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