Download Hypocalcemia and Hypercalcemia

Hypocalcemia and Hypercalcemia
By: Faustina, Mia, Kirsten, George, Allie, Chris, Tessa, Kate, Nick, Jennifer, Jenn
Hypocalcemia- Causes
 Inadequate intestinal absorption, deposition of ionized calcium into bone or soft tissue,
blood administration
 Decreases in PTH and vitamin D
 Hypoparathyroidism
 Renal Failure
 Pancreatitis
 Nutritional deficiencies occur with inadequate sources of dairy products or green leafy
vegetables
Hypocalcemia – Risk Factors
 P arathryroid disorder (too little parathyroid hormone)
 E nd-stage renal disease
 T hyroidectomy
 S teroids
Hypocalcemia
Nursing Implications
Clinical Manifestations
 Neuromuscular Irritability
(Tetany)
 Cardiac arrhythmias (QT
prolongation)
 Muscle spasm
 Paresthesias
 Intestinal cramping
 Hyperactive bowel sounds
 Continuous cardiorespiratory  Monitor PT/INR and PTT
monitoring
 Monitor serum calcium,
phosphate, magnesium,
 Focused cardiac assessment
and vitamin D
 Seizure precautions
 Assess and treat pain
 Fall precautions
 Identify and treat
underlying causes
(hypoparathyroidism)
Hypocalcemia – Signs
Trousseau’s sign (hand/finger spasms)
Watch for arrhythmias
(Prolonged QT interval, cardiac arrest…)
Increase in bowel sounds, diarrhea
Tetany
Chvostek’s sign (facial twitching)
Hypotension, Hyperactive DTR
Hypocalcemia – How to Correct
 S eizure precautions
 A dminister calcium supplements
 F oods high in calcium (i.e. dairy, and greens )
 E mergency equipment on standby
Hypercalcemia – Causes
 C
Calcium supplementation
 H
Hyperparathyroidism
 I
Iatrogenic, immobilization
 M Malignancies
 P
Parathyroid hyperplasia or adenoma
Hypercalcemia- Physical manifestations
 Most pts. with hypercalcemia do not
have specific findings on physical
assessment
 Hypercalcemia – excess calcium blocks
channels, raising threshold for
depolarization. This leads to…
 CNS effects: Lethargy, weakness,
confusion, coma
 Renal effects: Polyuria, nocturia,
dehydration, renal stones, renal failure
 GI effects: Constipation, nausea,
anorexia, pancreatitis, gastric ulcer
 Cardiac: Shortened QT intervals,
depressed T-wave, bradycardia, heart
block
Hypercalcemia- Nursing Implications
 Perform an ECG
 Check for changes associated with hypercalcemia (short QT interval and short ST
segment)
 Encourage fluid intake
 Facilitates calcium excretion by kidneys
 Monitor intake and output
 Restrict dietary calcium intake
 Increase patient mobility
 Identify and closely monitor patients with increased risk
 Hyperparathyroidism, cancer, prolonged immobility, thiazide diuretics, kidney
transplant
Hypercalcemia- How to Correct
 Administration of normal saline and diuretics
 Speed up dilution and excretion
 Administration of calcitonin or steroids
 Force the circulating calcium into the cells
 Administration of bisphosphonate drugs
 Prevents bone breakdown caused by malignancy
 Treat underlying disease
 Dialysis
 Alternative if other treatments fail and kidneys have severe damage
 Can help rid blood of extra calcium and waste