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Exam (elaborations)

NUR 104 Exam 2 Questions And Answers With Real Tests

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  • NUR 104
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  • NUR 104

NUR 104 Exam 2 Questions And Answers With Real Tests

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  • September 14, 2024
  • 33
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • nur 104 exam 2
  • NUR 104
  • NUR 104
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NUR 104 Exam 2 Questions And Answers With Real
Tests
Calcium ANS 8.5-10.5 mg/dL

-absorbed from food in the presence of normal Vitamin D

-99% is in bones, 1% in the blood

-3 forms in the blood: protein bound (45%), ionized (40%- which is just calcium by itself), bound to other
substances (15%)

-Ionized calcium vs. total calcium: means if there is low albumin (protein), you may have a low TOTAL calcium,
but normal ionized calcium



Functions of Calcium ANS (MUSCLES AND NERVES)

-major role in transmitting nerve impulses

-regulates muscle contraction and relaxation (including cardiac muscle)

-activates enzymes that stimulate various chemical reactions

-role in blood coagulation (specific to Ca)



Calcium Regulation ANS Calcitonin:

-produced by the thyroid, tonin down Ca (DECREASES Ca) by...

-preventing osteoclasts from breaking down bones and encouraging osteoblasts to create new bone

(take Ca from the blood and put it back)



Parathyroid Hormone (PTH):

-produced by the parathyroid, INCREASES Ca by....

-encouraging osteoclasts to break down bone and tells kidneys to reabsorb calcium and activate vitamin D

-Activated Vitamin D = Calcitrol: which tells intestines to absorb more calcium and tells kidneys to decrease
excretion of calcium



Hypocalcemia (low calcium) ANS Serum Level Less Than 8.5 mg/dL, must be in conjunction with serum
albumin level



Causes:

-Hypoparathyroidism: sucky parathyroid glands, therefore, DECREASES Ca

,-Malabsorption: not eating appropriately, no vitamin D, diarrhea, vomiting DECREASES Ca

-Pancreatitis

-Renal failure: INCREASES Pho, DECREASES Ca

-Alkalosis: not enough hydrogen, calcium binds to single proteins; no ionized Ca left

-Medications: aluminimum, aminoglycosides, LOOP DIURETICS



Hypocalcemia Manifestations ANS Ca CALMS: IRRITABLE NERVES/MUSCLES

-tetany: muscle spasms

-paresthesia: tingly/numbness (circumoral numbness- around the mouth)

-hyperactive DTRs

-Trosseau's Sign: inflate BP cuff, spasm of the wrisT

-Chovstek's Sign: tap CHeek, facial twitching

-seizures

-respiratory symptoms of dyspnea and laryngospasm

-mental status changes

-dangerous ECG changes (Torsades): heart beats fast

-Abnormal clotting



Hypocalcemia Medical/Nursing Management ANS Medical:

-IV calcium gluconate

-calcium and vitamin D supplements

-diet



Nursing:

-assessment of manifestations

-patient teaching related to diet and medications

-IV calcium administration: for severe issues- infuse on pump, ECG monitoring, monitor for infiltration

-seizure precautions: safety, bed pads, suction



Hypercalcemia (high Ca) ANS Serum Level Greater Than 10.5 mg/dL

-not as common, more deadlier/dangerous

,Causes:

-malignancy: cancer (attacks bone and releases Ca in blood)

-hyperparathyroidism: not actively working INCREASES Ca

-Medications: Ca containing antacids (tums), thiazide diuretics (prevent renal excretion of Ca)

-bone loss related to immobility or fracture



Hypercalcemia Manifestations ANS -muscle weakness

-incoordination (no signals firing)

-thirst leading to polyuria and dehydration

-mental status changes

-constipation occurs, then anorexia bc stomach hurts, then comes out the other way through N/V

-abdominal and bone pain

-ECG changes: heart nerve impulses are not moving, moving VERY slow (can die from this)



Hypercalcemia Medical/Nursing Management ANS Medical:

-treat underlying cause

-IV fluids: to flush it out

-Furosemide: loop diuretic

-Corticosteroids: decrease intestinal absorption of Ca

-Calcitonin: DECREASES Ca and tells body to stop bone breakdown and build new bone

-IV Phosphorus (emergency only): reciprocal relationship of pho and Ca, may cause hypocalcemia



Nursing:

-assessment of manifestations

-fluids of 3 to 4 L per day

-provide fluids containing sodium unless contraindicated

-fiber for constipation

-ensure safety

-ECG monitoring

, Phosphorus ANS 2.5-4.5 mg/dL

-located in bones and teeth (85%), intracellular fluid (blood-14%), extracellular fluid (vitamin D- 1%)

-may have low levels of phosphate in the blood while having normal phosphate stores in bone/teeth/etc.

-absorbed from food in the presence of Vitamin D



Phosphorus Functions ANS -maintains acid-base balance as a hydrogen buffer

-PROMOTES ENERGY STORAGE IN THE FORM OF ATP

-bone and teeth formation

-regulation of hormone and coenzyme activity

-role in muscle, white, and red blood cell function



Phosphorus Regulation ANS -readily absorbed in the GI tract (10% excreted by GI)

-certain conditions cause phosphorus to move in and out cells, which affects serum levels

-insulin and alkalosis cause phosphorus to move into cells

-excreted or reabsorbed mostly by kidneys as influences by PTH (PTH increases Ca)



PTH release: PTH DECREASES PHOSPHORUS

-tells bones to release phosphorus and intestines to increase absorption

-tells kidneys to INCREASE EXCRETION OF PHOSPHORUS

-RECALL: PTH release tells the kidneys to reabsorb calcium

-Therefore: calcium and phosphorus have an INVERSE RELATIONSHIP



Hypophosphatemia (low phosphate) ANS Serum level below 2.5 mg/dL



Causes:

-refeeding of patients after starvation

-vitamin D deficiency

-use of diuretics and phosphorus binding antacids

-diabetic ketoacidosis (DKA)

-hyperparathyroidism: INCREASES Ca, DECREASES Pho

-diarrhea

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