Slide 1:
CALCIUM IMBALANCE
Slide 2:
CALCIUM
Extracellular and intracellular cation
4.5 to 5.5 mEq/L
99% is in the bones and teeth
Primarily excreted in feces and some in urine
Vit. D-needed to absorb calcium from the GI tract
Slide 3:
FUNCTIONS
Acts as catalyst in transmission and conduction of nerve impulses
Stimulates contraction of skeletal, smooth and cardiac muscle
Maintain cardiac pacemaker(automaticity)
Maintain normal cellular permeability
Promotes coagulation
Promotes absorption and utilization of Vit. B12
Promotes strong and durable bones and teeth
Slide 4:
PTH and calcitriol
regulate plasma level of calcium
Resorption from bones
Reabsorption from the renal tubule
1% is in the tissue and ECF and ICF
Half is bound to protein
Half is free (ionized calcium)
Slide 5:
PTH
Parathyroid hormone does the following:
Stimulates bones to release calcium into blood
Causes the kidneys to excrete less calcium in urine
Stimulates the digestive tract to absorb more calcium
Causes the kidneys to activate vitamin D , which enables the digestive tract to absorb more calcium
Slide 6:
Calcitonin
Suppresses the function of PTH
Promotes calcium balance
Inhibits bone resorption and stimulate deposition
Slide 7:
Slide 8:
Slide 9:
HYPOCALCEMIA
4.5 and below
Dangerous when severe
Slide 10:
CAUSES
Hypoparathyroidism/ surgical parathyroidism
Pancreatitis
Open wounds/burns
Cushing’s syndrome
Hyperphosphatemia
Alkalosis
Multiple transfusion of stored blood
Renal failure
alcohol /caffeine Smoking
Magnesium depletion
Slide 11:
MEDICATIONS
MgSO4
Colchicine
Neomycin
Phosphate preparation
Loop diuretics
Slide 12:
Inadequate intake of calcium
Elderly
Long period of NPO
High protein diet and Weight reduction
Lactose intolerance
GI disease
Liver disease
Alcoholism
Anorexia and bulimia
Inadequate intake of Vit. D
Prolong institutionalization
Slide 13:
SIGNS AND SYMPTOMS
MILD/MOST COMMON
NEUROMUSCULAR HYPEREXCITABILITY
Paresthesia of hands, toes and lips
EMOTIONAL LABILITY
Rapid change in behavior
Slide 14:
SEVERE
Cardiac insufficiency
Hypotension
Dysrhythmias
Prolong QT interval
Prolong bleeding time
Trousseau’s sign
Chvostek’s sign
Slide 15:
Slide 16:
Slide 17:
PROGRESSES
Seizures
Laryngeal stridor and spasms
Tetany
Hemorrhage
Cardiac collapse
death
Slide 18:
PROLONGED
Cataracts
Dry sparse hair
Rough skin
osteoporosis
Slide 19:
MEDICAL MANAGEMENT
ASYMPTOMATIC
Oral calcium gluconate, calcium lactate or calcium chloride
Should be given with a glass of milk 1 to 1 ½ hours before meals
Chronic or mild
High calcium diet
Avoid high phosphate foods if with hypoparathyroidism
Milk products
Carbonated drinks
Excess proteins
Vit. D therapy
Aluminum hydroxide
Decreases phosphate
Slide 20:
ACUTE
IV ADMINISTRATION
Calcium chloride
High ionized calcium
Not use often
Irritating and causes sloughing of tissue if infiltrated
Calcium gluconate
More preferable
Must be given slowly to avoid hypotension and bradycardia and other dysrhytmias
Use D5W not saline solution as they promote calcium loss
Can cause cardiac arrest if given rapidly
Dangerous to patient taking digitalis
Kept in bed and monitor BP and heart rate
Slide 21:
NURSING INTERVENTION
Assess history
Check for early signs of tetany
Assess cardiac status
ECG and vital signs (apical HR)
Peripheral pulses
Monitor for bleeding
Monitor plasma calcium
Monitor for infiltration or phlebitis
Use fresh blood if transfusing blood
Prevent pathologic fracture
Provide a quiet safe stress free environment
Slide 22:
Instruct about food high in calcium and low in phosphate
Encourage taking calcium before meals and with milk except in hypoparathyroidism
Advice not to take OTC drug without consultations
Advise protein recommended by dietician
Seizure precaution
Slide 23:
Monitor airway
Safety precaution
Keep tracheostomy and emergency resuscitation bag at bedside
Health teachings
Disadvantages of smoking, alcohol and caffeine
Weight reduction diet
Weight bearing exercise
Slide 24:
HYPERCALCEMIA
Greater than 5.5 mEq/L
Dangerous when severe
50% mortality rate
Slide 25:
CAUSES
Metastatic cancer Hyperparathyroidism
Thiazide diuretic therapy
Excessive intake of calcium supplement with Vit. D or calcium containing antacid
Prolong immobilization
Metabolic acidosis
Hypophosphatemia
Multiple fracture
Excessive use of calcium during CPA
Slide 26:
complications
Coma
Cardiac arrest
Renal calculi
Slide 27:
SIGNS AND SYMPTOMS
MILD HYPERCALCEMIA
Near 5.5
Usually occurs when the client consumes calcium containing antacids
Usually asymptomatic
Slide 28:
Moderate hypercalcemia
Anorexia
N and V
Abdominal distention
Constipation
Weakness Fatigue
Depression
Difficulty concentrating
Slide 29:
Polyuria
Dehydration
Thirst
Kidney stones
Urinary blockade
severe colicky pain
Renal failure
Slide 30:
Severe (hypercalcemic crisis)
Extreme lethargy
Depress sensorium
Confusion Coma
Cardiac dysrhythmias
ECG changes
Widened T wave
Shortened QT interval
hypokalemia
Slide 31:
Medical management
IV normal saline with furosemide (loop diuretics)
Given rapidly to promote urinary excretion of calcium
Antitumor antibiotics
Inhibit the action of PTH
However it has many side effects
Blocks calcium resorption from bones
Observe for signs of hypocalcemia
Therapeutic effect may not be seen for 24 to 48 hours but the effect may last for 3 to 5 days
Calcitonin
Corticosteroids
competes with vit. D
Decreases intestinal absorption and bone resorption
Slide 32:
IV phosphate
Last resort
Will result in severe calcifications of tissue
Etidronate disodium (didronel)
Inhibits calcium mineralization
Client should be hydrated with normal saline
Should not last more than 6 months
Monitor renal function before, during and after therapy
Gallium nitrate
Inhibit bone resorption
Should be stop when urine output is less than 2 L/day
Surgery
Slide 33:
Nursing interventions
Health history and physical assessment
Monitor vital signs and ECG every 1 to 8 hrs
Monitor bowel sounds, renal function and hydration status q 8 hrs
If flank pain are present, strain all urine to capture renal calculi for analysis
Restrict high calcium foods as ordered
Force fluids
Report urine output of 30 ml/hr for 2 consecutive hours
Slide 34:
Report worsening of clinical status
Safety precautions
Report clinical manifestations of fracture
Health teachings:
High fiber foods and fluids
Increase Na to eliminate calcium
Avoid calcium supplements
Report any signs of renal calculi