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Similar to Chapter 13 And 15 Electrolyte Imbalance Part 4
Chapter 13 And 15 Electrolyte Imbalance Part 4
- 1. Electrolyte Imbalances PartIV Peggy D. Johndrow 2009
- 2. Hypocalcemia Low serumcalcium levels Causes include Decreased production of PTH Acute pancreatitis Multiple blood transfusions Alkalosis Decreased intake
- 3. Hypocalcemia ClinicalManifestations Include Positive Trousseau’s sign and Chvostek’s sign Laryngeal stridor Dysphagia Numbness, and tingling around the mouth or in the extremities
- 4.
- 5. Hypocalcemia Management Treatcause Oral or IV calcium supplements Treatment of pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
- 6. Nursing Diagnoses IWBullets p 193 Risk for injury r/t Risk for decreased cardiac output r/t Risk for impaired gas exchange r/t Imbalanced nutrition r/t Knowledge deficit r/t Risk for bone injury r/t
- 7. Nursing Actions AssessS/S Quiet, calm environment If IV Ca++ give slowly 0.5-1 mL per min; do not use central line Seizure precautions Observe laryngeal stridor; maintain airway Educate osteoporosis and foods Avoid hyperventilation Monitor ECG Assess for heart failure/ pulmonary edema Injury prevention strategies due to risk bone fracture
- 8.
- 9. Phosphate ( HPO4--) Phosphorus primary anion in ICF Most deposited with calcium in bones Maintenance requires adequate renal functioning Sources: meats, fish, dairy products, nuts
- 10. How does thePTH affect phosphorus?
- 11.
- 12. Hyperphosphatemia Causes includeAcute or chronic renal failure Chemotherapy Excessive ingestion of milk or phosphate containing laxatives Large intakes of vitamin D
- 13. Hyperphosphatemia Clinical ManifestationsHypocalcemia Muscle problems (tetany) Deposition of calcium-phosphate precipitates in skin, soft tissue, cornea, viscera, and blood vessels
- 14. Hyperphosphatemia Management Identifyingand treating underlying cause Restricting foods and fluids containing phosphorus Adequate hydration and correction of hypocalcemic conditions Sevelamer (Renagel)
- 15. What effect doesthe reaction of high phosphorus levels with calcium affect the body?
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- 17. Nursing Diagnoses Riskfor injury r/t Knowledge deficit r/t Diagnoses r/t hypocalcemia
- 18. Nursing Actions Assesstetany Monitor serum HPO4- & Ca Limit vitamin D Observe for calcifications Monitor urine output, BUN, creatinine
Editor's Notes
- #9 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