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NUR 104 Exam 2 Questions And Answers With Real Tests
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NUR 104 Exam 2 Questions And Answers With RealTests
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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