15. What effect does the reaction of high phosphorus levels with calcium affect the body?
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Editor's Notes
Phosphorus (2.5-4.5 mg/dl) General facts Inorganic salt; primary anion in ICF Metabolic functions – phosphate buffer system; forms ATP; RBC production; intermediary in metabolism of CHO, protein, fats Critical to normal nerve/muscle function Provides structural support for bones & teeth Excrete 90% kidneys; 10% feces Regulated by diet intake, GI absorption, hormone regulates bone reabsorptionHyperphosphatemia > 4.5 mg/dl Etiology - Renal insuff., hypoparathyroidism, increased vit. D, hypoparathyrodism, increased intake, Lab Tests - Serum HPO4-, PTH level, x-ray (skeletal changes) Therapeutic Management Correct cause IV Ca+, dialysis, phosphate binding gels (Al hydroxide), restrict intake Nursing care Assess S/S- anorexia, N/V, muscle weakness, hyperreflexia, tachycardia, tetany, soft tissue calcification Nursing diagnosis – Risk for injury r/t; Knowledge deficit r/t; Nursing actions Assess tetany Monitor serum HPO4- & Ca Limit vit D Observe for calcifications Monitor urine output, BUN, creatinine Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in phosphorus Medication therapy including possible side effects S/S and what and when to reportHypophosphatemia < 2.5 mg/dl Etiology – increased urine loss, decreased GI absorption, acid/base problems, ETOH withdrawal, phosphate binding antiacids, diabetic ketoacidosis, respiratory alkalosis Lab tests - Serum HPO4-, PTH, Mg+, x-ray Therapeutic Management Correct cause Increase diet intake Oral HPO4- if severe IV – very severe give NaHPO4 or KHPO4 Nursing Care Assess S/S - decreased energy (ATP), confusion, seizures, hemolytic anemia, chest pain, cyanosis Nursing diagnosis – Impaired physical mobility r/t; Risk for bone injury r/t; Impaired gas exchange r/t; Risk for falls r/t; Risk for decreased cardiac output Nursing actions Monitor V/S, resp rate & depth (assess S/S hypoxia) Monitor lab values Diet – increase foods high in HPO4 Oral/IV – if necessary Monitor ECG Monitor Serum K+ Salt substitutes Teach use of diuretics, laxatives, diet Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in phosphorus Medication therapy including possible side effects S/S and what and when to report
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