Hypercalcemia and Hypocalcemia (Calcium Imbalances) Nursing Care Plans

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.