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);

Answer 1

ANSWER

* Hypocalcemia

      * It occurs due to decreased level of calcium in the blood.

   Causes.

        * Hypothyroidism.

        * Pancreatitis.

        * Renal failure.

        * Increased phosphorus level in the blood.

        * Medullary thyroid carcinoma.

        * Vitamin D deficiency.

        * Alkalosis.

        * Magnesium deficiency.

        * Low serum albumin.

        * Drugs like isoniazid,corticisteroids etc.

Clinical manifestations.

       * Tetany.

       * Body pain.

       * Seizures.

       * Delirium.

       * Confusion.

       * Carpal spasm when inflating a blood pressure cuff on the

          upper arm (Trousseau's sign).

      * Laryngeal spasm.

      * Dry and brittle nail and hair.

Management.

      * IV administration of calcium salts (Calcium gluconate,Calcium chloride)

      * Give adequate vitamin D supplements to maintain normal calcium level.

      * Increase intake of calcium containing foods like milk,fish,meat,leafy vegetables etc.

Nursing interventions.

     * Educate the patient about foods which maintain normal serum calcium level.

     * If hypocalcemia is severe initiate seizure precautions .

     * Instruct the patient avoid intake of caffine and alchol which will decrease absorption

        of calcium.

     * Instruct the patient to avoid overuse of antacids and laxatives to avoid decrease

       absorption of calcium.

* Hypercalcemia.

     * It occurs due to increased calcium level in the blood.

   Causes.

         * Hyperparathyroidism.

         * Vitamin A and D intoxication.

         * Chronic lithium use.

         * Drugs like Thiazide diuretics,theophylline etc.

   Clinical manifestations.

        * Nausea

        * Vomiting.

        * Dehydration.

        * Abdominal distension.

        * Polyuria.

        * Slurried speech.

        * Lethargy.

        * Memory impairment.

Management.

      * IV administration of phosphate to maintain calcium level by reciprocal

        decrease in elevated calcium level.

      * Diuretics (frusemide) used to increased calcium excretion to maintain

        normal serum calcium level.

      * Calcitonin used to reduce serum calcium level.

Nursing interventions.

     * Encourage intake of fluids to eliminate excessive calcium present in the

          body.

       * Immobility causes elevated serum calcium level so increase patient mobility

          to maintain calcium level.

       * If hypercalcemic patient take drugs like digoxin for cardiac problems result in

          digitalis toxicity so carefully monitor the ECG changes in patient with elevated

          calcium level.

Hypomagnesemia.

       * It occurs due to decreased magnesium level in the blood.

      Causes.

          * Diarrhea.

          * Intestinal fistulas.

          * Alcohol use.

          * Diabetic ketoacidosis.

          * Burns.

          * Renal diseases.

          * Liver diseases.

Clinical manifestations.

          * Muscle weakness.

          * Tremors.

          * Hyperexcitability.

          * Nystagmus.

          * Tetany.

          * Dizziness.

          * Tachycardia.

          * Ventricular fibrillation.

Management.

          * Administration of magnesium salts orally to maintain normal       

            serum magneseum level.

          * IV administration of magnesium sulfate to correct magnesium

             deficiency.

          * Diet rich in green leafy vegetables,legumes,seafoods,seeds etc

             to correct magnesium deficiency.

Nursing interventions.

         * Assess the vital signs of patient to monitor changes in heart rate,

           blood pressure,and respiratory pattern due to magnesium deficiency.

         * Monitor urine out put during magnesium administration and inform

            physician if any change in urine output occur.

         * Educate the patient to avoid use of alcohol and prepare a diet plan to

            maintain normal serum magnesium level.

Hypermagnesemia.

          * It occurs due to increased magnesium level in the blood.

Causes.

         * Renal failure.

         * Diabetic ketoacidosis.

         * Addison's disease.

         * Adrenocortical insufficiency.

         * Hypothermia.

         * Drugs like opioids and anticholinergics.

         * Lithium toxicity.

         * Cardiac arrest.

         * Sepsis.

         * Burns.

Clinical manifestations.

        * Weakness.

        * Nausea.

        * Vomiting.

        * Lethargy.

        * Drowsiness.

        * Muscle weakness.

        * Calcification in soft tissues.

        * Facial flushing.

Management.

        * Restrict administration of magnesium in renal failure patients.

        * Use of diuretics in patient with normal renal function to maintain

           normal magnesium level by increase excretion of magnesium.

        * Hemodialysis with magnesium free dialysate to maintain normal

          magnesium level.

        * IV calcium gluconate administration to antagonize the effect of magnesium.

Nursing interventions.

        * Assess the vital signs of the patient for changes in respiration,heart rate and

          blood pressure due to excessive serum magnesium level.

        * Mental changes can occur as a result of hypermagnesemia so assess the

          neurological status of the patient.