Download NURSING PROCESS FOCUS Clients Receiving Calcium

ADAMMC47_0131756656 2/21/07 2:03 AM Page 737 TEAM-B 107:PEQY046:phada2:ch47:
Chapter 47
Drugs for Bone and Joint Disorders
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NURSING PROCESS FOCUS Clients Receiving Calcium Supplements
Assessment
Potential Nursing Diagnoses
Prior to administration:
Obtain a complete health history including allergies, drug history, signs of hypercalcemia or hypocalcemia, and possible drug interactions.
Obtain a baseline ECG.
Obtain baseline vital signs, especially apical pulse for rate and rhythm, and
blood pressure.
Obtain lab work, includoing complete blood count (CBC) and electrolytes, especially calcium.
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Injury, Risk for, related to loss of bone mass and side effects of drug
Knowledge, Deficient, related to drug therapy
Knowledge, Deficient, related to signs and symptoms to report to healthcare
provider
Knowledge, Deficient, related to rationale for baseline data and subsequent
laboratory data collection for optimal drug regimen
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Planning: Client Goals and Expected Outcomes
The client will:
Have normal serum calcium levels (8.5–11.5 mg/dl).
Demonstrate an understanding of the drug’s action by accurately describing drug side effects and precautions.
Immediately report side effects and adverse reactions.
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Implementation
Interventions and (Rationales)
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Client Education/Discharge Planning
Monitor electrolytes throughout therapy. (Calcium and phosphorus levels tend
to vary inversely: low magnesium levels coexist with low calcium levels.)
Monitor for signs and symptoms of hypercalcemia. (Overtreatment may lead
to excessive serum calcium levels.)
Initiate seizure precautions for clients at risk for hypocalcemia. (Low calcium
levels may cause seizures.)
Monitor for musculoskeletal difficulties. (Calcium supplements are used to
treat osteoporosis, rickets, and osteomalacia.)
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Teach client importance of routine lab studies, so deviations from normal can
be corrected immediately.
Instruct client to report signs or symptoms of hypercalcemia: drowsiness,
lethargy, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst.
Instruct client to recognize signs of hypocalcemia, such as facial twitching,
muscle spasms, seizures, and paresthesias.
Instruct client to:
Take special precautions to prevent fractures.
Report episodes of sudden pain, joints out of alignment, or inability of client
to assume normal positioning.
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Monitor intake and output. Use cautiously in client with renal insufficiency.
(Calcium is excreted by the kidneys.)
Monitor cardiac functioning. (Possible side effects may include short QT wave,
heart block, hypotension, dysrhythmia, or cardiac arrest with IV administration.)
Monitor injection site during intravenous administration for infiltration. (Extravasation may lead to necrosis.)
Monitor diet. (Consuming calcium-rich foods may increase effect of drug. Consuming foods rich in zinc may decrease calcium absorption.)
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Instruct client to report any difficulty in urination and to measure intake and
output.
Inform client to recognize and report palpitations, light-headedness, dizziness, or shortness of breath.
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Instruct client to report pain at IV site.
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Advise client to consume calcium-rich foods and avoid zinc-rich foods.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that client goals and expected outcomes have been met (see “Planning”).
The client’s calcium levels are normal.
The client demonstrates an understanding of the drug by accurately describing drug side effects and precautions.
The client accurately states signs and symptoms to be reported to the healthcare provider.
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See Table 47.1 for a list of drugs for which these nursing actions apply.
women cause an increase in osteoclasts, which causes increased resorption of bone. Thus, the bone mass and bone
density are decreased, and bones become fragile. Decreased
bone mass in men is typically related to decreased levels of
testosterone.
Client Teaching. Client education as it relates to calcium
supplements or medications should include the goals of
therapy, the reasons for obtaining baseline data such as vital
signs and the existence of underlying cardiac and hepatic
disorders, and possible drug side effects. Include the following