1. Hypocalcemia and Hypercalcemia
By: Faustina, Mia, Kirsten, George, Allie, Chris, Tessa, Kate, Nick, Jennifer, Jenn

2. Hypocalcemia- Causes
Inadequate intestinal absorption, deposition of ionized calcium into bone or soft tissue, blood administration
Decreases in PTH and vitamin D
Hypoparathyroidism
Renal Failure
Pancreatitis
Nutritional deficiencies occur with inadequate sources of dairy products or green leafy vegetables

3. Hypocalcemia – Risk Factors
P arathryroid disorder (too little parathyroid hormone)
E nd-stage renal disease
T hyroidectomy
S teroids

4. Clinical Manifestations
Hypocalcemia
Nursing Implications
Clinical Manifestations
Monitor PT/INR and PTT
Monitor serum calcium, phosphate, magnesium, and vitamin D
Assess and treat pain
Identify and treat underlying causes (hypoparathyroidism)
Continuous cardiorespiratory monitoring
Focused cardiac assessment
Seizure precautions
Fall precautions
Neuromuscular Irritability (Tetany)
Cardiac arrhythmias (QT prolongation)
Muscle spasm
Paresthesias
Intestinal cramping
Hyperactive bowel sounds

5. Hypocalcemia – Signs Trousseau’s sign (hand/finger spasms)
Watch for arrhythmias
(Prolonged QT interval, cardiac arrest…)
Increase in bowel sounds, diarrhea
Tetany
Chvostek’s sign (facial twitching)
Hypotension, Hyperactive DTR

6. Hypocalcemia – How to Correct
S eizure precautions
A dminister calcium supplements
F oods high in calcium (i.e. dairy, and greens )
E mergency equipment on standby

7. Hypercalcemia – Causes
C Calcium supplementation
H Hyperparathyroidism
I Iatrogenic, immobilization
M Malignancies
P Parathyroid hyperplasia or adenoma

8. Hypercalcemia- Physical manifestations
Most pts. with hypercalcemia do not have specific findings on physical assessment
Hypercalcemia – excess calcium blocks channels, raising threshold for depolarization. This leads to…
CNS effects: Lethargy, weakness, confusion, coma
Renal effects: Polyuria, nocturia, dehydration, renal stones, renal failure
GI effects: Constipation, nausea, anorexia, pancreatitis, gastric ulcer
Cardiac: Shortened QT intervals, depressed T-wave, bradycardia, heart block

9. Hypercalcemia- Nursing Implications
Perform an ECG
Check for changes associated with hypercalcemia (short QT interval and short ST segment)
Encourage fluid intake
Facilitates calcium excretion by kidneys
Monitor intake and output
Restrict dietary calcium intake
Increase patient mobility
Identify and closely monitor patients with increased risk
Hyperparathyroidism, cancer, prolonged immobility, thiazide diuretics, kidney transplant

10. Hypercalcemia- How to Correct
Administration of normal saline and diuretics
Speed up dilution and excretion
Administration of calcitonin or steroids
Force the circulating calcium into the cells
Administration of bisphosphonate drugs
Prevents bone breakdown caused by malignancy
Treat underlying disease
Dialysis
Alternative if other treatments fail and kidneys have severe damage
Can help rid blood of extra calcium and waste