive thirst, polyuria, volume depletion, altered LOC, and cardiac arrest |
| sympotmatic hypercalcemia is associated with... | a high mortality rate... |
| Hypercalcemia is considered a medical.... | emergency and admitted to ICU |
| What is the treatment of hypercalcemia? | cardiac monitoring and emergency equipment, hydration!11, assess cardiac monitoring q 2 hours duing fluid therapy, after Ecf volum is restored NaCl and diuretics Rx to ^urinary elimination of Ca, look at urine q hour and make sure at least 100ml out |
| What do loop diuretics do when takedn with hypercalcemia? | promote Ca excretion |
| What is taken to inhibit bone breakdown or resorption? | biophophates--etidronate, and calcitonin |
| What do Thiazides do to hypercalcemic pt's? | they cause resorption of Ca. AVOID THEM!!!! |
| What is some other treatment that can be done to help with hypercalcemia? | Administration of glucocorticosteroids which reduces intestinal absorption of Ca by competing with Vit D and is given for cancer related hypercalcemia |
| What med mentioned in class decreases Ca levels and inhibits absorption? | mithicin |
Created by:
anniemorel
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