Electrolyte Electrolyte ImbalancesImbalances

Part IIIPart III

Peggy D. JohndrowPeggy D. Johndrow

20092009

CalciumCalcium

Obtained from ingested foodsObtained from ingested foods More than 99% combined phosphorus & More than 99% combined phosphorus &

concentrated in skeletal systemconcentrated in skeletal system Inverse relationship with phosphorusInverse relationship with phosphorus Bones readily available store of calciumBones readily available store of calcium Calcium blocks sodium transport & stabilizes cell Calcium blocks sodium transport & stabilizes cell

membranemembrane Only ionized form of calcium is biologically activeOnly ionized form of calcium is biologically active Sources: dairy products, dark green leafy Sources: dairy products, dark green leafy

vegetablesvegetables

How are phosphorus and How are phosphorus and calcium levels related?calcium levels related?

When one goes up the other goes downWhen one goes up the other goes down Reciprocal relationshipReciprocal relationship

What are the processes that What are the processes that maintain calcium balance?maintain calcium balance?

Controlled byControlled by Parathyroid hormoneParathyroid hormone CalcitoninCalcitonin Vitamin DVitamin D

HypercalcemiaHypercalcemia

High serum calcium levels High serum calcium levels Causes includeCauses include

HyperparathyroidismHyperparathyroidism Malignancy Malignancy Vitamin D overdoseVitamin D overdose Prolonged immobilizationProlonged immobilization

Hypercalcemia Clinical Hypercalcemia Clinical manifestationsmanifestations

Decreased memoryDecreased memory ConfusionConfusion DisorientationDisorientation Fatigue Fatigue

Hypercalcemia ManagementHypercalcemia Management

Loop diureticLoop diuretic Hydration with isotonic saline infusionHydration with isotonic saline infusion Synthetic calcitoninSynthetic calcitonin MobilizationMobilization

Nursing DiagnosisNursing Diagnosis

Risk for injuryRisk for injury Risk for renal insufficiency r/tRisk for renal insufficiency r/t Risk for constipation r/tRisk for constipation r/t Risk for dysrrhythmiasRisk for dysrrhythmias Risk for fluid volume excess r/tRisk for fluid volume excess r/t Risk for decreased cardiac output r/t;Risk for decreased cardiac output r/t; Knowledge deficitKnowledge deficit

Nursing ActionsNursing Actions I&OI&O Assess renal function/renal stone; cardiac functionAssess renal function/renal stone; cardiac function Assess S/SAssess S/S Orientation to reality/LOCOrientation to reality/LOC Oral/ IV fluidsOral/ IV fluids Diet; decrease Ca (no milk)Diet; decrease Ca (no milk) SafetySafety Monitor S/S dig toxicityMonitor S/S dig toxicity Evaluate serum electrolytesEvaluate serum electrolytes Increase mobilityIncrease mobility Give loop diuretic & inorganic phosphatesGive loop diuretic & inorganic phosphates