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NRSG 102: Med Surg 1 > Exam 1: Calcium Imbalances > Flashcards

Exam 1: Calcium Imbalances Flashcards

1
Q

Where is Calcium located?

A

99% located in the skeletal system , major component of bones and teeth

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2
Q

What about the 1% of Calcium?

A

Rapidly exchangeable with blood calcium, adnd the rest is more stable and slowly exchanged.

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3
Q

Calcium plays a major role in

A

transmitting nerve impulses and helps regulate muscle contraction and relaxation, including cardiac muscle

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4
Q

Calcium is instrumental in

A

activating enzymes that stimulate many essential chemical reactions in the body and plays role in blood coagulation

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5
Q

Range for Hypocalcemia

A

< 8.5 mg/dL

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6
Q

Range for Hypercalcemia

A

> 10.5 mg/dL

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7
Q

Hypocalcemia Contributing Factors

A

Hypoparathyroidism, Vitamin D definicency, massive subcutaneous infection, decreased parathyroid hormone , fistulas, burns

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8
Q

Hypocalcemia Signs / Symptoms

A

Numbness, Tingling of Fingers, toes, SEizures, Hyperactive Deep Tendon Reflexesm diarrhea, Decreased BP, decreased clotting time, positive trousseau and chvostek , and tetany

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9
Q

Hypocalcemia Labs Indicate

A

Decrease in Magnesium or phosphorus

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10
Q

Hypercalcemia Contributing Factors

A

Hyperparathyroidism, Prolonged immobilization, Overuse of Supplements, Vitman D Excess, Increased Parathyroid Hormone

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11
Q

Hypercalcemia Signs/Symptoms

A

Muscular Weakness, Constipation, Anorexia, Nausea and Vomiting, Dehydration, Hypoactive Deep Tendon REflexes

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12
Q

Hypercalcemia ECG

A

Shortened ST Segmenet and QT Interval

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13
Q

Normal total serum calcium level?

A

8.6-10.2

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14
Q

Calcium exists in plasma in what forms?

A

Ionized, Bound, and Complex

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15
Q

50% Calcium exists in what form?

A

Ionized, and this is the most important for neuromusculalr activity and blood coagulation.

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16
Q

Normal Ionized Serum Calcium level?

A

4.5-5.1

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17
Q

Calcium is absorbed from foods in the presence of

A

normal gastric acidity and vitamin D

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18
Q

Calcium excreted primarily in

A

the feces, with remainder excreted in the urine.

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19
Q

Serum calcium level controlled by

A

PTH and Calcitonin

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20
Q

AS ionized serum calcium decreases,

A

the parathyroid glands secrete PTH. This increases calcium absorption from the GI tract, increases calcium reabsoprtion from the renal tube, and released calcium from the bone.

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21
Q

When calcium increases excessively, the thyroid gland secretes

A

calcitonin, which inhibits calcium reabsorption from bone and decreases the serum calcium concentration

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22
Q

Hypocalcemia range?

A

< 8,6 mg/dL

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23
Q

Who is at risk for Hypocalcemia?

A

Those who spend an increased amount of time in bed, because bed rest increases bone resorption

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24
Q

What is Hypocalcemia associated with?

A

Thyroid and Parathyroid surgery, but it can also occur after radial neck dissection.

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25
Q

Hypocalcemia is common with what disease?

A

Pancreatitis, because calcium ions combine with fatty acids rleased by lipolysis, forming soaps

26
Q

Hypocalcemia is common with those with a kidney injury because

A

these patients frequently have elevated serum phosphate levels.

27
Q

Hyperphosphatemia usually causes a

A

reciprocal drop in the serum calcium level

28
Q

Medications predisposing to hypocalcemia include

A

antacids, aminoglycosides, caffeine, cisplatin, phosphates, loop piuretics, proton pump inhibitors

29
Q

What is Tetany?

A

The most characteristics manifestation of hypocalcemia and hypomagnesemia, refers to the entire symptom complex induced by neural excitability.

30
Q

What two Signs occurs in Hypocalcemia?

A

Chvostek Sign and Trousseau Sign

31
Q

What is Chovstek sign?

A

A contraction of the facial muscles elicited in response to light tap over the facial nerve in front of the ear

32
Q

What is Trousseau Sign?

A

A carpopedal Spasm induce in by inflating a blood pressure cuff above systolic blood pressure

33
Q

What else signs/symptoms may occur with Hypocalcemia?

A

Seizures, and depression, impaired memory, confusion, delirium, and hallucinations.

34
Q

Signs and Symptoms of Chronic Hypocalcemia include

A

hyperactive bowel sounds, dry adn brittle hair and nails, and abnormal clotting

35
Q

When evaluating serum calcium levels, what else must be considered?

A

The serum albumin level and arterial pH.

36
Q

When artieral pH increases, calcium///

A

is more liekly to bound to protein resulting in the ionized portion decreasing. This is Alkalosis

37
Q

What is Acidosis in terms of Hypocalcemia?

A

Has the opposite effect; less calcium is bound to protein and therefore more exists i the ionized form.

38
Q

Acute hypocalcemia and should be treated with

A

IV administration of a calcium salt; such as calcium gluconate and calcium chloride.

39
Q

Hypocalcemia; Why should 0.9% NaCl not be used?

A

It increases renal calcium loss.

40
Q

What happens when solutions containing phosphates or bicarbonate are used with calcium?

A

They create prepicitation

41
Q

Hypocalcemia: Nutritional Therapy: Vitamin D

A

May be instituted to increase calcium absorption from the GI tract

42
Q

Hypocalcemia: Nutritional Therapy: In a patient with chronic kdiney disease, what might they be prescribed?

A

Aluminum Hydroxide, Calcium Acetate, or Calcium Carbonate Antacids to decrease elevated phosphorus levels before treating this

43
Q

What should dietary intake be increased to in Hypocalcemia?

A

100 to 1500 mg/day

44
Q

What is Hypercalcemia?

A

Its a dangerous imbalance when severe, it has a mortality rate as high as 50% if not treated promptly

45
Q

Hypercalcemia range?

A

> 10.2 mg/dL

46
Q

Most common causes of oHypercalcemia

A

Malignanices and Hyperparathyroidism

47
Q

Hypercalcemia: Excessive PTH secretion assited with hyperparathyroidism causes

A

increased release of calcium from the bones and increased intestinal and renal absorption of calcium

48
Q

Calcium levels are inversely realted to

A

phosphorus levels

49
Q

Hypercalcemia reduces neuromuscular excitability because it

A

supresses activity at the myoneural junction. Has decreased tone in smooth adn striated muscle

50
Q

Hypercalcemia: More sever symtpoms appear when its approximately

A

16 mg/dL or higher

51
Q

What is often present with Hypercalcemic crisis?

A

Severe thirst and polyuria. Also includes muscle weakness, intractable nausea, abdominal cramps, constipation, diarrhea

52
Q

What test can be used to determine the cause and different in Hypercalcemia

A

Double-Antibody PTH test, can differentiate between hyperparathyroidism and malignancy.

53
Q

Hypercalcemia: PTH levels in Hyperparathyroidism?

A

Increased

54
Q

Malignancy PTH levels? Hypercalcemia

A

Supressed in hypercalcemia

55
Q

Hypercalcemia: Therapeutic Aim?

A

Decreasing the serum calcium level and reversing the process causing the hypercalcemia.

56
Q

Hypercalcemia: Pharmacolgic Therapy?

A

Administering fluids to dilute serum calcium and promote its excretion by the kidneys, mobilizing the patient and restricting dietary calcium intake.

57
Q

Hypercalcemia: What IV Administration is given?

A

0.9% NaCl solution because it temporaily dilutes the serum calcium level and increases urinary calcium excretion by inhibiting tubular reabsorption of calcium.

58
Q

What is Calcitonin used for?

A

Used to lower the serum calcium level and is particularly useful for patients with heart disease or kidney injury who cannot tolerate large sodium loads

59
Q

What does Calcitonin do?

A

Reduces bone resportion, increases deposition of calciun and phosphorus in the bones, and increases urinary excreition of calcium and phosphorus.

60
Q

Hypercalcemia: Why should fluids containing sodium be given?

A

Because sodium assists with calcium excretion

NRSG 102: Med Surg 1 (52 decks)

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