Hypocalcemia
This is the most common cause of hypocalcemia
Kidney failure
These are the two most common causes of hypercalcemia
Malignancy associated
Hyperparathyroidism
These diagnoses/factors cause or contribute to the onset of metabolic acidosis.
Ingestion of salicylates, diabetic ketoacidosis (DKA), uremia, kidney disease, iron, metformin, methanol, carbon monoxide poisoning, and liver failure.
These conditions/behaviors increase the risk for metabolic alkalosis
Vomiting, nasogastric tube to suction, ingestion of sodium bicarbonate, hyperaldosteronism
These disorders are common causes of ACUTE respiratory acidosis
Myasthenia gravis and Guillain-Barre syndrome, asthma, and stroke.
Respiratory alkalosis is ultimately related to this altered breathing pattern
Hyperventilation
Removal of this organ increases the risk of hypocalcemia
Thyroid/parathyroid
While hypercalcemia is often benign, these symptoms may arise
Groans: Gastrointestinal (nausea, vomiting, discomfort)
Bones: Bone pain, osteoporosis, fractures
Stones: Renal calculi
Moans: Fatigue
Thrones: Polyuria and constipation (sitting on the throne [toilet])
Psychic overtones: Depression, mental status changes
Individuals with metabolic acidosis may present with one of these two respiratory patterns
Kussmaul respirations
These common medications may increase the patient's risk for metabolic alkalosis
Diuretics (both loop and thiazide)
This chronic disease is recognized as the most common cause of chronic respiratory acidosis
COPD
Others include: obesity, skeletal abnormalities, heart failure, sedating medications.
While respiratory alkalosis may be asymptomatic, what symptoms might the nurse see in these patients?
peripheral edema, orthopnea, acute onset of dyspnea, fever, weakness, chills, confusion, anxiety, wheezing, dizziness, numbness, and paresthesia.
Facial twitching elicited by tapping on the cheek to stimulate the facial nerve, is known as this sign of hypocalcemia
Chvostek’s sign
A patient enters the ED with symptoms of hypercalcemia. Serum calcium is 14.2 mg/dL. Which fluid does the nurse prepare to administer via IV?
0.9% Normal Saline
When reviewing an arterial blood gas, these two values allow the nurse to determine the imbalance, and whether the cause is metabolic or respiratory
pH and PaCO2.
Normal pH: 7.35-7.45
Normal PaCo2: 35-45
If PaCO2 is altered in same direction of pH (high when pH is high), it's metabolic
If opposite, Respiratory
ROME
Symptoms of metabolic alkalosis are often related to alterations in the levels of these electrolytes
Potassium and calcium ---> hypokalemia and hypocalcemia
This manifestation, caused by hypoxemia and hypercapnia is often the first symptom of respiratory acidosis
Altered mental status or confusion
A hyperventilating client is diagnosed with respiratory alkalosis. Which class of medication does the nurse anticipate administering?
Anxiolytics
This method is used to elicit Trousseau's sign, a sign of hypocalcemia
Inflate a BP cuff to 20mm Hg above systolic BP and maintain for 3 hours
A patient comes in with an elevated calcium level and symptoms of hypercalcemia. Which medications does the nurse anticipate administering?
Intravenous zoledronate, subcutaneous denosumab, or intramuscular or subcutaneous calcitonin
The client presents with a serum pH of 6.7 and altered mental status. The nurse correctly anticipates administering what medication?
Sodium bicarbonate
When treating the manifestations of metabolic alkalosis, the nurse prepares to teach the patient about what type of ongoing monitoring for complications of treatment?
Telemetry
Your client presents with respiratory acidosis related to acute asthma attack. Which type of medication(s) does the nurse correctly anticipate administering?
Bronchodilators and corticosteroids
A ventilated patient is experiencing respiratory alkalosis. Which change to the ventilator settings does the nurse correctly anticipate?
Decrease in rate
These medications increase the risk for hypocalcemia
Bisphosphonates (Fosamax (alendronate) & denosumab (Prolia)
If the client has failed to respond to medical therapy and administration of IV NS, what intervention will the nurse anticipate teaching the client/family about?
Dialysis
The client presents in diabetic ketoacidosis with a serum pH of 6.9. Which medications does the nurse anticipate administering?
Insulin, IV fluids, sodium bicarbonate
When reviewing the ABG of a client with metabolic alkalosis, the nurse anticipates which types of deviations in the pH and PaCO2?
Both elevated
Your patient presents with acute on chronic respiratory failure resulting in respiratory acidosis. Which non-pharmacological interventions do you prepare to utilize?
BiPAP
The nurse is reviewing the ABG of a patient with respiratory alkalosis. Which alterations does the nurse expect to see to the pH and PaCO2?
pH elevated
PaCO2 low