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*N126-U4-Ca & Mg
Dobrisky-Calcium & Magnesium Nursing Management
| Question | Answer |
|---|---|
| what is used for nerve transmission, cardiac excitability, muscular contraction, blood clotting and hormone regulation? | calcium |
| what amount of calcium is dissolved in the blood? | small amount |
| calcium and albumin have what type of relationship? | direct |
| what form of calcium is active in the cell? | ionized |
| what percent of calcium is free or ionized? | 50 |
| normal calcium values are | 8.5-10.5 |
| calcium is found primarily in the | bones and teeth |
| the regulation of calcium depends on | parathyroid hormone (PTH), vitamin D and calcitonin |
| PTH is released in response to what? | decreased serum calcium levels |
| when PTH is released is causing the movement of calcium | from bone to plasma |
| when pth is released in causes what change in the GI tract? | more calcium is absorbed |
| what influence does pth have on the renal tubules? | increases the reabsorption of calcium |
| PTH is dependend on what vitamin? | D |
| what hormone is produced by the thyroid gland that opposes the effects of PTH and vitamin D on bones? | calcitonin |
| Calcitonin has what affect on PTH & Vitamin D in bones? | it opposes their effects |
| high calcium levels stimulate the thyroid to secrete what? | calcitonin |
| low calcium levels stimulate the release of what? | PTH from the parathyroid |
| serum calcium concentrations of less than 8.5 is considered | hypocalcemia |
| ionized calcium concentration of less than 4 is considered | hypocalcemia |
| you see tetany in what extreme of calcium levels? | low |
| when ionized calcium numbers are high it is | acidosis |
| when more calcium is ionized less is bound to what? | protein |
| alkalosis causes more of the what fraction to become bound to protein | ionized |
| a ph of greater than 7.45 indicates an increase or decrease in ionized calcium? | decrease |
| a ph of 4 would indicate what change in ionized calcium | increase |
| when ph goes up, ionized calcium numbers go | down |
| decreased ionized calcium indicates there is more or less calcium working in the bone cells? | less |
| the fewer the ionized calcium the fewer the calcium working in the | bone |
| decreased calcium causes what change in blood clotting | decrease |
| large numbers of blood transfusions can lead to what calcium related disorder? | hypocalcemia |
| what vitamin helps with calcium absorption | vitamin d |
| in renal disease the kidney is unable to change provitamin d to | vitamin d |
| hypocalcemia causes sodium to move where easily? | into the cell |
| skeletal, smooth and cardiac muscle functions are affected how by hypocalemia? | over stimulated |
| the severity of clinical manifestations of hypocalcemia depnd on what? | rate of onset, ph and other electrolyte disorders |
| assessment of the patient with hypocalcemia should include | hx of blood transfusions, loop diuretics, chronic diarrhea, thyroid surgery, alcoholism, acute alkalosis, malnutrition and lethargy, anxiety, depression, numbness, tingling and muscle cramps |
| numbness, tingling, anxiety, lethargy, depression and muscle cramps are all s/s of what calcium disorder? | hypocalcemia |
| two clear signs of hypocalcemia found during physical assessment are | positive trousseau's and chvostek's signs |
| trousseau's.....trousers......cuff......bp cuff... | hypocalcemia |
| chvostek's....russian....strong facial features..... | hypocalcemia |
| the patient with hypocalcemia should be placed on what type of precautions? | seizure |
| calcium and vitamin D are better absorbed | without food |
| what is the ideal timing for calcium supplements? | 1-1 1/2 hours after food |
| what can you give along with calcium supplements to the patient with GI upset | milk |
| normal calcium levels....drink milk....lose weight.....be a ten | 8.5-10.5 |
| intravenous calcium should be given at what rate? | 0.5 to 1ml per minute |
| calcium chloride and calcium gluconate doses differ how? | calcium chloride is more concentrated |
| calcium chloride....c....concentrated | calcium chloride is more concentrated than calcium gluconate |
| what should a nurse assess when giving IV calcium? | IV site for sloughing and necrosis |
| calcium gluconate and calcium chloride both come in what? | ampules of 10ml |
| which calcium IV solution is more concentrated? | calcium chloride |
| which is 4.65 mEq/ml? | calcium gluconate |
| which is 13.6 mEq/ml? | calcium chloride |
| rapid IVP of calcium can cause | syncope, hypotension and cardiac arrhythmias |
| never dilute calcium mixtures with what? | bicarbonate or normal saline |
| normal saline mixed with IV calcium will cause what? | increased renal calcium loss |
| what should IV calcium be diluted with??? | dextrose 5% in water |
| which can be mixed with IV calcium: dextrose 5% in water or bicarbonate? | dextrose 5% in water |
| normal saline solutions should be _____ with IV calcium | avoided |
| patients with hypo and hypercalcemia should always be placed on | cardiac monitors |
| which vital sign is the most important to monitor for changes with a patient with hypocalcemia? | cardiac rhythm |
| if a seizure does occur what should you do? | after it is over turn the patient on side, count RR and give O2 if needed |
| hypocalcemia is present if the calcium level is below | 8.5 |
| hypercalcemia is present if the calcium level is above | 10.5 |
| iv calcium in dextrose 5%...calcium...dextrose...c.d.... | dilute iv calcium in dextrose 5% in water |
| if a patient's heart rate rises quickly after giving IV calcium what was done incorrectly? | pushed too fast |
| when the thyroid releases too large amounts of calcitonin what calcium disorder happens? | hypercalcemia |
| calcitonin is triggered by what level of calcium | low |
| renal failure has what effect on urinary excretion of calcium? | decrease |
| thiazide diuretics are noted for precipitating | hypokalemia and hypercalcemia |
| hypercalcemia indicates a loss of calcium from | bone |
| immobilization causes calcium | to leave the bone and concentrate in the ECF |
| excess calcium excreted in urine can lead to what complication? | stone formation |
| hypercalcemia has what effect on the excitability of nerve tissue and muscle? | decreases |
| the patient will complain of weakness or cramping when hypercalcemic | weakness |
| deep tendon reflexes in the patient with hypercalcemia are | decreased or absent |
| hypercalcemia....muscle weakness....decreased GI movement leads to | constipation, n/v |
| calcium levels and muscle activity have what type of relationship? | inverted, hypocalcemia is increased muscle activity, hypercalcemia is decreased muscle activity |
| pvcs, ventricular dysrhythmias and increased risk for digitalis toxicity are all cardiac effects of what serum calcium level? | elevated |
| cognitive problems occur when calcium levels are | increased |
| alterd LOC, confusion, stupor, personality changes, hallucinations, paranoia, constipation, nausea, anorexia and thirst are all signs of what change in calcium? | hypercalcemia |
| high risk factors for hypercalemia are | hx of cancer, immobiliztion, thiazide diuretics, steroids, multiple fractures. |
| if you are not active, weight bearing bones do what? | give up their calcium causing hypercalcemia |
| flabby muscles and bone related pain are signs of which calcium disorder? | hypercalcemia |
| ecg changes including prolonged QT intervals indicate | hypocalcemia |
| QT interval....prolonged...."o"... | hypocalcemia |
| shortened QT...."e".... | hypercalcemia |
| QT sells milk....QT interval is related to | calcium levels |
| the priority intervention for a pt with hypercalcemia is | safety r/t altered LOC |
| pts with hypercalcemia should be encouraged to | ambulation and hydration |
| what is a patient at risk for when you handle them if they have hypercalcemia? | pathologic fracture |
| what will more than likely be orderd for the patient with hypercalcemia? | IV saline and loop diuretics |
| how much fluid should the pt with hypercalcemia be encouraged to take in? | 3000 to 4000 ml/day (unless contraindicated) |
| what unit will most patients be on if they have hypercalcemia? | ICU |
| increased polyuria and thirst is a sign of what type of calcium disorder? | hypercalcemia |
| hypercalcemia...hyper thirst....hyper uria.. | hypercalcemia |
| hypercalcemia is considered a | medical emergency |
| what are the three top actions with a patient with hypercalcemia? | heart monitor, hydrate, crash cart close by |
| how often should renal and cardiac status be assessed during fluid therapy of the hypercalcemic patient? | at least every 2 hours |
| the ideal urine output when receiving fluid therapy for hypercalcemia is | 100ml every 2 hours |
| after ECF volume is restored, what may be prescribd to increase urinary elimination of calcium? | sodium chloride and diuretics |
| why should thiazides be avoided in the patient with a hx of hypercalcemia? | they cause reabsorption of calcium |
| what affect do glucocorticosteroids have on the absorption of calcium? | reduces it |
| what is prescribed for cancer related hypercalcemia? | glucocorticosteroids |
| magnesium is toxic to the | heart |
Created by:
Lori Dobrisky
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