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Hypercalcemia and Hypocalcemia (Calcium Imbalances) Nursing Care Plans

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By Matt Vera BSN, R.N.

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.

Table of Contents

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

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

Possibly evidenced by

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.
  • 7.4. 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.

Risk For Electrolyte Imbalance (Hypocalcemia)

Hypocalcemia, which is a low level of calcium in the blood, can occur in patients with chronic laxative use, diarrhea, renal failure, or as a side effect of certain medications. This can lead to an electrolyte imbalance as low levels of calcium can disrupt the balance of other electrolytes in the body, such as phosphorus 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

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 and laboratory results within normal limits and the absence of neuromuscular irritability and respiratory impairment.

Nursing Assessment and Rationales

1. Monitor respiratory rate, effort, and rhythm. Place tracheostomy set at the bedside.
Hypocalcemia may result in laryngeal stridor leading to respiratory arrest.

2. Monitor heart rate and rhythm.
The heart muscle may contract irregularly with calcium and magnesium deficit.

3. Assess for areas of possible bleeding. Observe for petechiae and ecchymosis.
Severe hypocalcemia is associated with depressed circulatory function and alterations in coagulation.

4. Assess neuromuscular strength, tone, movement, and reflexes; observe for Trousseau’s and Chvostek’s sign.
Hypocalcemia directly increases peripheral neuromuscular irritability resulting in muscle spasms.

5. Monitor laboratory studies.
Evaluates therapy needs and effectiveness.

6. Review the client’s medication regimen such as digoxin, insulin use, mithramycin (Mithracin), and parathyroid injection.
These drugs can decrease magnesium levels, affecting calcium levels. The effect of digoxin is enhanced by calcium, and, in clients receiving calcium, digoxin intoxication may develop.

Nursing Interventions and Rationales

1. Discuss the use of antacids and laxatives.
Those containing phosphate may negatively affect the metabolism of calcium.

2. Maintain a safe, quiet environment and seizure precautions.
Reduces CNS stimulation and protects the client from injury.

3. Stress the importance of meeting calcium needs.
Adverse effects of long-term deficiency include cataracts, eczema, osteoporosis, and tooth decay.

4. Encourage relaxation and stress-reduction measures such as deep-breathing exercises, guided imagery, and visualizations.
Hypocalcemic tetany can be potentiated by stress and hyperventilation.

5. Encourage the use of calcium-containing antacids if needed, such as Dicarbosil, Titralac, and Tums.
Possible sources for an oral replacement to help maintain calcium levels, especially in clients at risk for osteoporosis.

6. Encourage the client to eat foods high in calcium such as dark leafy greens, cheese, low-fat milk, yogurt, eggs, oranges, green beans, and sardines. Avoid intake of phosphorus-rich foods such as bran, chocolates, nuts, whole wheat, and barley.
Vitamin D aids in the absorption of calcium from the intestinal tract. Phosphorus competes with calcium for intestinal absorption.

7. Review dietary intake of vitamins and fat.
Vitamin D and fat insufficiency impair calcium absorption.

8. Administer medication as indicated:

  • 8.1. Calcium gluconate, gluceptate, or chloride intravenously (IV)
    Provides rapid treatment in acute calcium deficit, especially in the presence of tetany or convulsions.
  • 8.2. Calcium carbonate/lactate PO
    Oral preparations are useful in correcting subacute deficiencies.
  • 8.3. Vitamin D supplement
    May be used in combination with calcium therapy to enhance calcium absorption once concomitant phosphate deficiency is corrected.
  • 8.4. Magnesium sulfate IV or PO
    Hypomagnesemia is a precipitating factor in calcium deficit.

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.

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 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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