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Electrolyte Concept Map

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Allison Pflaum

on 7 September 2013

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Transcript of Electrolyte Concept Map

Phosphorus
Electrolyte
Electrolytes
Allison Pflaum
Grand Canyon University
Adult Health Nursing I
NUR-311
Professor Evinrude
September 1, 2013
Sodium
Magnesium
Calcium
Concept Map
Potassium
Action:


Health Provider Prescriptions
About Hypernatremia


Signs and Symptoms
Geriatric Concerns
Hypernatremia
Greater than 145 mEq/L
Result of excess sodium in relation to water
Causes a shift of water out of the cells, resulting in cellular dehydration
Can occur as a result of different diseases and conditions
Can cause neurological, endocrine and cardiac disturbances




Health Provider Prescriptions
About Hyponatremia


Signs and Symptoms
Geriatric Concerns
Hyponatremia
Less than 135 mEq/L
Occurs when there is a shift of water into the cells, causing the cells to swell
Occurs when there is an excess sodium loss or excess water gain
Results in the dilution of body fluids
Can cause a fluid volume deficit, seizure, coma or permanent neurological damage




Health Provider Prescriptions
About Hypermagnesemia


Signs and Symptoms
Geriatric Considerations
Hypermagnesemia
Greater than 2.5 mEq/L
Occurs when there is an increase in magnesium intake accompanied by renal insufficiency or failure
Can occur if there is an increased dietary intake of magnesium
Can lead to the blocking of nerve impulses
Can cause hypocalcemia due to the release of parathyroid hormone
Health Provider Prescriptions
About Hypomagnesemia


Signs and Symptoms
Geriatric Considerations
Hypomagnesemia
Less than 1.5 mEq/L
Result of prolonged fasting or starvation
Can be associated with hypokalemia
Can resemble hypocalcemia and can contribute to the development of hypocalcemia due to the decreased action of PTH

Health Provider Prescriptions
About Hypophosphatemia


Signs and Symptoms
Geriatric Considerations
Hypophosphatemia
Less than 2.4 mg/dL
Occurs primarily in individuals who are malnourished or who have malabsorption syndrome
Results in impaired cellular energy and oxygen delivery
Heath Provider Prescriptions
Hyperphosphatemia


Signs and Symptoms
Geriatric Considerations
Hyperphosphatemia
Greater than 4.4 mg/dL
Occurs in individuals with acute or chronic renal failure as their kidneys are unable to excrete phosphorus
Hypocalcemia can cause hyperphosphatemia
Health Provider Prescriptions
About Hypercalcemia
Signs and Symptoms
Geriatric Considerations
Hypercalcemia
Greater than 10.2 mg/dL
Health Provider Prescriptions
About Hypocalcemia


Signs and Symptoms
Geriatric Considerations
Hypocalcemia
Less than 8.6 mg/dL
Caused by any condition that decreases the production of the parathyroid hormone
Medications can block the function of the parathyroid
Health Provider Prescriptions
About Hyperkalemia


Signs and Symptoms
Geriatric Considerations
Hyperkalemia
Greater than 5 mEq/L
Occurs when there is a shift of potassium from the intracellular fluid to the extracellular fluid
Can occur if there is an excessive intake of potassium
Can occur if there is inadequate renal excretion




Health Provider Prescriptions
About Hypokalemia:


Signs and Symptoms
Geriatric Considerations
Hypokalemia
Less than 3.5 mEq/L
Occurs when there is an excessive loss of potassium from the body
Can occur from an inadequate dietary intake
Can occur as a result of diarrhea and vomiting




The primary cation of the extracellular fluid
Maintains osmolality and acid-base balance
Maintains the concentration and volume of the
extracellular fluid
Generates and transmits nerve impulses
Excreted through urine, sweat and feces


(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 311)
Sodium
135-145 mEq/L
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 311)
Patients at Risk
Individuals who are NPO or deprived of water
Children or infants
Elderly patients
Individuals who are immobilized or unconscious
Individuals who have an excessive sodium intake
Individuals with:
Primary hyperaldosteronism
Cushing syndrome
Diabetes insipidus
Individuals receiving concentrated hyperosmolar tube feedings and osmotic diuretics
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 312)
With decreased extracellular fluid:
Restlessness and agitation
Twitching, seizures and coma
Increased thirst and a dry, swollen tounge
Sticky mucous membrane
Postural hypotension
Weight loss
Weakness and lethargy
With normal or increased extracellular fluid:
Restlessness and agitation
Twitching, seizures and coma
Intense thirst
Flushed skin
Weight gain
Peripheral and pulmonary edema
Increased blood pressure
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
Labs and Diagnostics
Serum osmolality of blood and urine
Serum sodium of blood and urine
Comprehensive metabolic panel
Increase oral fluid consumption
Sodium restriction
IV solution:
Hypotonic saline
5% dextrose in water
Diuretics
Nursing Assessment
Assess muscle strength, range of motion, and reflexes
Assess skin and monitor for edema
Assess dietary intake
Assess for signs and symptoms of hypernatremia
Assess for muscle twitching or irregular contractions
Assess intake and output
Assess level of consciousness, personality changes, and mental status
Assess heart rate, blood pressure and lung sounds
Nursing Interventions
Monitor and administer IV infusions
Monitor and administer diuretics if ordered
Monitor intake and output
Monitor and restrict oral sodium and fluid intake
Monitor vital signs, mental status and level of consciousness
Monitor and provide oral hygiene
Monitor and auscultate lung sounds
Educate the patient
Encourage patient to report and signs and symptoms
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011)
Encourage oral fluid consumption
Monitor intake and output and electrolyte levels
Monitor and assess skin turgor
Monitor vital signs
Assess for comorbidities that could alter electrolyte levels
Provide assistance with oral hygiene
Monitor for edema
Provide safety
Patients at Risk
Individuals who have experienced traumas such as burns and wounds
Individuals experiencing vomiting and diarrhea
Individuals with:
Congestive heart failure
Kidney failure or kidney disease
Liver cirrhosis
SIADH
Hypoaldosteronism
Pregnant women
Individuals on fasting diets
Individuals taking diuretic medications
Excessive water intake or hypotonic IV fluids
Excessive perspiration
Labs and Diagnostics
Nursing Assessment
Nursing Interventions
With decreased extracellular volume
Irritability, apprehension, confusion, and personality changes
Dizziness, tremors, seizures and coma
Dry mucous membranes
Postural hypotension, and decreased jugular venous filling
Tachycardia or thready pulse
Cold and clammy skin
With normal or increased extracellular volume
Headache, apathy and confusion
Muscle spasms, seizure and coma
Nausea, vomiting, diarrhea and abdominal cramps
Weight gain
Increased blood pressure
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
Serum osmolality of blood and urine
Serum sodium of blood and urine
Urine specific gravity, BUN, creatinine
Fluid restriction
IV hypertonic saline solution
Diuretic
Conivaptan (Vaprisol)
Tolvaptan (Samsca)
Infuse 3% sodium chloride solution
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313-314)
Assess heart rate, blood pressure, respiratory rate
Assess muscle strength, range of motion, and reflexes
Assess for headache
Assess level of consciousness, personality changes, and mental status
Assess for seizure activity and coma
Assess for bowel movements and cramping
Assess intake and output
Assess mucous membranes
Assess patient's diet
Assess daily weight
Assess patient's support system
Monitor and administer IV infusions
Monitor and administer medications if ordered
Monitor and restrict oral sodium and fluid intake
Monitor vital signs, mental status and level of consciousness
Monitor intake and output
Educate the patient
Encourage the patient to report any signs or symptoms
Provide safety
Document
Restrict oral fluid consumption
Monitor intake and output and electrolyte levels
Provide safety when ambulating
Monitor vital signs
Assess for comorbidities that could alter electrolyte levels
Monitor neurological and personality status
Monitor intake and output
Monitor daily weight
Monitor labs and report any changes
Provide safety
Second most abundant intracellular cation
Stored primarily in bones
Acts as a coenzyme in the metabolism of carbohydrates and protein
Regulated by GI absorption and renal excretion


(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Magnesium
1.5-2.5 mg/dL
Most abundant anion in the intracellular fluid
Essential for the normal functioning of muscle, red blood cells and the nervous system
Important mechanism in acid-base buffering,
Key component in ATP production
Important in the cellular uptake and use of glucose
Helps metabolize carbohydrates, proteins and fat


(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
Phosphorus
2.4-4.4 mg/dL
Necessary for:
Transmission of nerve impulses,
Myocardial contractions
Muscle contractions
Blood clotting
Formation of teeth and bones
Blocks sodium transport



Calcium
8.6-10.2 mg/dL
The most abundant cation found in the intracellular fluid
Necessary for:
The transmission and conduction of nerve and muscle impulses
Cellular growth
Healthy electrical activity in the heart
Helps regulate blood pH
Major influence on the sodium-potassium pump found within cell membranes

Potassium
3.5-5.0 mEq/L
Fatigue
Muscle weakness and leg cramps
Decreased reflexes
Nausea and vomiting
Weak or irregular pulse
Decreased GI motility and constipation
Polyuria
Shallow respiration or respiratory distress
Hypoactive reflexes
Cardiac dysrhythmias or bradycardia
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314)
Patients at Risk
Individuals who are experiencing diarrhea or vomiting
Individuals with an NG suction
Individuals with fistulas
Individuals taking diuretics
Individuals with a magnesium depletion
Individuals with hyperaldosteronism or diabetes
Individuals undergoing dialysis
Individuals with a low potassium diet or who are malnourished
Individuals who are NPO
Individuals who are stressed
Individuals with kidney disease
Elderly patients
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011), p. 314
Labs and Diagnostics
Serum potassium
Arterial Blood Gas
Electrocardiogram
Diet diary
BUN and creatinine
Nursing Assessment
Monitor vital signs
Monitor any cardiac and respiratory changes
Monitor dietary intake
Monitor ECG to detect any dysrhythmias
Monitor liver functions
Monitor intake and output
Monitor muscle strength and range of motion
Assess legs for cramping
Assess abdomen and GI function
Assess cognitive function and any personality changes
Obtain a complete list of medications
Increase dietary intake of potassium
Administer potassium chloride oral supplements
Administer spironolactone
Potassium IV at 5-10 mEq/L (Never a bolus)
Nursing Interventions
Monitor level of consciousness
Monitor urine output
Monitor bowel sounds
Monitor cardiac rhythms
Monitor kidney function
Monitor ECG for dysrhythmias
Monitor depth and quality of respirations
Monitor electrolyte lab values
Monitor any potassium supplements
Educate the patient
Encourage the patient to report any signs or symptoms
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 315)
Monitor vital signs
Monitor fluid intake and nutritional status
Monitor neurological and personality changes
Monitor IV site (if applicable)
Monitor intake and output
Monitor daily weight
Monitor bowel sounds and document any bowel movements, especially diarrhea
Assess the skin
Assess for any comorbidities
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 315)
Patients at Risk
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
Individuals who are chronic alcoholics
Individuals who have vomiting and diarrhea
Individuals who have prolonged malnutrition
Individuals with poorly controlled diabetes
Individuals taking diuretics
Individuals with hyperaldosteronism
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 311)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 312)
(Potter, Perry, Stockert, & Hall, 2013, p. 888)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 315)
(ATI Nursing Education, 2013, p. 488)

(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314)
Patients at Risk
Individuals with renal failure
Individuals who experienced severe trauma
Burns
Crash injury
Tumor lysis
Individuals with severe infections
Individuals with diabetic ketoacidosis
Individuals taking certain potassium-sparing diuretics or ACE inhibitors
Individuals with adrenal insufficiency
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314-315)
Irritability
Weakness of lower extremities
Anxiety
Paresthesias
Irregular pulse
Abdominal cramping
Cardiac arrest
Diarrhea
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314)
Lab and Diagnostic Tests
Serum potassium
Arterial blood gas
Electrocardiogram
(Potter, Perry, Stockert, & Hall, 2013, p. 890)
Restrict oral consumption of potassium
Administer sodium bicarbonate to reverse acidosis
Administer IV fluids
Calcium gluconate
5% dextrose
Administer sodium polystyrene sulfonate with 70% sorbitol
Administer insulin and IV glucose
Loop diuretics
(ATI Nursing Education, 2013, p. 490)

Nursing Assessment
Assess vital signs
Assess electrocardiogram
Assess liver functions
Assess intake and output
Assess patient's diet
Assess cognitive function
Assess for signs and symptoms
Assess abdomen and GI function
Nursing Interventions
Eliminate oral and parenteral potassium intake
Eliminate foods high in potassium
Monitor vitals
Monitor intake and output
Monitor lab values
Monitor cardiac status
Educate patient on correct way to take medications
Encourage patient to increase fluid intake
Encourage the patient to report any signs and symptoms
Educate the patient
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 315)
Encourage oral fluid consumption
Monitor intake and output
Monitor GI function
Monitor vital signs
Monitor effects of medications
Assess for comorbidities
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 316-317
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314-315
References
Eckman, M., & Comerford, K. (2012). Medical-surgical nursing made incredibly
easy! (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-
surgical nursing: Assessment and Management of Clinical Problems (8th ed.). MO: Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2013). Fundamentals of
nursing (8th ed.). St. Louis, Missouri: Elsevier.

Van Leeuwen, A. M., Poelhuis-Leth, D., & Bladh, M. L. (2011). Davis’s comprehensive handbook
of laboratory & diagnostic tests with nursing implications (4th ed.). Philadelphia, PA: F.A
Davis Company

Lethargy
Confusion
Hyperactive deep tendon reflexes
Tremors
Seizures
Predisposition to cardiac dysrhythmias
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
Labs and Diagnostics
Serum magnesium load measurement
Serum potassium
Serum calcium
Electrocardiogram
Urinalysis
Comprehensive metabolic panel
Oral supplements
Encourage an increased dietary intake of magnesium-rich foods
In severe cases, a parenteral IV or IM magnesium sulfate
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
Nursing Assessment
Assess for increased nerve impulse transmission
Assess for hypoactive bowel sounds
Assess for constipation
Assess for abdominal distention
Assess for insomnia
Assess for hypertension
Assess for a positive Chvostek's and Trousseau's sign
Nursing Interventions
Monitor vital signs
Monitor cardiac functions
Monitor electrolyte imbalances
Monitor dietary intake and encourage an increased consumption of magnesium-rich food (green vegetables, nuts, bananas, oranges, chocolate and peanut butter)
Encourage the patient to report any signs and symptoms
Educate the patient
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Patients at Risk
Individuals who has chronic kidney disease
Individuals with renal failure
Individuals with adrenal insufficiency
Pregnant women who receive an excessive amount of magnesium sulfate for eclampsia
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
Lethargy
Drowsiness
Nausea and vomiting
Loss of deep tendon reflexes
Somnolence
Cardiac and respiratory distress
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Labs and Diagnostics
24 hour serum magnesium load measurement
Electrocardiogram
Arterial blood gas
BUN and creatinine
Thyroid function test
Serum potassium
IV administration of calcium chloride or calcium gluconate
Encourage patient to increase fluid intake
Dialysis for patients with impaired renal function or renal failure
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 320)
Nursing Assessment
Assess for hypoactive deep tendon reflexes
Assess vital signs
Assess for bradycardia and hypotension
Assess for flushing or sensations of warmth
Assess for muscle weakness and flaccid muscle paralysis
Assess for fatigue
Assess for changes in cardiac function
(Potter, Perry, Stockert, & Hall, 2013, p. 891)
Nursing Interventions
Monitor vital signs
Monitor cardiac functions
Monitor for signs and symptoms of hypermagnesemia
Monitor lab values
Encourage fluid intake
Encourage urinary excretion
Encourage the patient to talk to their health care provider before taking certain over-the-counter medications
Encourage the patient to report any signs or symptoms
Educate the patient
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Higher incidence of renal failure
Monitor GI motility
Monitor adrenal function
Monitor and restrict products that contain milk of magnesium
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Patients at Risk
Individuals with malabsorption syndrome
Individuals suffering from alcohol withdrawal
Individuals who use phosphate-binding antacids
Individuals who have respiratory alkalosis
Individuals who have nutritional recovery syndrome
CNS depression
Confusion
Coma
Muscle weakness
Cardiac dysrhytmias
Osteomalacia
Rhabdomyolysis
Changes in mental status
Fatality
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Labs and Diagnostics
Serum phosphate level
Electrocardiogram
Comprehensive metabolic panel
Blood urea nitrogen
Creatinine
Urinalysis
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Oral supplements
Neurta-Phos
Encourage patient to increase dietary intake of foods high in phosphorus
Diary products
IV administration of sodium phosphate or potassium phosphate
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Nursing Assessment
Assess level of consciousness and mental status
Assess muscle strength
Assess respiratory function
Assess dietary intake
Assess intake and output
Assess for symptomatic hypocalcemia
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Nursing Interventions
Monitor dietary intake and encourage foods high in potassium
Monitor serum phosphate levels
Monitor for symptomatic hypocalcemia
Monitor vital signs
Monitor level of consciousness and mental status
Educate patient on the discontinuation of potassium-binding antacids
Educate patient to change positions slowly
Educate patient on the signs and symptoms
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Patients at Risk
Individuals with renal failure
Individuals exposed to chemotherapeutic agents
Individuals who have enemas containing phosphorus
Individuals with a large vitamin D intake
Individuals with hypoparathyroidism
Individuals who have excessive ingestion
Milk
Phosphate-containing laxatives
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Hypocalcemia
Muscle problems
Neuromuscular irritability and tetany
Deposition of calcium-phosphate precipitates in the skin, soft tissue, cornea, viscara, and blood vessels
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Labs and Diagnostics
Instruct patient to restrict dietary intake of foods and fluids that are high in phosphorus
Diary products
Administration of calcium supplements
Administration of phosphate-binding agents or gels
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Nursing Assessment
Assess vital signs
Assess dietary intake
Assess intake and output
Assess for signs and symptoms of hyperphosphatemia
Assess for hypocalcemia
Assess muscle strength
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Nursing Interventions

Monitor dietary intake
Monitor lab values
Monitor cardiac and respiratory functions
Monitor intake and output
Encourage patient to increase fluid intake
Encourage patient to limit or restrict phosphorus containing foods
Encourage patient to report signs and symptoms
Educate the patient
Provide safety
Document
Patients at Risk
Labs and Diagnostics
Nursing Assessment
Nursing Interventions
Patients at Risk
Labs and Diagnostic
Nursing Assessment
Nursing Interventions
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
Encourage oral fluid consumption
Monitor GI motility and absorption
Monitor dietary intake high in vitamin D and phosphate
Monitor vital signs
Monitor renal function
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
Individuals who undergo a surgical removal of a portion of the parathyroid glands
Individuals who injure the parathyroid glands during thyroid or neck surgery
Individuals with chronic kidney disease
Individuals with primary hypoparathyroidism
Individuals with a vitamin D or magnesium deficiency
Individuals with acute pancreatitis
Individuals with elevated phosphorus levels
Individuals with Crohn's disease
Individuals who are chronic alcoholics
Individuals who have a decreased serum albumin
Individuals who take loop diuretics
Individuals who are lactose intolerant
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Easy to fatigue
Depression
Anxiety
Confusion
Numbness or tingling in extremities and region around the mouth
Hyperreflexia
Muscle cramps
Chvostek's sign
Trousseau's sign
Laryngeal spasm
Tetany
Seizures
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Decreased calcium levels
Decreased magnesium levels
Decreased vitamin D levels
Increased phosphorus levels
Increased pH level
Electrocardiogram
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Oral or IV calcium supplements
Calcium gluconate
Vitamin D supplements
Instruct patient to increase dietary intake of foods that are high in calcium and vitamin D
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
Assess vital signs
Assess cardiac functions
Assess dietary intake
Assess for decreased myocardial contractility
Assess for a positive Chvostek's and Trousseau's sign
Assess for hyperactive bowel sounds
Assess for abdominal cramping
Assess for diarrhea
Assess for pain and anxiety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
(ATI Nursing Education, 2013, p. 493)
Administer any prescribed medications
Oral supplements
Monitor dietary intake and encourage the consumption of foods with calcium
Monitor patient's who have undergone thyroid or neck surgery
Monitor for respiratory alkalosis
Educate the patient
Encourage the patient to report and signs and symptoms
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
Monitor dietary intake and encourage foods with calcium
Dairy products: yogurt and milk
Monitor for falls as a result of decreased muscle mass and bone weakness
Monitor elderly women for loss of estrogen
Monitor vital signs
Monitor cardiac function
Provide safety
(ATI Nursing Education, 2013, p. 493)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 318)
Caused by hyperparathyroidism
Caused by malignancies from breast cancer, lung cancer and multiple myeloma
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 316)
Individuals with multiple myeloma
Individuals with excessive vitamin D intake
Individuals with malignancies with bone metastasis
Individuals with prolonged immobilization
Individuals with milk-alkali syndrome
Individuals with acute osteoporosis
Individuals taking thiazide diuretics
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Lethargy
Weakness
Depressed reflexes
Confusion
Personality changes
Psychosis
Anorexia
Nausea and vomiting
Bone pain
Fractures
Polyuria
Dehydration
Nephrolithiasis
Stupor
Coma
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Elevated vitamin D and magnesium levels
Acidosis
pH level greater than 7.35
Electrocardiogram
Creatinine
Comprehensive metabolic panel
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Administer a loop diuretic
Administer IV isotonic saline
Administer synthetic calcitonin
Adminster plicamycin (Aredia)
Administer pamidronate (Aredia)
Restrict oral intake of calcium
Encourage patient to stay mobile
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Assess vital signs
Assess cardiac function
Assess activity and mobility level
Assess dietary intake
Assess for signs and symptoms
Assess for intake of vitamin D
Assess intake and output
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Monitor vital signs
Monitor intake and output
Monitor fluid intake
Should be 3,000-4,000 mL daily
Monitor dietary intake
Monitor medication adherence
Monitor for signs and symptoms
Educate the patient
Provide safety
Document
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
Monitor the use of laxatives and stool softeners
Monitor the use of diuretics
Monitor vital signs
Encourage the patient to remain active to avoid prolonged immobilization
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 317)
(ATI Nursing Education, 2013, p. 486)

(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 313)
(ATI Nursing Education, 2013, p. 494)

Monitor intake and output
Monitor for hypoactive bowel sounds and constipation
Monitor dietary intake
Monitor circulation
Monitor intake of alcohol
Provide safety
(ATI Nursing Education, 2013, p. 494)

Monitor and assess muscle strength
Monitor nutrition status
Monitor mental status
Monitor llevel of consciousness
Monitor cardiac function
Encourage dietary intake of foods high in phosphate
Dairy
Monitor intake of alcohol
Provide safety
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
(ATI Nursing Education, 2013, p. 488)

(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 315)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 314)
(Eckman & Comerford, 2012, p. 42)

Comprehensive metabolic panel
Urinalysis
Creatinine
Electrocardiogram
Monitor phosphate and calcium levels
(Van Leeuwen, Poelhuis-Leth, & Bladh, 2011, p. 911)
(Van Leeuwen, Poelhuis-Leth, & Bladh, 2011, p. 911)
(Van Leeuwen, Poelhuis-Leth, & Bladh, 2011, p. 1030)
(Lewis, Dierksen, Heitkemper, Bucher, & Camera, 2011, p. 319)
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