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Module 4 > Calcium - Electrolytes > Flashcards

Calcium - Electrolytes Flashcards

1
Q

what is the normal calcium range?

A

8.4 - 11.0

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2
Q

what is the function of calcium?

A

99% stored in bones (bones & teeth)
- bones
- blood
- beats (Heart)

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3
Q

what is calcium bound to?

A

to proteins (less than 50%)

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4
Q

where is calcium ionized?

A

found in serum (50% of calcium and is most important)

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5
Q

what is complexed calcium?

A

combined with nonprotein anions: phosphate, citrate, and carbonate

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6
Q

what is ionized calcium? and its purpose? 5

A
  1. Activate body chemical rxn
  2. Muscle contractions and relaxation
  3. Promote transmission of nerve impulse
  4. Cardiac contractility & automaticity
  5. Formation of prothrombin
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7
Q

what is one calcium regulator?

A
  • Parathyroid Hormone (PTH) “pulls” *
    1. Releases Ca from the bone
    2. Increases Ca absorption from GI
    3. Increases Ca absorption from renal tubules
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8
Q

what is the second calcium regulator?

A
  • Calcitonin – secreted by thyroid “keeps” *
    1. Antagonist of PTH
    2. Secretion stimulated by high serum Ca++
    3. Inhibits Ca reabsorption from bone
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9
Q

what are two other minor calcium regulators?

A
  1. Phosphate
    Reciprocal relationship with Ca
    (Ca = Phos)
  2. Vitamin D
    Necessary for absorption & utilization of Ca
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10
Q

what causes HYPOcalcemia? 6

A
  • think “LOW CAL”*
    1. Low parathyroid hormone
    2. Oral intake inadequate
    3. Wound drainage
    4. Celiac’s, Crohn’s Disease, & Corticosteroids
    5. Acute pancreatitis
    6. Low Vitamin D levels
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11
Q

what are the signs and symptoms of HYPOcalcemia? 6

A
  • think CRAMPS
    1. Confusion
    2. Reflexes hyperactive
    3. Arrhythmias (prolonged QT interval)
    4. Muscle spasms (calves/feet, tetany, seizures)
    5. Positive Trousseau’s
    6. Signs of Chvostek’s (facial nerves hyperexcitable)
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12
Q

CATS of hypocalcemia?

A

Convulsions
Arrythmias
Tetany (hand thing)
Spasms and stridor

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13
Q

what is a positive trousseau’s?

A

Carpopedal spasm of hand when
- Blood supply
- Pressure on nerve
Occurs several minutes after BP cuff inflated > systolic BP

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14
Q

what is a positive chvostek’s ?

A
  1. Spasm of muscles innervated by facial nerve
  2. Tap facial nerve anterior to ear lobe below zygomatic process
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15
Q

how can HYPOcalcemia affect the heart?

A
  1. prolong QT interval
  2. Prolong ST segment
  3. cardiac contractility
  4. sensitivity to digoxin
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16
Q

HYPOcalcemia lab data includes what? 5

A
  1. Serum calcium levels < 8.4 mg/dl
  2. Albumin/protein levels can give incorrect levels of Ca
  3. Ionized (serum) levels of Ca should be obtained for accurate results
  4. PTH levels can effect Ca
  5. Magnesium and phosphorus levels should also be obtained
17
Q

Medical treatment of HYPOcalcemia?

A

Acute symptomatic 🡫 Ca is emergency =
Requires prompt adm. of IV Calcium
*10% Ca-Gluconate
For severe symptoms
*Ca-Chloride
Never give IM
*Oral Ca or Vitamin D

18
Q

Nursing interventions for HYPOcalcemia?

A
  1. Identify pt at risk
  2. Seizure precautions if severe Ca
  3. Monitor airway
  4. Monitor ECG
  5. Educate pt: Ca loss & risks & Ca rich foods
19
Q

What can cause HYPERcalcemia? 7

A

*think “HIGH CAL”
1. Hyperparathyroidism
2. Increased intake of calcium
3. Glucocorticoids usage
4. Hyperthyroidism
5. Calcium excretion < w/Thiazide diuretics & renal failure, bone ca
6. Adrenal insufficiency (Addison’s)
7. Lithium usage (affects parathyroid)

20
Q

HYPERcalcemia signs and symptoms? 4

A

*think “WEAK”
1.Weakness of muscles
2. EKG changes-(shortened QT interval & prolonged PR interval)
3. Absent reflexes, “a”bsent minded (disoriented), “a”bdominal distention from constipation
4. Kidney stone formation

21
Q

how can HYPERcalcemia affect the heart? 4

A
  1. Calcium: inotropic effect on heart & reduces heart rate
  2. Shorten ST segment & QT interval
  3. Prolonged PR interval
  4. Potentiate digoxin toxicity
22
Q

HYPERcalcemia lab data? 5

A
  1. Serum calcium > 11.0 mg/dl
  2. ECG-dysrhthmias
  3. PTH- increased
  4. X-ray-reveal osteoporosis
  5. Urine
23
Q

Medical treatment for HYPERcalcemia? 7

A

1.Treat underlying cause
2. Dilute serum Ca++ with NS
3. Lasix/furosemide
4. IV phosphate
5. Calcitonin
6. Glucocorticoids
7. Hemodialysis or CAPD

24
Q

nursing interventions for HYPERcalcemia? 7

A
  1. Monitor for pt risk
  2. activity & fluids if possible
  3. ↓ Ca++ intake
  4. Safety measures for confusion
  5. Monitor ECG, I&O, breath sounds
  6. Monitor for Digoxin toxicity
  7. Prevent Ca++ renal stones
25
Q
A

Module 4 (11 decks)

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