Electrolyte Electrolyte ImbalancesImbalances
Part IVPart IV
Peggy D. JohndrowPeggy D. Johndrow
20092009
HypocalcemiaHypocalcemia
Low serum calcium levelsLow serum calcium levels Causes includeCauses include
Decreased production of PTHDecreased production of PTH Acute pancreatitis Acute pancreatitis Multiple blood transfusions Multiple blood transfusions AlkalosisAlkalosis Decreased intakeDecreased intake
Hypocalcemia Hypocalcemia Clinical ManifestationsClinical Manifestations
Include Include Positive Trousseau’s sign and Chvostek’s Positive Trousseau’s sign and Chvostek’s
sign sign Laryngeal stridorLaryngeal stridor DysphagiaDysphagia Numbness, and tingling around the mouth or Numbness, and tingling around the mouth or
in the extremities in the extremities
Trousseau’s and Chvostek’s SignsTrousseau’s and Chvostek’s Signs
Hypocalcemia ManagementHypocalcemia Management
Treat causeTreat cause Oral or IV calcium supplementsOral or IV calcium supplements Treatment of pain and anxiety to prevent Treatment of pain and anxiety to prevent
hyperventilation-induced respiratory hyperventilation-induced respiratory alkalosisalkalosis
Nursing DiagnosesNursing Diagnoses
IW Bullets p 193IW Bullets p 193 Risk for injury r/tRisk for injury r/t Risk for decreased cardiac output r/tRisk for decreased cardiac output r/t Risk for impaired gas exchange r/tRisk for impaired gas exchange r/t Imbalanced nutrition r/tImbalanced nutrition r/t Knowledge deficit r/tKnowledge deficit r/t Risk for bone injury r/tRisk for bone injury r/t
Nursing ActionsNursing Actions Assess S/S Assess S/S Quiet, calm environmentQuiet, calm environment If IV Ca++ give slowly 0.5-1 mL per min; do not use If IV Ca++ give slowly 0.5-1 mL per min; do not use
central linecentral line Seizure precautionsSeizure precautions Observe laryngeal stridor; maintain airwayObserve laryngeal stridor; maintain airway Educate osteoporosis and foodsEducate osteoporosis and foods Avoid hyperventilationAvoid hyperventilation Monitor ECGMonitor ECG Assess for heart failure/ pulmonary edemaAssess for heart failure/ pulmonary edema Injury prevention strategies due to risk bone Injury prevention strategies due to risk bone
fracturefracture
Phosphate (Phosphate (HPO4 --)HPO4 --)
Phosphorus primary anion in ICFPhosphorus primary anion in ICF Most deposited with calcium in bonesMost deposited with calcium in bones Maintenance requires adequate renal Maintenance requires adequate renal
functioningfunctioning Sources: meats, fish, dairy products, nutsSources: meats, fish, dairy products, nuts
How does the PTH affect How does the PTH affect phosphorus?phosphorus?
HyperphosphatemiaHyperphosphatemia
Causes includeCauses include Acute or chronic renal failureAcute or chronic renal failure ChemotherapyChemotherapy Excessive ingestion of milk or phosphate Excessive ingestion of milk or phosphate containing laxativescontaining laxatives Large intakes of vitamin DLarge intakes of vitamin D
Hyperphosphatemia Clinical Hyperphosphatemia Clinical ManifestationsManifestations
Hypocalcemia Hypocalcemia Muscle problems (tetany) Muscle problems (tetany) Deposition of calcium-phosphate Deposition of calcium-phosphate
precipitates in skin, soft tissue, cornea, precipitates in skin, soft tissue, cornea, viscera, and blood vesselsviscera, and blood vessels
Hyperphosphatemia ManagementHyperphosphatemia Management
Identifying and treating underlying causeIdentifying and treating underlying cause Restricting foods and fluids containing Restricting foods and fluids containing
phosphorus phosphorus Adequate hydration and correction of Adequate hydration and correction of
hypocalcemic conditionshypocalcemic conditions Sevelamer (Renagel) Sevelamer (Renagel)
What effect does the reaction of high What effect does the reaction of high phosphorus levels with calcium affect phosphorus levels with calcium affect the body?the body?
Nursing DiagnosesNursing Diagnoses
Risk for injury r/tRisk for injury r/t Knowledge deficit r/tKnowledge deficit r/t Diagnoses r/t hypocalcemiaDiagnoses r/t hypocalcemia
Nursing ActionsNursing Actions
Assess tetanyAssess tetany Monitor serum HPO4- & CaMonitor serum HPO4- & Ca Limit vitamin DLimit vitamin D Observe for calcificationsObserve for calcifications Monitor urine output, BUN, creatinineMonitor urine output, BUN, creatinine