AMS1

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Author:
alyn217
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164396
Filename:
AMS1
Updated:
2012-07-29 23:35:25
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AMS1T2 Calcium Imbalances
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Calcium Imbalances
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  1. General info about Ca2+
    • Primary source is from ingested foods
    • >99% combined w/PO4 & concentrated in skeletal system
    • Inverse relationship w/PO4 
    • Bones provide readily available store of Ca2+
    • Controlled by PTH, calcitonin, vitamin D
    • Normal 8.5-11 mg/dL
  2. What are the functions of Ca2+
    • Blocks sodium Na+ transport & stabilizes cell membrane
    • Transmission of nerve impulses
    • Contraction of muscle (including myocardium)
    • Aids in blood clotting
    • Aids in formation of teeth & bone
    • Only the ionized form is biologically active
  3. What is the pathophys of hyperCa2+
    • Hyperparathyroidism--Parathyroid-->PTH-->release of Ca2+ from bone into blood stream (resorption) and ^ reabsorption of Ca2+ in the GI and renal tubules. 
    • Malignant cancer-->destruction of bone and release of calcium into BS.
    • Prolonged immobilization-->Ca2+ release into blood stream from bones. 
    • Hypophosphatemia due to inverse relationship between PO4 and Ca2+ levels. 
    • Excess vit D-->^reabsorption of Ca2+ from GI. 
    • Acidosis (increases ionized Ca2+ ). Decreases binding of Ca2+ with albumine to ^ levels of biolgically active Ca2+ in BS. 
  4. SnSs of hyperCa2+
    • Decreased memory, confusion, disorientation
    • Fatigue
    • Bone pain and fractures
    • Irritability of cardiac muscle
    • Renal calculi w/renal impairment
    • ^DTRs.
  5. What are some nursing interventions for pt w/hyperCa2+
    • Administer loop diuretic (ie Lasix) to eliminate via urine
    • PO4. Due to inverse relationship with Ca2+ increasing one will decrease the other. 
    • Hydration w/isotonic saline infusion
    • Synthetic calcitonin/etidronate
    • Mobilization with weight bearing exercise to encourage Ca2+ reabsorption into bones. 
    • Increase hydration to 3-4L water/day to eliminate excess Ca2+ and to avoid producing kidney stones. 
  6. What are the common pathologies of hypoCa2+?
    • Decreased production of PTH, ie due to partial removal of the thyroid gland. 
    • Acute pancreatitis-->lipolysis-->^binding of Ca2+ to fatty acids--> v levels of biologically active Ca2+
    • Multiple blood transfusions due to addition of citrate (anticoagulant) during transfution. Ca2+ binds to citrate--> v levels of biologically active Ca2+
    • Alkalosis. ^pH-->^binding of Ca2+ to protiens. 
    • Decreased intake
  7. SnSs of hypoCa2+
    • Trousseau’s sign: dorsaflexion of hand with BP cuff for a few minutes.
    • Chvostek’s signs: tetany of face with mild finger poke to cheek. 
    • Laryngeal stridor
    • dysphagia
    • siezure
    • numbness & tingling around the mouth or extremities
  8. What are some nursing intervensions for the pt w/hypoCa2+?
    • Oral or IV supplements
    • Tx pain or anxiety to prevent hyperventilation-induced respiratory alkalosis-->hypoCa2+
    • Sz precautions
    • Tx cause

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