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Chapter 13 And 15 Electrolyte Imbalance Part 3
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Chapter 13 And 15 Electrolyte Imbalance Part 3

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  • Calcium - (ionized serum Ca 4.5- 5.1 mEq/L) General facts – 99% in bones/teeth; inversely related to phosphorus, dissolved Ca++ as bound (to protein/albumin) or ionized (only ionized involved in neuromuscular function – very narrow range) Hypercalcemia (>5.1 mEq/L) Etiology – hyperparathyroidism; malignancy/cancer; increased in diet; Al hydrochloride antiacids; lithum; vitamin A/D Lab tests - Total serum Ca++, Ionized Ca++, Parathorome, X-ray (osteoporsis, renal calculi); albumin levels; ECG changes Therapeutic management Hydrate – ½ NS or NS for volume expansion to help Ca excretion, decreased absorption; increase oral fluids Lasix – to inhibit absorption of Ca; prevent fluid overload when giving NS Renal/cardiac function – not use increased IV fluid; danger of fluid overload Mithracin/other antineoplastic antibiotics – inhibit bone resorption and can be repeated for several days; monitor for toxic effects Thyroid surgery – monitor carefully for hypercalcemia Immobility – increased serum Ca Nursing Care Assessment - S/S - irregular HR; muscular incoordination, decreased muscle tone/strength; decreased GI motility/constipation; decreased reflexes; anorexia Nursing Diagnosis - Risk for injury r/t; Risk for renal insufficiency r/t; Risk for constipation r/t; Risk for dysrrhythmias; Risk for fluid volume excess r/t; Risk for decreased cardiac output r/t; Knowledge deficit Nursing Actions I&O Assess renal function/renal stone Assess S/S Orientation to reality/LOC Oral/ IV fluids Diet – decrease Ca; No milk Safety Monitor S/S dig toxicity Evaluate Serum electrolytes Increase mobility Assess cardiac function Give loop diuretic Inorganic phosphates Client education Explanation of condition; include risk factors Strategies to prevent further episodes Need to restrict Ca in diet (teach food high in CA) Medication therapy including possible side effects S/S and what and when to report Reading labels for foods and OTC medications that contain CaHypocalcemia - less than 4.5 mEq/L General facts – Rare; maintenance depends on dietary intake Ca++/Vitamin D/Phosphorus/effective function of Parathyroid; Chronic hypoglycemia’ Estrogen; Renal failure; medications (aminoglycosides, phosphates, loop diuretics) Etiology - hypoparathyroid, decreased intake, renal failure, medications Lab tests - Total Ca++, Ionized Ca++, PTH levels, Mg++, HPO4 Therapeutic management Ca++ oral supplements Only give IV if very severe; give very slowly and in small amounts; do not increase too quickly Nursing Care Assess: tetany, tingling tips of fingers/around mouth/feet; Trousseau’s and Chvostek’s signs; bone fractures; ECG changes; mental changes; seizures Nursing Diagnosis - Risk for injury r/t, Risk for decreased cardiac output r/t; Risk for impaired gas exchange r/t; Altered nutrition r/t; Knowledge deficit r/t; Risk for bone injury r/t Nursing actions Assess S/S If give IV Ca++ - slowly .5-1 mL per min; do not use central line Seizure precautions Observe larngeal stridor – maintain airway Educate – osteoporosis and foods Avoid hyperventilation Monitor ECG Assess for -heart failure/ pulmonary edema Client education Explanation of condition; include risk factors Strategies to prevent further episodes Need to add Ca in diet (teach food high in Ca) Medication therapy including possible side effects S/S and what and when to report
  • Theory: Primary action of PTH really on renal phosphorus excretion Resulting change in calcium secondary to PTH induced change in serum phosphorus Increase in phosphorus reduced calcium efflux from bone & reduced calcemic action of PTH on bone

Transcript

  • 1. Electrolyte Imbalances Part III Peggy D. Johndrow 2009
  • 2.  
  • 3. Calcium
    • Obtained from ingested foods
    • More than 99% combined phosphorus & concentrated in skeletal system
    • Inverse relationship with phosphorus
    • Bones readily available store of calcium
    • Calcium blocks sodium transport & stabilizes cell membrane
    • Only ionized form of calcium is biologically active
    • Sources: dairy products, dark green leafy vegetables
  • 4. How are phosphorus and calcium levels related?
    • When one goes up the other goes down
    • Reciprocal relationship
  • 5.  
  • 6. What are the processes that maintain calcium balance?
    • Controlled by
      • Parathyroid hormone
      • Calcitonin
      • Vitamin D
  • 7.  
  • 8. Hypercalcemia
    • High serum calcium levels
    • Causes include
      • Hyperparathyroidism
      • Malignancy
      • Vitamin D overdose
      • Prolonged immobilization
  • 9. Hypercalcemia Clinical manifestations
    • Decreased memory
    • Confusion
    • Disorientation
    • Fatigue
  • 10. Hypercalcemia Management
    • Loop diuretic
    • Hydration with isotonic saline infusion
    • Synthetic calcitonin
    • Mobilization
  • 11. Nursing Diagnosis
    • Risk for injury
    • Risk for renal insufficiency r/t
    • Risk for constipation r/t
    • Risk for dysrrhythmias
    • Risk for fluid volume excess r/t
    • Risk for decreased cardiac output r/t;
    • Knowledge deficit
  • 12. Nursing Actions
    • I&O
    • Assess renal function/renal stone; cardiac function
    • Assess S/S
    • Orientation to reality/LOC
    • Oral/ IV fluids
    • Diet; decrease Ca (no milk)
    • Safety
    • Monitor S/S dig toxicity
    • Evaluate serum electrolytes
    • Increase mobility
    • Give loop diuretic & inorganic phosphates