Question

. Describe the cause, clinical manifestations, management, and nursing interventions for the following imbalances: calcium deficit (hypocalcemia) and calcium excess (hypercalcemia); magnesium deficit (hypomagnesemia) and magnesium excess (hypermagnesemia); phosphorus deficit (hypophosphatemia) and phosphorus excess (hyperphosphatemia); chloride deficit (hypochloremia) and chloride excess (hyperchloremia

Answer 1

1. Hypocalcemia is a condition in which the calcium level in your blood is above normal. The causes are low dietary intake of calcium, dietary intolerance to calcium rich foods, genetic factors, some medications such as phenytoin, phenobarbital, and rifampin will inhibit the absorption of calcium in the body, stress, anxiety, kidney diseases, digestive problems will also prevent calcium absorption, malignant cancer, diabetes. Clinical manifestations are muscle stiffness and spasms, parenthesias, mood swings, memory problems, hypotension, dysphagia, severe hypocalcemia will lead to seizures , arrhythmias, congestive heart failure, laryngospasms.. management steps are medications such as calcium, vitamin D , magnesium supplements, and calcium rich foods. Nursig interventions are advising patient to spend time in early morning sun raise to increase vitamin d which will in turn increase absorption of calcium, advise calcium rich food such as milk , nuts. Advice for review of calcium levels.

2. HYPERCALCEMIA: it is a condition where the concentration o calcium is too high in the blood.

Causes: hyperparathyroidism, lung diseases and cancer, side effects of medications such as excessive intake of vitamin D, excess intake of calcium supplements, antacids. Dehydration.

Symptoms: headache, fatigue, excessive thirst and excessive urination, nausea, abdominal pain, decreased appetite, constipation, vomiting, abnormal heart rhythms, muscle twitches, cramps, weakness , bone pain, osteoporosis, memory problems, irritability.

Management: in mild cases these is no requirement for treatment , but need to follow doctors recommendations. In moderate to severe cases treatment is essential. Intravenous fluids are administered to lower the calcium levels in the blood . Corticosteroids are administered. Loop diuretics helps the kidney to remove extra fluid in order to reduce calcium levels, intravenous bisphosphonates are administered to lower blood calcium levels by regulating bone calcium.

Nursing interventions: keep the patient hydrated, prevention of falls and injuries, cardiac monitoring, watch for complaint of flank and abdominal pain and look for calculi formation. Advice for decrease intake of calcium rich foods .