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
  • Chapter 13 And 15 Electrolyte Imbalance Part 3

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