calcium

Question 1

calcium - cation or anion?

Answer 1

One of body’s most abundant ions (major ECF cation)
Primarily combined with phosphorus to form mineral salts of bone & teeth

Question 2

Exerts sedative effect on (milk before bedtime calms my nerves)

Answer 2

(drink milk before bedtime) nerve cells
Functions to develop cardiac action potential and contraction of muscle

Question 3

what regulates Ca? and what does it activate? (Ca goes from bones to ECF, to kidney for reabsoption)

Answer 3

Parathyroid Hormone
- Released from parathyroid gland
- Promotes transfer of Ca from bones to ECF
- Activates vitamin D
- Promotes Kidney reabsorption

Question 4

vitamin D is a major source of

Answer 4

calcium through oral intake of foods rich in Ca++

Question 5

calcitonin - what is it and where is it produced? (mom needs to tone her thyroid)

Answer 5

• Hormone produced by thyroid gland.

Question 6

hypocalcemia causes - (when the albino is low, the milk is low)

Answer 6

Due to reduction of total body Ca++ or due to % of Ca++ that is ionized (look at albumin levels; low albumin is most common cause)
Increased Ca++ loss
Altered intestinal absorption
Altered regulation
Increased phosphorus or decreased Mg levels

Question 7

hypocalcemia - Clinical Manifestations (low ca makes me french)

Answer 7

Related to diminished function of
neuromuscular, cardiac and renal systems
Numbness, tingling of hands, muscle spasms,
+ Truosseau (20 mm above systolic and cramping of fingers) , +Chvosteks sign (twitching of cheek - Ch for cheek), increased DTRs (deep tendon reflex)
Muscle cramps, can progress to tetany
Cardiac Arrhythmias

Question 8

hypocalcemia - what numbers on blood test (Selene without Ca) and what number is serum albumin?

Answer 8

Diagnostic Tests
Serum Ca++ less than 8.5
Look at serum albumin less than 3.5
Xray findings may show osteoporosis, bone cavitation

Question 9

hypocalcemia signs and monitor what? (everyone else is doing it)

Answer 9

Monitor for signs of hypocalcemia - altered sensorium, assess orientation. call light within reach, etc. deep tendon reflexex, apical heart rate for arrythemias.

Question 10

hypercalcemia typically develops when there is an…(Ca moves from what to what)

Answer 10

increased movement of calcium from bone to ECF (hyperparathyroid, matestis of bone)
Shift of Ca++ from Bone to ECF
Increased Intake & Absorption
Decreased Ca++ Excretion

Question 11

hypercalcemia clinical manifestions (too much ca makes me weak)

Answer 11

Many effects related to excess Ca++ in cells, which causes a decrease in cell membrane excitability. Especially in skeletal and heart muscle and nervous system:
Weakness, decreased or absent DTRs
Bone pain
Constipation
Potential for renal calculi (flank pain, abdominal pain)
Dysrythmias

Question 12

hypercalcemia - labs (not 10 exactly)

Answer 12

Total serum Ca++ > 10.5mg/dL (also look at albumin level)

Question 13

hypercalcemia - monitor for what? (buffy drinking milk)

Answer 13

Monitor for altered sensorium
Provide safe environment (fall risk)

Question 14

hypercalcemia from taking what meds?

Answer 14

tums, maalox

Question 15

Ca is necessary for…

Answer 15

blood clotting process

Question 16

where is Ca located? and where is most of it?

Answer 16

Less than 1% of Ca++ is located in ECF & ICF compartments (of which approx 40% is bound to albumin)
99% located in bone

Question 17

what has an inverse relationship with Ca?

Answer 17

Phosphorus & calcium have inverse relationship.

Question 18

• Vitamin D is required to promote absorption of calcium via the

Answer 18

GI tract
You need a functioning GI tract. won’t work if you have - diarrhea, chrones, CF, malabsoportion.

Question 19

sources of vitamin D

Answer 19

food and produced via the skin with exposure to sunlight. Sun is the best source.

Question 20

Parathyroid antagonist is…

Answer 20

calcitonin

Question 21

calcitonin inhibits…and what can the nasal spray do?

Answer 21

bone resorption. Enhances excretion of Ca by kidneys
- Decreases Calcium levels
it blocks bone reabsorption. calcitonin nasal spray can prevent bone fractures, keep Ca in the bones.

Question 22

hypocalcemia - IV Ca precautions - what you know about calcium and blood

Answer 22

Administer po calcium and Vit D supplement as ordered
May need phosphorus binding antacids ex. tums or phoslow.
Encourage foods rich in Ca++/low in PO-4 (look at foods posted on canvas)
Administer IV calcium as ordered (use caution) go slowly, dilute properly, monitor output! should be on cardiac monitor.
Seizure precautions
Observe for bleeding or bruising (Ca promotes clotting)

Question 23

symptoms of hypercalcemia don’t usually occur until levels reach…

Answer 23

Sx usually absent unless concentration is >11mg/dL

Question 24

what happens to PTH with hypercalcemia? And x-rays?

Answer 24

PTH increased with hyperparathyroidism
Xray findings show osteoporosis, bone cavitation

Question 25

hypercalcemia - how often to monitor symptoms? (too much milk every hour on the hour)

Answer 25

Monitor for worsening hypercalcemia (weakness, DTR hourly, HR and rhythm)

Question 26

hypercalcemia - if taking digoxin, (can you dig, too much milk and mag)

Answer 26

Monitor for signs of digoxin toxicity if taking digoxin (causes dig toxicity)

Question 27

hypercalcemia - what meds to administer? (hulu loop - 3 in the hulu loop)

Answer 27

Administer saline and loop diuretics (lasix (furosamide) as prescribed
Avoid Vitamin D preparations
Low Ca++ diet, avoid Ca++ containing meds
loop for calcium, phosphorus and potassium

Question 28

hypercalcemia and kidneys…

Answer 28

Monitor renal fx
Monitor for kidney stones. last resort dialysis.

Question 29

Ca normal values

Answer 29

Normal value is 4.3 –
5.3 mEq/L (ionized Ca++) or 8.5 – 10 mg/dL (total Ca++) Serum value is
usually total Ca++

Question 30

high calcium causes body to

Answer 30

relax, low calcium more excitable

Question 31

calcium has an inverse relationship with

Answer 31

phosphorus

Question 32

opposite of pth

Answer 32

calcitonin

Question 33

mg required for

Answer 33

parathyroid hormone.

Question 34

hyperphosphatemia causes what to happen with calcium?

Answer 34

hypocalcemia

Question 35

calcium - reasons regulation is altered

Answer 35

damage to the parathyroid gland - ppl who have had thyroid removed are at risk for hypocalcemia bc the parathyroid can be damaged. also hypoparathyroidism

Question 36

low albumin a cause of

Answer 36

low calcium ionization

Question 37

low calcium GI can be caused by

Answer 37

vitamin D absorption

Question 38

calcium, mag, and potassium..(maggie milk and potatoes in the race)

Answer 38

run in same direction

Question 39

if someone has neck surgery, always check for

Answer 39

hypocalcemia = could be damage to parathyroid gland

Question 40

IV calcium = what precaution?

Answer 40

seizure precaution if signs of tetany

Question 41

hydrothiazide dirutics promote what? (thia can only hold onto to milk, everyone else runs)

Answer 41

the retention of ca so could cause hypercalcemia

Question 42

hypercalcemia symptoms usually not present until you reach what level? (hyper after 11)

Answer 42

11 mg/dl

Question 43

low calcium and mag vs. low phosphorus

Answer 43

low cal and mag increases muscle twitches, low mag relaxes.