lOMoARcPSD|10196013
Fluid and Electrolytes
Med surg (Saint Francis Medical Center College of Nursing)
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Hyperkalemia
Hyper= excessive
Kal= root word for potassium
Emia= blood
Meaning of hyperkalemia: excessive potassium in the blood
Normal potassium is 3.5 to 5.1. Anything higher than 7.0 or higher is very dangerous!
Most of the body’s potassium is found in the intracellular part of the cell compared to the
extracellular which is where sodium is mainly found. Blood tests that measure potassium levels
are measuring the potassium outside of the cell in extracellular fluid.
Remember that potassium is responsible for nerve impulse conduction and muscle contraction.
Causes of Hyperkalemia
Remember that phrase “The Body CARED too much about potassium”
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Cellular Movement of Potassium from intracellular to extracellular (burns, tissue
damages, acidosis)
Adrenal Insufficiency with Addison’s Disease
Renal Failure
Excessive potassium intake
Drugs (potassium- sparing drugs: spironolactone), Triamterene, ACE inhibitors, NSAIDS)
Signs and Symptoms of hyperkalemia
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Remember the word MURDER
● Muscle weakness
● Urine production little or none (renal failure)
● Respiratory failure (due to the decreased ability to use breathing muscles or seizures
develop)
● Decreased cardiac contractility (weak pulse, low BP)
● Early signs of muscle twitches/cramps… late profound weakness, flaccid
● Rhythm changes: Tall peaked T waves, flat p waves, widened QRS and prolonged PR
interval
Nursing interventions for hyperkalemia
● Monitor cardiac, respiratory, neuromuscular, renal, and GI status
● Stop IV potassium if running and hold any PO potassium supplements
● Initiate potassium restricted diet and remember foods that are high in potassium
● Remember the word POTASSIUM for food rich in potassium
○ Potatoes, pork
○ Oranges
○ Tomatoes
○ Avocados
○ Strawberries
○ Spinach
○ fIsh
○ mUshrooms
○ Musk melons: cantaloupe
Also included are carrots, cantaloupe, raisins, and bananas.
● Prepare a patient ready for dialysis. Most patients are renal patients who get
dialysis regularly and will have high potassium
● Kayexalate is sometimes ordered and given PO or via enema. This drug
promotes GI sodium absorption which causes potassium excretion
● Doctor may order potassium wasting drugs like Lasix or hydrochlorothiazide
● Administer a hypertonic solution of glucose and regular insulin to pull the
potassium into the cell
Hypokalemia
Hypo= low
Kal= root word for potassium….. don’t get it confused with cal= calcium
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Emia=blood
Meaning of hypokalemia: Low Potassium in the Blood
Normal Potassium Level 3.5-5.1 (2.5 or less is very dangerous)
Most of the body’s potassium is found in the intracellular part of the cell compared to the
extracellular which is where sodium is mainly found. Blood tests measure potassium levels via the
outside of the cell (extracellular fluid).
Remember potassium is responsible for nerve impulse conduction and muscle contraction.
Causes of Hypokalemia
”Your body is trying to DITCH potassium”
Drugs (laxatives, diuretics, corticosteroids)
Inadequate consumption of potassium (NPO, anorexia)
Too much water intake(dilutes the potassium)
Cushing’s syndrome (during this condition the adrenal glands produce excessive amounts of
cortisol (if cortisol levels are excessive enough, they will start to affect the action of the Na+/K+
pump which will have properties like aldosterone and cause the body to retain sodium/ water but
waste potassium)... hence hypokalemia.
Heavy Fluid Loss (NG suction, vomiting, diarrhea, wound drainage, sweating)
(Other causes: when the potassium moves from the extracellular to the intracellular with
alkalosis or hyperinsulinism (this is where too much insulin in the blood and the patient will have
symptoms of hypoglycemia)
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Signs & symptoms of Hypokalemia
Try to remember everything is going to be SLOW and LOW. Don’t forget potassium plays a role
in muscle and nerve conduction of muscle systems are going to be messed up and affect the
heart, GI, renal, and the breathing muscles for the lungs.
● Weak pulses (irregular and thread)
● Orthostatic hypotension
● Depression ST, flat or inverted T wave and prominent u-wave
●
Shallow respirations with diminished breath sounds… due to weakness of accessory
muscle movement to breath)
● Confusion, weak
● Flaccid paralysis
● Decreased deep tendon reflexes
● Decreased bowel sounds
Easy way to remember 7 L’s
1. Lethargy (confusion)
2. Low, shallow respirations (due to decreased ability to use accessory muscles for
breathing)
3. Lethal cardiac dysrhythmias
4. Lots of urine
5. Leg cramps
6. Limp muscles
7. Low BP & heart
Nursing interventions for hypokalemia
Watch heart rhythm(place on cardiac monitor… most are already on telemetry), respiratory
status, neuro, GI, urinary output and renal status (BUN and creatinine levels)
Watch other electrolytes like Magnesium (will also decrease… hard to get K= to increase if mag
is low), watch glucose, sodium, and calcium all go hand in hand and play a role in cell transport.
Administer oral supplements for potassium with doctor’s order: usually for levels 2.5-3.5… give
with food can cause GI upset
IV potassium for levels less than 2.5 (NEVER EVER GIVE POTASSIUM via IV push or by IM or
subq routes)
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●
According to the bag instruction, don't increase the rate… has to be given slowly…
patients who give more than 10-20 meq/hr should be on a cardiac monitor and
monitored for EKG changes.
● Cause phlebitis or infiltrations
Don’t give LASIX, demadex, or thiazides (waste more potassium) or Digoxin (cause digoxin
toxicity) if potassium level low… notify MD for further orders.
Physician will switch patient to a potassium sparing diuretic Spironolactone (Aldactone),
Dyazide, Maxide, Triamterene
Instruct patient to eat potassium rich foods
Remember POTASSIUM to help remember the foods
● Potatoes, Pork
● Oranges
● Tomatoes
● Avocadoes
● Strawberries
● Spinach
● fIsh
● mUshrooms
● Musk melons: cantaloupe
Also included are: (carrots, raisins, bananas)
Hyponatremia
Hypo: “under/breath”
Natr: prefix for sodium
Emia: blood
Meaning of Hyponatremia: low sodium in the blood
Normal sodium: levels: 135- 145 mEq/L (<135= hyponatremia)
Role of sodium in the body: an important electrolyte that helps regulate water inside and
outside of the cell. Remember that water and sodium love each other and wherever sodium
goes so does water.
In hyponatremia sodium outside of the cell is very low and this causes water to move inside the
cell. In turn, the cell will swell and you will start to see problems in the body, especially with brain
cells (confusion).
Sodium also plays a role in muscle, nerve, and organ function.
Types of Hyponatremia
Euvolemic hyponatremia is where the water in the body increases but the sodium stays the
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same. The causes include: SIADH (Syndrome of inappropriate antidiuretic hormone secretion)
which is due to the increased amount of secretion of antidiuretic hormone. This hormone retains
water in the body which dilutes sodium. Other causes: diabetes insipidus, adrenal insufficiency,
Addison’s disease etc.
Hypovolemic Hyponatremia is where the patient has lost a lot of fluid and sodium. Causes:
vomiting, diarrhea, NG suction, diuretic therapy, burns, sweating
Hypervolemic Hyponatremia is where the body has increased in fluid and sodium. However,
sodium decreases due to dilution and because total body water and sodium are regulated
independently in the body. Causes: congestive heart failure, kidney failure, IV infusion of saline,
liver failure etc.
Causes of Hyponatremia
Remember “NO Na+”
Na+ excretion increased with renal problems, NG suction (GI system rich in sodium), vomiting,
diuretics, sweating, diarrhea, decreased secretion of aldosterone (diabetes insipidus) (wasting
sodium)
Overload of fluid with CHF, hypotonic fluids infusions, renal failure (dilutes sodium)
Na+ intake low through low salt diets or nothing by mouth
Antidiuretic hormone over secreted **SIADH (syndrome of inappropriate antidiuretic hormone
secretion… remember retains water in the body and this dilutes sodium)
Signs & Symptoms of Hyponatremia
Remember “SALT LOSS”
● Seizures & stupor
● Abdominal cramping, attitude changes (confusion)
● Lethargic
● Tendon reflexes diminished, trouble concentrating (confused)
● Loss of urine & appetite
● Orthostatic hypotension, overactive bowel sounds
● Shallow respirations (happens late due to skeletal muscle weakness)
● Spasms of muscles
Nursing Interventions for Hyponatremia
● Watch cardiac, respiratory, neuro, renal, and GI status
● Hypovolemic hyponatremia: give IV sodium chloride infusion to restore sodium and
fluids (3% Saline hypertonic solution… harsh on the veins… given in ICU usually
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through central line very slowly… must watch for fluid overload)
Hypervolemic hyponatremia: restrict fluid intake and in some cases administer
diuretics to excretion the extra water rather than sodium to help concentrate the sodium.
If the patient has renal impairment they may need dialysis
Caused by SIADH or Antidiuretic hormone problems: fluid restriction or treated with
an antidiuretic hormone antagonist called Declomycin which is part of the tetracycline
family (don’t give with food especially dairy or antacids… bind to cations and this affect
absorption).
If a patient takes Lithium remember to monitor drug levels because lithium excretion will
be diminished and this can cause lithium toxicity.
Instruct to increase oral sodium intake and some physicians may prescribe sodium
tablets. Food rich in sodium include: bacon, butter, canned food, cheese, hot dogs, lunch
meat, processed food, table salt
Hypernatremia
Hyper: “excessive”
Natr: prefix for sodium
Emia: blood
Meaning of hypernatremia: excessive sodium in the blood. Isotonic, hypotonic, and hypertonic
tonicity.
Normal sodium levels: 135-145 mEq/L (>145 sodium is hypernatremic)
Hypernatremia is a water problem rather than a sodium problem. This is because when the
body collects sodium it causes a lot of water retention and this is what causes the patient
problems.
Role of sodium in the body: it’s an important electrolyte that helps regulate the amount of
water inside and outside of the cell (water and sodium loves each other).
Where every sodium goes, so does water.
For example, in hypernatremia there is a lot of sodium outside the cell and this attracts the
water from inside the cell which will cause water to move outside the cell and dehydrate the cell.
Sodium also plays a role in muscle, nerves, and organ function.
Causes of Hypernatremia
Remember the phrase “HIGH SALT”
Hypercortisolism (Cushing’s syndrome), hyperventilation
Increased intake of sodium (oral or IV route)
GI feeding (tube) without adequate water supplements
Hypertonic solutions
Sodium excretion decreased (body keeping too much sodium) and corticosteroids
Aldosterone overproduction (Hyperaldosteronism)
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Loss of fluids (dehydrated) infection (fever), sweating, diarrhea,, and diabetes insipidus
Thirst impairment
Signs & Symptoms of hypernatremia
Remember: “No FRIED foods for you!” (too much salt)
Fever, flushed skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth/skin
Nursing Interventions for Hypernatremia
● Restrict sodium intake! Know foods high in salt such as bacon, buter, canned food,
cheese, hot dogs, lunch meat, processed food, and table salt.
● Keep patient safe because they will be confused and agitated
● Doctors may order to give isotonic or hypotonic solutions such as 0.45% NS (which is
hypotonic and most commonly used). Give hypotonic fluids slowly because brain tissue
is at risk due to the shifting of fluids back into the cell (remember the cell is dehydrated
with hypernatremia) and the patient is at risk for cerebral edema. In other words, the
cell can lyse if fluids are administered too quickly.
● Educate patients and family about signs and symptoms of high sodium levels and
proper foods to eat.
Hypomagnesemia
Hypo: “under”
Magnes: prefix for magnesium
Emia: blood
Meaning of hypomagnesemia: low levels of magnesium in the blood
Normal levels of magnesium: 1.6- 2.6 mg/dL (<1.6 hypomagnesemia)
Magnesium plays a role in: major cell functions like transferring and storing energy, regulation
of parathyroid hormone PTH (which also plays a role in calcium levels). In hypomagnesemia,
the release of calcium is inhibited and that is why you will see hypocalcemia if you have low
magnesium levels. Magnesium also plays a role in the metabolism of carbs, lipids, and proteins,
and blood pressure regulation.
Magnesium is absorbed in the small intestine and excreted via the kidneys (any issues with
these systems can cause magnesium level issues).
Causes of hypomagnesemia
Remember “LOW MAG”
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Limited intake Mg+ (starvation”
Other electrolyte issues cause low mag levels (hypOkalemia, hypOcalcemia)
Wasting magnesium kidneys (loop and thiazide diuretics & cyclosporine… stimulates the
kidneys to waste mag)
Malabsorption issues (Crohn’s, Celiac, proton-pump inhibitors drugs” Prilosec, Nexium,
Protonix,”... drug family ending in “prazole” Omeprazole, diarrhea/vomiting)
Alcohol(due to poor dietary intake, alcohol stimulates the kidneys to excreted mag, acute
pancreatitis)
Glycemic issues (diabetic ketoacidosis, insulin administration)
Signs and Symptoms of hypomagnesemia
Remember “Twitching” because the body is experiencing neuromuscular excitability. This is the
OPPOSITE in hypermagnesemia where everything in the body is lethargic.
Trousseau's (positive due to hypocalcemia)
Weak respirations
Irritability
Torsades de pointes (abnormal heart rhythm, that leads to sudden cardiac death… seen
alcoholism) Tetany (seizures)
Cardiac changes(moderate losS: Tall T-waves and depressed ST segments**** Severe losS:
prolonged PR & QT interval (prolong of QT interval increases patient’s risk for Torsades de
pointes) with widening QRS complex, flattened t-waves, Chvostek’s sign (positive which goes
along with hypocalcemia)
Hypertension, Hyperreflexia
Involuntary movements
Nausea
GI issues (decreased bowel sounds and mobility)
Nursing Interventions for Hypomagnesemia
● Monitor cardiac, GI, respiratory, neuro status. Place on a cardiac monitor (watching for
any EKG changes prolonging of PR interval and widened gQRS complex)
● May administer potassium supplements due to hypokalemia (hard to get magnesium
level up if potassium level is down)
● Administering calcium supplements (oral calcium supplements with Vitamin D or 10%
calcium gluconate)
● Administer Magnesium Sulfate IV route. Monitor Mg+ level closely because patients
can become magnesium toxic. (*** Watch for depressed or loss of deep tendon
reflexes)
● Place patient in seizure precautions
● Oral forms of Magnesium may cause diarrhea which can increase magnesium loss so
watch out for this
● Watch other electrolyte levels like calcium and potassium
● Encourage foods rich in magnesium
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“Always Get Plenty Of Foods Containing Large Numbers Of Magnesium”
● Avocado
● Green leafy veggies
● Peanut Butter, potatoes, pork
● Oatmeal
● Fish (canned white tuna/mackerel)
● Cauliflower, chocolate (dark)
● Legumes
● Nuts
● Oranges
● Milk
Hypermagnesemia
Hyper: “excessive”
Magnes: prefix for magnesium
Emia: blood
Meaning of hypermagnesemia: high levels of magnesium in the blood
Normal levels of Magnesium: 1.6- 2.6 mg/DL (>2.6 hypermagnesemia)
Magnesemia plays a role in: major cell functions like transferring and storing energy,
regulation of parathyroid hormone PTH (which also plays a role in calcium levels). In
hypermagnesemia, the release of calcium is inhibited and that is why you will see hypocalcemia
if you have a high magnesium level. Magnesium also plays a role in the metabolism of carbs,
lipids, and proteins, and blood pressure regulation.
Magnesium is absorbed in the small intestine and excreted via the kidneys (any issues with
these systems can cause magnesium level issues).
Causes of Hypermagnesemia
Remember “MAG”
Hypermagnesemia is less common than hypomagnesemia. It typically happens when you are
trying to correct hypomagnesemia with magnesium sulfate IV infusion. However, other causes
can include:
Magnesium containing antacids and laxatives *** (Mylanta, Maalox)
Addison’s disease (adrenal insufficiency)
Glomerular filtration insufficiency (<30 mL/min) renal failure. This is because the kidneys are
keeping too much magnesium.
Signs & symptoms Hypermagnesemia
Remember: Every system of the body is “Lethargic” (opposite of hypomagnesemia where the
boyd systems are experiencing hyper-excitability)
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Note: you will typically only see symptoms in severe cases of hypermagnesemia (mild cases
patients will be asymptomatic)
● Lethargy (profound)
● EKG changes with prolonged PR & QT interval and widened QRS complex
● Tendon reflexes absent/grossly diminished
● Hypotension
● Arrhythmias (bradycardia, heart blocks)
● Respiratory arrest
● GI issues (nausea, vomiting)
● Impaired breathing (due to skeletal weakness)
● Cardiac arrest
Nursing Interventions for Hypermagnesemia
● Monitor cardiac, respiratory, neuro system, renal status. Put patient on cardiac monitor
(watch for EKG changes)
● Ensure safety due to lethargy/drowsiness
● Prevention:
○ Avoid giving magnesium containing antacids/laxative to patients with renal failure
○ Assess for hypermagnesemia during IV infusions of magnesium sulfate for
hypomagnesemia (sign and symptom would be diminished/absent deep tendon
reflexes)
○ Withhold foods high in magnesium, such as:
Remember: “Always Get Plenty Of Foods Containing Large Numbers Of Magnesium”
● Avocado
● Green leafy veggies
● Peanut Butter, potatoes, pork
● Oatmeal
● Fish (canned white tuna/mackerel)
● Cauliflower, chocolate (dark)
● Legumes
● Nuts
● Oranges
● Milk
● Administer diuretics that waste magnesium (if patient is not renal failure) such as Loop
and Thiazide diuretics
● Patient in renal failure patient prep for dialysis
● IV calcium may be order to reverse side effects of Magnesium (watch IV for infiltration…
prefer central line)
Hyperphosphatemia
Hyper: “excessive”
Phosphat: prefix for phosphate
Emia: blood
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Meaning of hyperphosphatemia: high levels of phosphate in blood
Normal phosphate levels: 2.7- 4.5 mg/dL (>4.5 is hyperphosphatemia)
Role of phosphate in the body: helps build bones and teeth and nerve/muscle function
Stored mainly in the bones. The kidneys and parathyroid play a role in the regulation of calcium
and phosphate
*** calcium and phosphate influence each other in opposite ways. For example, when calcium
levels increase in turn phosphate levels decrease (vice versa)
Vitamin D plays an important role in phosphate absorption.
Causes of Hyperphosphatemia (***main cause if Renal Failure)
Remember “PhosHi” (there is a drug called Phoslo (calcium acetate) which is prescribed for
patients in end stage renal failure (ESRF) to help keep phosphate level low. Phoslo is a
phosphate binder and it prevents the GI system from absorbing phosphate.
Phospho-- soda overuse: phosphate containing laxatives or enemas (sodium phosphate/Fleets
Enema)... do not administer to patients with renal failure
Hypoparathyroidism due to under secretion of parathyroid hormone. The parathyroid plays a
role in maintaining calcium and phosphate levels and it normally inhibits reabsorption of
phosphate by the kidneys. In hypoparathyroidism, there is secretion of PTH which causes
phosphate to become over absorbed by the kidneys.
Overuse of Vitamin D (remember Vitamin D helps with phosphate absorption. Too much vitamin
D would cause too much phosphate to be absorbed).
Syndrome of Tumor Lysis is a metabolic problem that mainly occurs with treatment of cancer
with chemotherapy. It causes the electrolytes to imbalance due to the cell dying and releasing
intracellular contents into the blood, hence too much phosphate is released into the blood.
rHabdomyolysis is rapid necrosis of the muscles and this leads to myoglobin being released into
the bloodstream which affects the kidneys and causes renal failure. In renal failure, you stat to
have phosphate excretion decreased.
Insufficiency of kidneys (end renal failure) causes phosphate to not be excreted
Signs & symptoms of Hyperphosphatemia
Will have many of the same symptoms as hypoglycemia because remember phosphate and
calcium function oppositely.
Remember CRAMPS (same mnemonic used for hypocalcemia)
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● Confusion
● Reflexes hyperactive
● Anorexia
● Muscle spasms in calves or feet, tetany, seizures
● Positive Trousseau’s Signs, Pruritus
● Signs of Chvostek
Nursing Interventions of Hyperphosphatemia
● *** administer phosphate- binding drug (PhosLo) which works on the GI system and
causes phosphorus to be excreted through the stool. ***
○ NCLEX: give with meals or right after meals
● Avoid using phosphate medication such as laxatives and enema
● Restrict foods high in phosphate ***eat: poultry, fish, dairy, nuts,m sodas,m oatmeal
● Prepare patient for dialysis if patient in renal failure
Hypophosphatemia
Hypo: “below”
Phosphat: prefix for phosphate
Emia: blood
Meaning of hypophosphatemia: low levels of phosphate in the blood
Normal phosphate levels: 2.7- 4.5 mg/dL (<2.7 is hypophosphatemia)
Role of phosphate in the body: helps build bones. Teeth and nerve/muscle function
Stored mainly in the bones. The kidneys and parathyroid play a role in the regulation of
calcium and phosphate.
***calcium and phosphate influence each other in opposite ways. For example, when
calcium levels increase in turn phosphate levels decrease (vice versa)
Vitamin D plays an important role in phosphate absorption.
Causes of Hypophosphatemia
Remember phrase: low “Phosphate”
Pharmacy: drugs such as aluminum hydroxide- based or magnesium based antacids cause
malabsorption in the GI system, so no phosphate is absorbed through the GI tract and the lack
of vitamin D (which plays a role in phosphate absorption).
Hyperparathyroidism: due to over secretion of parathyroid hormone (parathyroid plays a role in
maintaining calcium and phosphate levels and it normally inhibits reabsorption of phosphate by
the kidneys). However, in hyperparathyroidism there is an over secretion of PTH which causes
phosphate to NOT be reabsorbed at all.
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Oncogenic osteomalacia: kidneys start to waste phosphate which leads to low phosphate levels
and softening of the bones (this puts the patient at risk for bone fractures)
Syndrome of Refeeding (aka Refeeding Syndrome): causes electrolytes and fluid problems
due to malnutrition or starvation
***Watch patients who are on TPN (total parenteral nutrition). This happens when food is
reintroduced after the body is in starvation mode (hence the body went into survival mode and is
depleted of almost everything). When the nutrition is introduced, the body releases insulin due
to the increased blood sugar from the food which causes the body to rapidly use the already low
stores of phosphate, magnesium, and potassium to help with synthesizing. This depletes
phosphate levels.
Pulmonary issues as respiratory alkalosis (under alkalotic conditions phosphate moves out of
the blood into the cell which causes phosphate blood levels to decrease)
Hyperglycemia leads to symptoms of glycosuria, polyuria, ketoacidosis which causes the
kidneys to waste phosphate
Alcoholism: alcohol affects the body’s ability to absorb phosphate and many alcoholics are
already malnourished (hence already have low phosphate level to begin with)
Thermal Burns due to the shifting of phosphate intracellularly
Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia also cause phosphate
levels to decrease
Signs & symptoms of Hypophosphatemia
Remember the word: “BROKEN”
These patients are at risk for broken bones and the systems of the body are breaking down
(respiratory, muscles, neuro, immune etc.)
● Breathing problems due to muscle weakness
● Rhabdomyolysis which is caused by an electrolyte disorder. This happens when there is
a rapid necrosis of the skeletal muscles which leads to renal failure.
○ ***These patients will have tea- colored looking urine due to myoglobin in the
urine and will have muscle weakness/pain. The renal failure occurs because
when the muscle dies, myoglobin is released into the blood which is very toxic to
the kidneys. Reflexes (deep tendon) decrease.
● Osteomalacia (softening of the bones) fractures and decreased bone density (alteration
in bone shape), cardiac Output decreased
● Kills immune system with immune suppression and decreases platelet aggregation
(which leads to increased bleeding)
● Extreme weakness, Ecchymosis from decreased platelets
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● Neuro status changes (irritability, confusion, seizures)
Nursing interventions for Hypophosphatemia
● *** administer oral phosphorus with vitamin D supplement (remember vitamin D helps
with absorbing phosphate)
● If patient receiving TPN watch for patient complaints of muscle pain or weakness (may
be due to rhabdomyolysis or refeeding syndrome)
● Ensure patient safety due to risk of bone fractures
● Encourage foods high in phosphate but low in calcium: *Foods high in phosphate are
fish, organ meats, nuts, pork, beef, chicken, whole grains
● If phosphate levels are less than 1 mg/dL, the doctor may order IV phosphorus which
affects calcium levels causing hypocalcemia or increase phosphate levels
(hyperphosphatemia). *** also, assess renal status (BUN/creatinine normal) before
administering phosphorus because if the kidneys are failing the patient won’t be able to
clear phosphate). Place on cardiac monitor and watch for EKG changes.
Hypocalcemia
Hypo: low
Calc: prefix is calcium
Emia: blood
Meaning of hypocalcemia: low calcium in the blood
Normal calcium level: 8.6- 10 mg/dL (<8.6 mg/dL)
Role of calcium: plays a huge role in bone and teeth health along with muscle/nerve function,
cell, and blood clotting. Calcium is absorbed in the GI system and stored in the bones and then
excreted by the kidneys.
Vitamin D helps play a role in calcium absorption.
In addition, phosphorus and calcium affect each other in the opposite way. For instance, if
phosphorus levels are high in the blood, calciu will decrease and vice versa. They are always
doing the opposite (remember this because it is important for the causes of hypocalcemia.
Causes of Hypocalcemia
Remember “Low Calcium”
● Low parathyroid hormone due. This is due to the destruction or removal of the
parathyroid gland (any surgeries of the neck ex: thyroidectomy you want to check the
calcium level) professors like to ask this on an exam.
● Oral intake is inadequate (alcoholism, bulimia etc.)
● Wound drainage (especially GI system because this is where the calcium is absorbed)
● Celiac’s & Crohn’s Disease cause malabsorption of calcium in the GI tract
● Acute pancreatitis
● Low vitamin D levels (allos for calcium to be reabsorbed)
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●
●
Chronic kidney issues (excessive excretion of calcium by the kidneys)
Increased phosphorus levels in the blood (phosphorus and calcium do the opposite of
each other)
● Using medications such as magnesium supplements, laxatives, loop diuretics, calcium
binder drugs
● Mobility issues
Signs & symptoms of Hypocalcemia
Remember “CRAMPS”
● Confusion
● Reflexes hyperactive
● Arrhythmias (prolonged QT interval and ST interval) Note: definitely remember
prolonged Qt interval… another major test question
● Muscle spasms in calves or feet, tetany, seizures
● Positive Trousseau’s! You will see this before Chvostek’s sign or before tetany. This sign
may be positive before other manifestations of hypocalcemia such as hyperactive
reflexes.
○ (KNOW How to elicit a positive Trousseau’s. You do this by using a blood
pressure cuff and place it around the upper arm and inflate it to a pressure
greater than the systolic blood pressure and hold it in place for 3 minutes. If it is
positive the hand of the arm where the blood pressure is being taken will start to
contract involuntarily).
● Signs of Chvostek’s (nerve hyperexcitability of the facial nerves. To elicit this response
you would tap at the angle of the jaw via the masseter muscle and the facial muscles on
the same side of the face will contract momentarily (the lips or nose will twitch).
Nursing Interventions for Hypocalcemia
● Safety (prevent falls because patient is at risk for bone fractures, seizures precautions,
and watch for laryngeal spasms)
● Administer IV calcium as ordered (ex: 10% calcium gluconate)... give slowly as ordered
(be on cardiac monitor and watch for cardiac dysrhythmias). Assess for infiltration or
phlebitis because it can cause tissue sloughing (best to give via a central line). Also,
watch if the patient is on Digoxin because this can cause Digoxin toxicity.
● Administer oral calcium with Vitamin D supplements (give after meals or at bedtime with
a full glass of water)
● If phosphorus level is high (remember phosphorus and calcium do the opposite) the
doctor may order aluminum hydroxide antacids (Tums) to decrease phosphorus level
which in turn would increase calcium levels.
● Encourage intake of foods high in calcium:
Young Sally’s Calcium Serum Continues To Randomly Mess-up.
● Yogurt
● Sardines
● Cheese
● Spinach
● Collard green s
● Tofu
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lOMoARcPSD|10196013
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●
Rhubarb
Milk
Hypercalcemia
Hyper: excessive
Calc: prefix for calcium
Emia: blood
Meaning of hypercalcemia: excessive calcium in the blood
Normal calcium levels in the blood: 8.6- 10 md/dL (>10 is hypercalcemia)
Calcium plays a huge role in bone and teeth health along with muscle/nerve function, cell, and
blood clotting
Calcium is absorbed in the GI system and stored in the bones and then excreted by the kidneys
Vitamin D helps play a role calcium absorption
Causes of Hypercalcemia
Remember “High Cal”
Hyperparathyroidism (high parathyroid hormone causes too much calcium to be released into
the blood)
Increased intake of calcium (excessive use of oral calcium or Vitamin D supplements)
Glucocorticoids usage (suppresses calcium absorption which leaves more calcium in the blood)
Hyperthyroidism
Calcium excretion decreased with Thiazide* diuretics & renal failure, cancer of the bones
Adrenal insufficiency (Addison’s disease)
Lithium usage (affects the parathyroid and causes phosphate to decrease and calcium to
increase)
Signs & symptoms of hypercalcemia
“The body is too WEAK”
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●
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Weakness of muscles (profound)
EKG changes shortened QT interval (most common) and prolonged PR interval
Absent reflexes, absent minded (disoriented), abdominal distention from consti[ation
Kidney stone formation
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Nursing interventions for Hypercalcemia
Mild Cases of Hypercalcemia
● Keep patient hydrated (decrease chance of renal stone formation)
● Keep patient safe from falls or injury
● Monitor cardiac, GI, renal, neuro status
● Assess for complaints of flank or abdominal pain & strain urine to look for stone
formation
● Decrease calcium rich foods and intake of calcium- preserving drugs like thiazide,
supplements, vitamin D
To help you remember foods high in calcium remember the phrase:
Young Sally’s Calcium Serum Continues To Randomly Mess-up.
● Yogurt
● Sardines
● Cheese
● Spinach
● Collard green s
● Tofu
● Rhubarb
● Milk
Moderate cases of Hypercalcemia
Administer calcium reabsorption inhibitors: Calcitonin, Bisphonates, prostaglandin synthesis
inhibitors (ASA, NSAIDS)
Severe cases of Hypercalcemia
Prepare patient for dialysis
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