Question

The patient is a 42-year-old female, Tracy Williams, who had a Thyroidectomy a week ago. The patient is complaining of twitching and numbness and tingling feelings of the hands, fingers and around the mouth. She states that her breathing is difficult. 5. What 3 factors control calcium levels and how? 6. Hospitalization is required for this patient for stabilization and treatment of the hypocalcemia. What orders do you as the nurse anticipate? 7. As you develop your plan of care for the patient you include Risk for impaired gas exchange and Risk for injury related to tetany and neuromuscular impairment. What interventions are you including? 8. The patient is discharged 48 hours later. What should be included in this patient’s teaching related to the best dietary sources of calcium? What additional supplements should the patient be taking for adequate calcium absorption?

Answer 1

5. Three factors which control calcium levels are

A. PTH ( parathyroid hormone) it increases blood calcium levels by stimulating osteoclasts, which breakdown bone to release calcium into blood stream .

B. Calcitonin , it inhibits the activity of osteoclast , which are the cells responsible for breaking down bone and thus lessens the amount of calcium in blood.

C. Calcitrol , it works by helping the body to use more of the calcium found in foods or supplements and regulating the body's production of parathyroid hormone.

6. Check the ionized calcium 8th hourly post -operatively .

- Treatment focuses on oral calcium and vitamin- D supplements along with this calcium infusion is indicated if patient has severe acute or symptomatic hypocalcemia .

7. Nursing interventions for risk for impaired gas exchange

- Monitor breathing pattern and respiratory rate .

- Auscultate breath sounds for the presence of rhonchi.

- Elevate head , support head wiith pillows.

- Provide steam inhalation.

- Encourage deep breathing and coughing exercise.

Nursing interventions for risk for injury related to tetany and neuromuscular impairment

- Evaluates reflexes periodically, observe for neuromuscular irritability ; twitching , numbness and parasthesias .

- Check vital signs .

- Monitor serum calcium levels.

- Administer medications as per doctor's order.

8. Teach the patient about the best dietary sources of calcium ie , dairy products like milk , cheese , yogurt and non-dairy products like seafood , green leafy vegetables ,legumes , dried fruit , tofu , fish with bones , dried peas and beans.

Additional supplements for adequate calcium absorption are calcium citrate supplements, calcium carbonate , vitamin d ,in addition to that vitamin c ,e , k and magnesium assist in absorbing calcium.