Imbalances: Calcium, Magnesium, Phosphorous ✅ Flashcards
(138 cards)
1
Q
what level represents hypocalcemia?
A
less than 8.5 mg/dL
2
Q
what level represents hypercalcemia?
A
greater than 10.5 mg/dL
3
Q
what imbalance can affect over 70% of critical care pts?
A
hypocalcemia
4
Q
When pH is low (acidosis) what happens with calcium?
A
causes a decrease in protein binding of calcium, increases ionized calcium
5
Q
When pH is high (alkalosis) what happens with calcium?
A
reduction in ionized calcium
6
Q
besides alkalosis, what else can cause a reduction in ionized calcium?
A
when the body is stressed with an increase in:
- epinephrine
- glucagon
- growth hormone
- beta adrenergic drugs
- ETOH (alcohol)
7
Q
pancreatitis can cause what imbalance? (2)
A
hypocalcemia
hypercalcemia
8
Q
elevated protein levels can increase ____ _____ _____ but NOT _____ ____
A
can increase total calcium levels but NOT the ionized levels
9
Q
hypoparathyroidism can cause what imbalance?
what about hyperparathyroidism?
A
hypoparathyroidism → hypocalcemia
hyperparathyroidism → hypercalcemia
10
Q
a calcium deficit from diet effects the _____ rather than _____ _____
A
bones rather than blood levels
11
Q
when albumin is high, what can be falsely elevated?
A
calcium
12
Q
hypercalcemia occurs when calcium levels move into the blood (ECF) faster than ________ _______ or _______ ______ can control
A
regulatory hormones or kidney excretion
13
Q
if someone is unable to make vitamin D, what can we start to see?
A
hypocalcemia
14
Q
what pts might be unable to make vitamin D?
A
CKD or pts on some medications like seizure meds
15
Q
what imbalances can loop diuretics such as furosemide (lasix) cause? (4)
A
hypokalemia
hypocalcemia
hypophosphatemia
hypomagnesemia
16
Q
lithium can cause what imbalance? why?
A
hypercalcemia
bc it increases PTH activity
17
Q
what tuberculosis med can cause hypocalcemia?
A
INH
18
Q
what imbalance can cause mental fogginess & irritability?
A
hypophosphatemia
19
Q
what imbalance can cause kidney stones (renal calculi)?
A
hypercalcemia
20
Q
thiazide diuretics can cause what imbalance?
why?
A
hypercalcemia
bc it increases PTH activity
21
Q
aminoglycosides can cause what imbalance?
A
hypocalcemia
22
Q
what imbalance is majorly caused by malignancy? about how many cases?
how does this happen?
A
hypercalcemia
about 10-20% of people with malignancy
Either the tumor causes osteoclastic activity or humoral immune factors stimulate osteoclastic activity or prevents bone formation
23
Q
how does hypercalcemia affect neuromuscular activity? what sx does this cause? (3)
A
Decreases in neuromuscular activity
1)Lethargy
2)Weakness
3) Flaccid muscles
24
Q
corticosteroids can cause what imbalances? (2)
A
hypocalcemia
hypophosphatemia
25
crazy calcium levels are sometimes the reason _______ is found
malignancy
26
massive amounts of blood transfusions can cause what imbalance?
why?
hypocalcemia
citrate binds & takes away ionized calcium
27
why is putting calcium citrate in the blood a good AND bad thing?
good → prevents blood from clotting
bad → this takes away ionized calcium, which can be bad bc the ionized calcium is the type of calcium that we need to take care of things
28
is hypocalcemia acute or chronic?
can be either
29
what does hypocalcemia cause in the body? (3)
1) increased neuromuscular excitability (acute)
2) cardiovascular effects (acute)
3) overstimulation → repetitive response to single stimulus or even continuous activity
**Hypocalcemia revs things up**
30
if we have TOO much parathyroid we have TOO much of what?
calcium
31
paresthesia is a sx of what imbalance? (2)
hypocalcemia
hypomagnesemia
32
respiratory alkalosis can cause what imbalance?
hypophosphatemia
33
immobilization and decreased weight bearing is a cause of what imbalance? why?
Hypercalcemia
Natural breakdown of bone density → will cause a release of calcium in the blood
34
what is tetany? what imbalance is it a sx of?
spasms of muscles of face, hands & feet
hypocalcemia
35
what imbalance can cause altered neural function?
hypophosphatemia
36
excessive vitamin D ingestion can cause what imbalance?
Hypercalcemia
37
what is Chvostek’s sign?
what imbalances can cause it? (3)
tapping facial nerve right below temple
hypocalcemia
hyperphosphatemia (r/t low calcium)
hypomagnesemia (r/t low calcium)
38
is Chvostek’s sign always seen in hypocalcemia?
NO, it is NOT always seen in hypocalcemia
- absent in about 30% of pts with hypocalcemia
- present in about 10% of pts with normal calcium levels
39
what is milk-alkali syndrome?
what imbalance can it cause?
excessive calcium or dairy intake
hypercalcemia
40
what imbalance can cause hypoxia to tissues?
hypophosphatemia
41
what is Trousseau's sign?
what imbalances can cause it? (3)
spasm after inflating BP cuff about 20 mm above systolic pressure and wait 2-3 min will see spasms of fingers
hypocalcemia
hyperphosphatemia (r/t low calcium)
hypomagnesemia (r/t low calcium)
42
is Trousseau's sign always seen in hypocalcemia?
YES, ALWAYS seen (more specific) to hypocalcemia
- present in 94% of pts with hypocalcemia
- only present in ~ 1% of patients with normal calcium levels
43
what imbalance can cause decreased muscle contraction?
hypermagnesemia
44
Taking too much tums can cause what imbalances?
why?
hypercalcemia and hypophosphatemia
*it is an antacid with calcium carbonate in it
*these bind with phosphorus and increase excretion through stool
45
what imbalances can cause seizures? (2)
hypocalcemia
hypomagnesemia
46
what imbalance inhibits ADH?
what does this cause?
hypercalcemia
the person is always thirsty
**When we feel we are low volume we usually produce ADH → so if ADH is not working properly the patient will always feel thirsty!**
47
what imbalance can cause hypotension?
hypocalcemia
hypermagnesemia
48
what imbalance can cause altered musculoskeletal function?
hypophosphatemia
49
what imbalances can cause dysrhythmias? (3)
hypocalcemia
hypercalcemia (ventricular arrhythmias)
hypomagnesemia (arrhythmias)
50
what imbalances can cause osteoporosis? (2)
hypercalcemia
hypomagnesemia (long term leads to bone changes)
51
what imbalance can cause cardiac & neuromuscular irritability?
hyperphosphatemia (r/t to low calcium)
hypomagnesemia
hypermagnesemia
52
excessive alcohol intake can cause what imbalance?
hypophosphatemia
hypomagnesemia (alcoholism)
53
what imbalance can cause poor response to medications?
hypocalcemia
54
what happens to the heart in hypercalcemia?
heart becomes irritable and ventricular arrhythmias occur **can be life threatening**
55
what imbalance can cause bradycardia?
hypermagnesemia
56
acute hypoglycemia is treated with what?
IV calcium gluconate
57
what IV fluid can calcium gluconate ONLY be given in?
**D5W only**
58
what imbalance can lead to bone disease?
hyperphosphatemia
59
NG suction can cause what imbalance?
hypomagnesemia
60
why CAN'T IV calcium gluconate be given in NSS?
NSS will cause renal loss
61
what imbalance can cause blood disorders?
hypophosphatemia
62
when giving IV calcium gluconate, what must you monitor for?
extravasation
63
what is extravasation?
when meds leak into the tissue when IV goes bad and causes sloughing of the skin
64
in an ideal world, how would calcium gluconate be given?
infused through central line
65
what imbalances call for the patient to be put on seizure precautions? (2)
hypocalcemia
hypomagnesemia
66
DKA can cause what imbalance?
hypophosphatemia
67
metabolic acidosis can cause what imbalance?
hypomagnesemia
68
what can calcium gluconate cause that requires the pt to stay in bed during infusion?
postural hypotension
69
what imbalance can cause constipation, nausea, and vomiting?
hypercalcemia
70
when do sx of hypercalcemia usually begin?
after levels rise above 12 mg/dL & become more severe as levels rise
**but Sx can be severe at any level**
71
low vitamin D levels can cause what imbalances? (2)
hypocalcemia
hypophosphatemia
72
what is a hypercalcemia crisis?
what can happen?
what is it seen in?
Hypercalcemia crisis → results in acute increase calcium with the mentioned Sx
Can result in death from arrhythmias (usually levels above 17 mg/dL)
Seen in malignancies → or something really bad going on!!
73
what is a major way to tx hypercalcemia?
rehydration
74
rehydration promotes _______ _______ of calcium.
why?
Urinary excretion of calcium → if Na+ is excreted Ca++ will go with it
75
what diuretics can be used to tx hypercalcemia and why?
loop diuretics → heavy duty & get rid of fluid
76
what IV solution can be used in hypercalcemia?
NSS fluid replacement
77
when can dialysis be used in hypercalcemia?
in renal failure or when other Tx do NOT work
78
what meds can be used to tx hypercalcemia in pts with hyperparathyroid disease?
Bisphosphonates (Alendronate)
79
what can Bisphosphonates (Alendronate) do?
help maintain & build bone → decrease osteoclastic activity & increase osteoblastic activity (help bring Ca++ levels down)
80
what imbalance can lead to hyperparathyroidism?
hyperphosphatemia
81
treatment for _________ can be treatment for hypercalcemia (hint: major cause)
malignancy
82
for hypercalcemia, check double ____ blood test.
it would be would be elevated in _________ and normal in _________
PTH
elevated in hyperparathyroidism
normal in malignancy
83
to tx hypercalcemia, keep the person ______ if able
mobile
84
to tx hypercalcemia, the pt should increase ______ ______
fluid intake
85
what imbalance can be caused with increased glucose intake?
why?
hypophosphatemia
forces the insulin & phosphorus out of the blood and into the cell
86
what precautions should be taken in hypercalcemia?
Fall precautions if confused → b/c they will be confused & lethargic
87
TPN can cause what imbalance?
hypophosphatemia
88
when having a pt with hypercalcemia, the nurse should assess for ______ __________
cardiac abnormalities
89
when having a pt with hypercalcemia, how can the nurse support the patient / family?
reassure that Sx will resolve when calcium is lower
90
what level indicates hypophosphatemia?
levels less than 2.5 mg/dL
91
when is hypophosphatemia considered severe?
when level is less than 1.0 mg/dL
92
what imbalance can lead to calcifications in tissues?
hyperphosphatemia
93
hypophosphatemia comes from ____ _____ and losses through the _______
fluid shifts; kidneys
94
hypophosphatemia can be caused by increased intake of what other electrolyte?
magnesium
95
how can TPN cause hypophosphatemia?
TPN does NOT have enough phosphorus & can cause the phosphorus to go into the muscle → causes drop in blood levels
96
what imbalance can cause decreased reflexes?
hypermagnesemia
97
what type of people is hypophosphatemia usually seen in?
people who are malnourished or critically ill
98
when can laxatives cause hyperphosphatemia?
when they contain phosphorous
**lots of laxatives are phosphorus based bc it will help loosen stools**
99
hypophosphatemia causes a decrease in ___ _______ which is responsible for the sx of this imbalance
ATP production
100
what happens if a pt on a ventilator has hypophosphatemia?
Muscles get weak → will not be able to wean off ventilator because they are not making that ATP if they have low phosphorus
**Patient will not be able to inspire/ expire on their own**
101
how is hypophosphatemia typically treated?
oral supplements → such as Potassium phosphate/ sodium phosphate (Neutra Phos)
102
what is the dose for oral supplements when tx hypophosphatemia?
Dose is typically 250-500 mg several times a day but is weight based
103
after giving oral supplement for hypophosphatemia, when are levels checked?
2-12 hours after given
104
how is hypophosphatemia tx if severe?
what is important to know? (2)
IV, usually under 1 mg/dL
very irritating to veins
must be given slowly
105
what level represents hyperphosphatemia?
levels exceed 4.5 mg/dL
106
what causes hyperphosphatemia?
kidneys can NOT excrete the phosphorous
extreme intake
107
what is the most common cause of hyperphosphatemia?
renal dysfunction!!!!
108
Over-treatment in pre-eclampsia can cause what imbalance?
hypermagnesemia
109
hyperphosphatemia can also be caused from _____ ______ such as what? (3)
tissue injury
burns
heat stroke
low K+ (hypokalemic)
110
excessive intake of what antacids can cause hyperphosphatemia?
phosphorous based!!
**Do not confuse this with tums causing hypophosphatemia. tums are calcium based**
111
hyperphosphatemia is almost ALWAYS accompanying what?
what pts is this common in?
HYPOcalcemia
in pts with renal disease/dysfunction
112
what is a big thing to know about tx for hyperphosphatemia?
**Treat the cause!!**
113
what can be used, if needed, to tx hyperphosphatemia?
dialysis
114
what should be avoided in hyperphosphatemia?
foods high in phosphorous
115
what level represents hypomagnesemia?
level less than 1.8 mg/dL
116
hypomagnesemia can be caused by changes in movement of ICF/ECF. what things can cause this? (3)
glucose
insulin
acid-base imbalances
117
hypomagnesemia can be caused by what other electrolyte imbalances?
what sx can this cause?
hypokalemia / hypocalcemia
cardiac & neuro sx
118
hypomagnesemia increases hypokalemia, so how does this impact tx?
the hypokalemia will NOT respond to K+ replacement
**The K+ will not rise until magnesium is corrected!!**
119
how is mild hypomagnesemia tx?
can be corrected with diet or oral supplements
120
how is severe hypomagnesemia tx?
severe deficiency needs IV replacement
**Magnesium sulfate (IV form)**
121
how must Magnesium sulfate (IV form) be given
SLOWLY
**no more than 1-2 gm per hour**
122
what can happen if IV mag sulfate is given too fast?
**Can result in life threatening arrhythmias if given TOO fast**
Can also cause diarrhea
123
when tx a pt with hypomagnesemia the nurse should assess cardiac _______ by assessing what? (3)
cardiac stability
by assessing:
heart rhythm
pulses
perfusion
124
when tx a pt with hypomagnesemia the nurse should assess for difficulty ________. why?
difficulty swallowing
bc can increase risk of aspiration
125
when tx a pt with hypomagnesemia the nurse should look at what other electrolytes?
potassium and calcium
126
**Test question might be → Which of the following electrolyte abnormalities does the nurse need to assess for / put the patient on seizure precautions?**
Sodium; Calcium; & Magnesium
127
what levels indicate hypermagnesemia?
excess levels of 3.0 mg/dL
128
how common is hypermagnesemia and why?
rare bc kidneys usually are able to handle the excretion
129
what pts is hypermagnesemia seen in?
Renal insufficiency is the most common – usually more in older adults
130
what OTCs can cause hypermagnesemia?
Too much magnesium containing laxatives or antacids
131
hypermagnesemia causes irritability. how is this shown?
depressed nerve function & muscle contractions; decreased DTRs
132
how can hypermagnesemia be treated if kidneys are working?
diuretics and NSS
133
how can hypermagnesemia be treated in pts with severe renal disease? (2)
Treated with IV calcium gluconate
Would also need dialysis for the kidney disease
134
what MUST be avoided in pts with hypermagnesemia?
Avoid ALL magnesium containing medications and IV solutions (i.e. Lactated RInger’s)
135
when tx a pt with hypermagnesemia the nurse should assess for cardiac _______.
what can be found & why?
cardiac instability
hypotension due to vasodilation
136
why are pts with hypermagnesemia a fall risk?
If they have too much magnesium they become critically hypotensive → getting them out of bed can be very dangerous
137
when tx a pt with hypermagnesemia the nurse should assess DTRs. what is expected?
will be decreased or absent
138
when tx a pt with preeclampsia, what needs to happen?
need to have neuro status & DTRs monitored frequently
