Calcium

Question 1

Calcium- Functions

Answer 1

major cation in bone and teeth 
blood clotting 
transmission of nerve impulse 
myocardial contractions 
muscle contractions

Question 2

how the body regulates calcium

Answer 2

source of calcium= diet

Question 3

how the body regulates calcium- calcium absorption requires

Answer 3

active form of vitamin D (diet or sunlight)

Question 4

how the body regulates calcium- PTH

Answer 4

maintain normal serum Ca level by regulating the movement of Ca into/out of bone
Ca readily available supply b/c bone
production and release are stimulated by low serum Ca level
inc bone resorption (movement of Ca out of bone)
inc GI absorption of Ca
inc renal tubule reabsorption of Ca
vit B12 absorption and use
Ca and P have inverse relationship

Question 5

how the body regulates calcium- to inc Ca: PTH secretion

Answer 5

bone
intestine
kidneys

Question 6

how the body regulates calcium- to dec Ca: Calcitonin

Answer 6

bone 
intestine
kidneys 
produced by thyroid gland
stimulated by high serum Ca level 
Opposes action of PTH and lowers the Ca level by dec GI absorption, inc Ca deposition into bone, promoting renal excretion

Question 7

how the body regulates calcium- Vitamin D facilitates Ca absorption

Answer 7

Dietary intake

sunlight

Question 8

Calcium info

Answer 8

1% in serum
ionized ca- free ca (most active form)
bound to protein (albumin)
complexed bound to other anions

Question 9

Calcium info: NM activity

Answer 9

inc calcium stabilizes excitable membranes (Ca calms)

Question 10

Calcium info: blood clotting

Answer 10

ca clot (CC) inc ca causes excessive clotting 
dec calcium (DC)- low Ca doesnt clot(bleeding)

Question 11

Calcium info: teeth and bone formation

Answer 11

98% of it found in bone

osteoporosis-> fx

Question 12

Calcium info: changes in serum pH

Answer 12

alter the level of ionized Ca without altering the total Ca level
a dec plasma pH (acidosis) de Ca binding to albumin (more ionized Ca)
inc plasma pH (alkalosis) inc Ca binding leading to dec ionized Ca
alteration in serum albumin levels affect total Ca level
Low albumin levels = drop in total Ca level (BUT the level of ionized Ca is not affected)

Question 13

Calcium: Pt at risk- Labs

Answer 13

8.6-10.62 mg/dL

Question 14

Hypercalcemia: Pt at risk-

Answer 14

high serum ca
excitability of muscles and nerves- need stronger stimulus
2/3 caused by hyperthyroidism
1/3 caused by malignancy from myeloma and breast, lung, and kidney cancer (through bone destruction from tumor invasion, or tumor secretion of a parathyroid related protein), which stimulates Ca release from bone

Question 15

Hypercalcemia: Pt at risk- prolonged immobilization

Answer 15

bone mineral loss and inc plasma Ca concentration

Question 16

Hypercalcemia: Pt at risk- rare case

Answer 16

vit D overdose/ inc Ca intake

Question 17

Hypercalcemia: Pt at risk- etc

Answer 17

excess Ca- excitability of both muscles and nerves 
hyperparathyroidism 
malignancy 
prolonged immobility 
RF 
multiple bon Fx 
thiazide diuretics- inc action of PTH 
overuse of Ca containing meds 
Steroids- mobilize Ca from bone 
Vit D/Ca overdose

Question 18

Hypercalcemia: Assessment- dec NM excitability

Answer 18

muscle weakness
incoordination
fatigue

Question 19

Hypercalcemia: Assessment: dec peristalsis

Answer 19

dec peristalsis

Question 20

Hypercalcemia: Assessment: Neuro

Answer 20

lethargy, confusion

depressed reflexes

Question 21

Hypercalcemia: Assessment: flank pain

Answer 21

may indicate renal calculi

Question 22

Hypercalcemia: Assessment: dec (Faster) blood clotting time (easy blood clotting)

Answer 22

esp lower extremities

risk of DVT

Question 23

Hypercalcemia: Assessment: cardiac

Answer 23

dysrhythmias

monitor: HR,BP, O2stats, pallor, EKG charges, DVT, assess blood flow in LE, LE temp

Question 24

Hypercalcemia: Assessment: bone Fx

Answer 24

with Ca released from bone

Question 25

Hypocalcemia: Pts at risk

Answer 25

inc nerve excitability can be caused by any condition that dec the production of PTH surgical removal of parathyroids

Question 26

Hypocalcemia: Pts at risk- meds

Answer 26

in loss of ca= hypocalcemia loop diuretics (lasix- furosemide) laxative abuse dec vit D

Question 27

Hypocalcemia: Pts at risk- inc phosphorus

Answer 27

combines with Ca-> deposited in tissue | Dec Ca absorption in intestines

Question 28

Hypocalcemia: Pts at risk- pancreatitis

Answer 28

lipolysis produces fatty acids that combine with Ca ions dec serum Ca levels

Question 29

Hypocalcemia: Pts at risk- multiple blood transfusion

Answer 29

b/c citrate used to anticoagulate the blood binds with the Ca

Question 30

Hypocalcemia: Pts at risk- dec serum albumin levels

Answer 30

will dec total Ca | ionized Ca not affected

Question 31

Hypocalcemia: Pts at risk- burned or diseased tissue

Answer 31

traps Ca ions from ECF

Question 32

Hypocalcemia: Pts at risk- high pH inc Ca binding to protein

Answer 32

dec amt of ionized Ca

Question 33

Hypocalcemia- Assessment: Dec Ca

Answer 33

inc Na movement into cells

Question 34

Hypocalcemia- Assessment: most common S&S

Answer 34

overstimulation of nerves and muscles

Question 35

Hypocalcemia- Assessment: painful cramps

Answer 35

foot, leg, abdomen (diarrhea)

Question 36

Hypocalcemia- Assessment: etc

Answer 36

``` tingling, numbness tetany Trousseau's sign chvostek's sign inc tendency to bleed (dec clotting) ECG changes, thread pulse high risk for bone Fx ```

Question 37

Hypocalcemia- Assessment: labs

Answer 37

Mg, PTH, P, albumin

Question 38

Hypercalcemia- Nsg Dx: risk for

Answer 38

activity intolerance- muscle weakness electrolyte imbalance- excessive bone destruction injury- NM and sensorium changes

Question 39

Hypercalcemia- Nsg Dx: potential complications

Answer 39

dysrhythmias

Question 40

Hypocalcemia- Nsg Dx: risk for

Answer 40

acute pain- sustained muscle contraction ineffective breathing pattern- laryngospasm electrolyte imbalance- dec production of PTH injury- tetany and seizures

Question 41

Hypocalcemia- Nsg Dx: potential complications

Answer 41

Fx, respiratory arrest

Question 42

Hypercalcemia- Nursing goals

Answer 42

hydration and promote excretion

Question 43

Hypercalcemia- Nursing goals: meds (IV/PO hydration)

Answer 43

IV/PO hydration (3000-4000mL daily PO): promotes excretion of Ca and dec kidney stone formation

Question 44

Hypercalcemia- Nursing goals: meds (loop diuretics)

Answer 44

inc Ca excretion (basic treatment promoting urinary excretion of Ca and hydrating with isotonic saline infusions) monitor: UOP, FVD no thiazide diuretics: inhibits Ca excretion avoid antacids- most have Ca Calcitonin- given IM/subcut lowers serum Ca level; intranasal form not effective

Question 45

Hypercalcemia- Nursing goals: mobilize pt

Answer 45

wt bearing activity

Question 46

Hypercalcemia- Nursing goals: etc

Answer 46

dec dietary Ca intake | safety precaution with LOC

Question 47

Hypocalcemia- Nursing goals: severe hypocalcemia

Answer 47

IV preparations of Ca are given

Question 48

Hypocalcemia- Nursing goals: mild hypocalcemia

Answer 48

diet high in Ca rich foods along with Vit D supplementation

Question 49

Hypocalcemia- Nursing goals: administer

Answer 49

supplements: PO 1-1.5 hrs after meal; IV may be necessary after thyroid surgery dietary intake Ca with Vit D supplement if inc P, administer phosphate binding antacids

Question 50

Hypocalcemia- Nursing goals: monitor

Answer 50

``` bone fx with chronic low Ca chvotstek's and trousseau's sign Mg, PTH, Ca, albumin cardiac rhythm observe pt with thyroid or neck srugery ```