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NUR544 Complex > Calcium, Magnesium, & Phosphorus pt. 1 > Flashcards

Calcium, Magnesium, & Phosphorus pt. 1 Flashcards

(73 cards)

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1
Q

What are the 3 major positive cations in the body?

A

1) Calcium
2) Magnesium
3) Phosphorus

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2
Q

How are Ca++, Mg+, & phos ingested & absorbed in the body?

A

Ingested through the diet and absorbed from the intestines

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3
Q

How are Ca++, Mg+, & phos filtered & reabsorbed in the body?

A

Filtered in glomerulus & reabsorbed in renal tubules

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4
Q

How are Ca++, Mg+, & phos excreted?

A

Excreted through the urine

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5
Q

What % of Ca++, Mg+, & phos are found in the bone?

A

1) 99% of calcium
2) 85% of phosphorus
3) 55% of magnesium

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6
Q

Where is the rest of Ca++, Mg+, & phos found?

A

Found in the cells → only small amount in the ECF
Mainly ICF ions

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7
Q

List 3 things that regulate Ca++, Mg+, & phos

A

1) Vitamin D
2) Parathyroid hormone
3) Calcitonin

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8
Q

What type of vitamin is vitamin D?

A

Fat soluble vitamin

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9
Q

How does vitamin D function?

A

Maintains normal Ca++ & phos levels by increasing absorption from the intestines

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10
Q

What is the major regulator of Ca++ & phos?

A

Parathyroid hormone secreted by parathyroid glands

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11
Q

What is the main function of the parathyroid hormone?

A

Maintain the ECF calcium levels
when Ca++ is high → PTH is inhibited
when Ca++ is low → PTH is stimulated

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12
Q

List 2 things parathyroid hormone requires in order to function

A

1) Vitamin D
2) Magnesium

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13
Q

When do we see increased excretion of phos?

A

When Ca++ & Mg+ are reabsorbed
Ca++ & phos have an inverse relationship

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14
Q

List the 4 steps that occur due to the parathyroid hormone in a client with hypocalcemia

A

1) Low conc. of Ca++ in blood causes release of PTH
2) Leads to Ca++ pulling away from the bone
3) When PTH is released we decrease loss of Ca++ in the urine (kidneys kick in)
4) Vit. D kicks in to enhance absorption of Ca++ from intestine

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15
Q

How does Ca++ enter the body?

A

Through the GI tract & is absorbed by effects of vit. D

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16
Q

Where is Ca++ stored & excreted?

A

Stored in bone & excreted in kidneys

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17
Q

List the 3 types of Ca++

A

1) ~ 40% Ca++ is protein bound (to albumin)
2) ~ 10% complexed/ chelated Ca++
3) ~ 50% ionized Ca++

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18
Q

Protein bound Calcium

A

Can NOT pass through capillary wall → inactive form and we can NEVER use it

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19
Q

Complexed or Chelated Calcium

A

Combined with citrate, phosphate, etc

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20
Q

What is calcium citrate used for?

A

To prevent blood clotting in transfusions

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21
Q

Ionized Calcium Hint: 2

A

Ability to leave the vascular compartments & participate in cellular function
Makes nerve cells less sensitive to stimuli

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22
Q

What may we see when a client has low albumin levels?

A

FALSELY low calcium levels → by obtaining corrected Ca++ we can determine if the Ca++ is actually normal or not

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23
Q

List 7 functions of calcium

A

1) Essential for many enzyme reactions
2) Bone development
3) Action potentials
4) Neuron excitability
5) Needed for skeletal, cardiac, & smooth muscle contraction
6) Affects cardiac contractility & automaticity
7) Essential for blood clotting

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24
Q

List 11 dietary sources we can get Ca++ from

A

1) Milk
2) Dairy
3) Kale
4) Broccoli
5) Bony fish
6) Seeds & nuts
7) Beans
8) Orange
9) Peas
10) Meat
11) Fortified foods → i.e. OJ & non dairy milk (oat/ almond)

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25
~ how many mg of Ca++ are absorbed per day?
150 mg/day
26
Why is it crucial to increase our dietary intake of Ca++?
We only absorb about half of the Ca++ we take in
27
What population should avoid taking Ca++ supplements?
Perimenopausal/ postmenopausal women
28
How does one become hypocalcemic?
If their Ca++ intake is less than what is secreted into the bowel
29
Calcium level considered hypocalcemia
Less than 8.5 mg/dL
30
What happens to Ca++ when pH is low (acidotic)?
It causes a decrease in protein binding of Ca++, increases ionized Ca++
31
What happens to Ca++ when pH is high (alkalotic)?
when body is stressed w an increase in epinephrine, glucagon, GH, beta adrenergic drugs, & ETOH causes reduction in ionized Ca++
32
List 6 possible causes of hypocalcemia
1) Pancreatitis 2) Hypoparathyroidism 3) deficit from diet effecting bones rather than blood levels 4) Inability to make Vit. D 5) Loop diuretics, INH, corticosteroids, aminoglycosides 6) Massive amounts of blood transfusion
33
What type of patients are unable to make vit. D? **Hint: 2**
1) Patients with CKD 2) Patients taking seizure meds
34
List the loop diuretic that can cause hypokalemia & hypocalcemia
Furosemide (lasix)
35
What is INH used to treat?
Tuberculosis
36
How can massive amounts of blood transfusions cause hypocalcemia?
Calcium citrate thats put into blood to prevent clotting → takes away ionized Ca++; which is bad b/c ionized Ca++ is active form
37
Acute hypocalcemia
Increased neuromuscular excitability & CV effects
38
List 2 things acute hypocalcemia causes
1) Overstimulation 2) Repetitive response to single stimulus or even continuous activity
39
List 8 Sx/ complaints associated with hypocalcemia
1) Paresthesia 2) Tetany 3) Chvostek's sign 4) Trousseau's sign 5) Seizures 6) Hypotension 7) Dysrhythmias 8) Poor response to meds
40
What is tetany?
Spasms of muscles of the face, hands & feet
41
What is Chvostek's sign?
Tapping of the facial nerve right below the temple
42
Is Chvostek's sign present in all hypocalcemic patients?
NO → only present in ~ 30% of patients w hypocalcemia **Present in ~ 10% of patients w normal calcium levels**
43
What is trousseau's sign?
Spasm after inflating BP cuff about 20 mm above systolic pressure & wait 2-3 min will see spasms of fingers
44
How often is Trousseau's sign seen in hypocalcemia?
ALWAYS seen → present in 94% of patients w hypocalcemia
45
What is Tx for acute hypocalcemia?
IV calcium gluconate
46
How should IV calcium gluconate be administered for acute hypocalcemia?
SLOWLY in D5W only → NSS will cause increased renal loss
47
What should nurse monitor for when calcium gluconate is infusing?
Extravasation → when meds leak into the tissue if IV goes bad & causes sloughing of skin
48
What are 2 things the nurse should implement when treating a client with acute hypocalcemia?
1) Seizure precautions 2) Must stay in bed when getting infusion → can cause postural hypotension
49
What other electrolyte imbalance can cause seizures?
Hyponatremia
50
Calcium level considered hypercalcemia
Levels greater than 10.5 mg/dL
51
Hypercalcemia: What do elevated protein levels do?
Increase total calcium levels but NOT ionized levels → falsely elevated Ca++
52
How does hypercalcemia occur?
When Ca++ levels move into the blood (ECF) faster than regulatory hormones or kidney excretion can control
53
What is a MAJOR cause of hypercalcemia?
Malignancies → either the tumor causes osteoclastic activity or humoral immune factors stimulate osteoclastic activity or prevent bone formation
54
Extremely elevated Ca++ levels can sometimes be the reason _____ are found
Malignancies
55
Elevated _____ hormone can cause hypercalcemia
Parathyroid hormone → hyperparathyroidism
56
List 4 less frequent causes of hypercalcemia
1) Immobilization & decreased weight bearing 2) Excessive Vit. D ingestion 3) Excessive Ca++ or dairy intake (Milk-alkali syndrome) 4) Lithium & thiazide diuretics
57
How does immobilization lead to hypercalcemia?
Causes natural breakdown of bone density → causes a release of Ca++ in the blood
58
How can a client experience excessive Ca++ or dairy intake (milk-alkali syndrome)?
Too much Ca++ carbonate antacids (i.e. tums)
59
How do lithium & thiazide diuretics cause hypercalcemia?
Increases parathyroid hormone activity
60
List 7 clinical manifestations of hypercalcemia
1) Decrease in neuromuscular activity 2) Heart becomes irritable & ventricular arrhythmias occur 3) Constipation, N/V 4) Inhibits ADH so person is always thirsty 5) Kidney stones (renal calculi) 6) Pancreatitis 7) Osteoporosis
61
List 3 things we see with decreased neuromuscular activity in hypercalcemia
1) Lethargy 2) Weakness 3) Flaccid muscles
62
What causes both hyper and hypocalcemia?
Pancreatitis
63
When do Sx usually begin in a client experiencing hypercalcemia?
After levels rise above 12 mg/dL & Sx become more severe as levels rise
64
Hypercalcemia crisis
Results in acute increase in calcium
65
Death from arrhythmias in hypercalcemia crisis can occur when levels reach ___?
> 17 mg/dL
66
What are the 4 key points to remembering hypercalcemia?
1) Bones (bone pain/ osteopororsis) 2) Stones (kidney stones) 3) Groans (constipation, N/V) 4) Psychic moans (lethargy)
67
What is the main Tx option for hypercalcemia?
Rehydration
68
Tx of hypercalcemia: If Na+ is excreted via urine what happens to Ca++
Ca++ will go with it **Loop diuretics / NSS fluid replacement**
69
Tx of hypercalcemia: What can we use if client has renal failure & other Tx don't work?
Dialysis
70
Tx of hypercalcemia: What meds can be used for hyperparathyroid disease?
Bisphosphonates (Alendronate)
71
How do Bisphosphonates work?
Help maintain & build bone → decrease osteoclastic activity & increase osteoblastic activity (helps bring Ca++ levels down)
72
Tx of hypercalcemia: When is PTH blood test elevated?
In hyperparathyroidism → NOT malignancies
73
List 5 other nursing interventions for hypercalcemia
1) Keep client mobile 2) Increase fluid intake 3) Place on fall precautions if confused 4) Assess for cardiac abnormalities 5) Support pt/ family that Sx will resolve when Ca++ is lower

NUR544 Complex (12 decks)

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