Hypercalcemia and Hypocalcemia (Calcium Imbalances) Nursing Care Plans


Learn about the nursing care plans and nursing diagnosis for hypercalcemia and hypocalcemia, two medical conditions that affect calcium levels in the body. Discover the symptoms, causes, and treatment options for these conditions.

Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia

Calcium (Ca) is a major cation that is regulated closely with magnesium and phosphorus. Calcium has a variety of functions: in bones, it contributes to bone and tooth rigidity and strength; it is also required for nerve, muscle, and cardiac conduction by its participation in the sodiumpotassium pump, it is also required for hormonal secretion.

The normal serum calcium level ranges from 8.5 to 10.5 mg/dL.

  • Hypercalcemia is serum calcium levels above 10.5 mg/dL.
  • Hypocalcemia is serum calcium levels below 8.5 mg/dL.

Nursing Care Plans

Nursing care plans and nursing diagnosis play a critical role in managing these conditions. Nurses are responsible for assessing patients, identifying symptoms, and developing a care plan that is tailored to the patient’s specific needs. In this article, we will explore the nursing care plans and nursing diagnosis for hypercalcemia and hypocalcemia.

Here are two nursing diagnosis for patients with calcium imbalances: hypercalcemia and hypocalcemia nursing care plans:

  1. Hypercalcemia: Risk for Electrolyte Imbalance
  2. Hypocalcemia: Risk for Electrolyte Imbalance

Risk For Electrolyte Imbalance (Hypercalcemia)

Hypercalcemia, which is an excessive level of calcium in the blood, can occur in patients with hyperparathyroidism, hyperthyroidism, renal disease, or as a side effect of certain medications. This can lead to an electrolyte imbalance as high levels of calcium can disrupt the balance of other electrolytes in the body, such as potassium and magnesium. The resulting electrolyte imbalances can cause symptoms ranging from mild to severe and can potentially be life-threatening if left untreated.

Nursing Diagnosis

  • Risk for Electrolyte Imbalance

May be related to

  • Hyperparathyroidism
  • Hyperthyroidism
  • Renal disease
  • Treatment-related side effects of medications such as anticancer drugs, theophylline, lithium, thiazide diuretics

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • The client will display heart rhythm, muscle strength, cognitive status, and laboratory results within the normal limit for the client.

Nursing Assessment and Rationales

1. Assess the level of consciousness and neuromuscular status, including muscle tone, strength, and movement.
Nerve and muscle activity is depressed. Lethargy and fatigue can progress to convulsions or coma.

2. Auscultate bowel sounds.
Hypotonicity leads to constipation when the smooth muscle tone is inadequate to produce peristalsis.

3. Monitor cardiac rate and rhythm. Be aware that cardiac arrest can occur in a hypercalcemic crisis.
Overstimulation of cardiac muscle occurs with resultant dysrhythmias and ineffective cardiac contraction. Sinus bradycardia, sinus dysrhythmias, wandering pacemaker, and atrioventricular (AV) block may be noted. Hypercalcemia creates a predisposition to cardiac arrest.

4. Monitor intake and output; calculate the fluid balance.
Efforts to correct the original condition may result in secondary imbalances and complications.

5. Monitor laboratory studies such as calcium, magnesium, and phosphate.
Evaluates therapy needs and effectiveness.

6. Review the drug regimen, noting the use of calcium-elevating drugs, such as heparin, methicillin, phenytoin, and tetracycline.
May affect drug choice or require a reduction in oral sources of calcium.

Nursing Interventions and Rationales

1. Strain urine if flank pain occurs.
A large amount of calcium present in kidney parenchyma may lead to stone formation.

2. Provide safety measures, including gentle handling when moving clients.
Reduces the risk of injury and pathological fractures.

3. Identify and restrict sources of calcium intake such as dairy products, eggs, and spinach and calcium-containing antacids such as Dicarbosil, Tums, and Titralac, if indicated.
Foods or drugs containing calcium may need to be limited in chronic conditions causing hypercalcemia.

4. Maintain bulk in the diet.
Constipation may be a problem because of decreased GI tone.

5. Encourage fluid intake of 3 to 4 liters per day, including sodium-containing fluids (within cardiac tolerance), and use of acid-ash juices such as cranberry and prune, if kidney stones are present or suspected.
Reduces dehydration, encourages urinary flow and clearance of calcium, and reduces the risk of stone formation.

6. Encourage frequent repositioning and range-of-motion (ROM) and/or muscle-setting exercises with caution. Promote ambulation as tolerated.
Muscle activity may reduce calcium shifting from the bones that occur during immobilization.

7. Administer medications, as indicated:

  • 7.1. Calcitonin
    Promotes movement of serum calcium into bones, temporarily reducing serum calcium levels, especially in the presence of the increased parathyroid hormone.
  • 7.2. Disodium edetate (EDTA)
    Chelating action lowers the serum calcium level.
  • 7.3. Diuretics, such as furosemide (Lasix)
    Diuresis promotes renal excretion of calcium and reduces risks of fluid excess from an isotonic saline infusion.
  • 7.4. Glucocorticoid therapy
    Inhibits intestinal absorption of calcium and reduces inflammation and the associated stress that mobilizes calcium from the bone.
  • 7.5. Mithramycin (Mithracin)
    A cytotoxic antibiotic that lowers serum calcium by inhibiting inappropriate bone resorption, typically seen in malignancies or hyperparathyroidism.
  • 7.6. Neutra-Phos and Fleet Phospho-Soda
    These drugs bind calcium in the GI tract, promoting excretion.
  • 7.7. Phosphate
    A rapid-acting agent that induces calcium excretion and inhibits bone resorption.
  • 7.8. Sodium bicarbonate
    Induces alkalosis, thereby reducing the ionized calcium fraction.

8. Administer isotonic saline and sodium sulfate PO or IV.
Emergency measures in severe hypercalcemia are used to dilute extracellular calcium concentration and inhibit tubular reabsorption of calcium, thereby increasing urinary excretion.

9. Prepare for and assist with hemodialysis.
Rapid reduction of serum calcium may be necessary to correct the life-threatening situation.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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