Today we're wrapping up hypercalcemia. Hyper meaning high, cal meaning calcium and emia in the blood. Calcium more than 10.5 in the blood. Now calcium is a strong guy and so his function is to keep the 3Bs strong.
So strong bones, blood and beats. For blood the clotting factors will be strong and beats we're talking about heartbeats. Calcium is regulated by three main hormones.
First, the parathyroid hormone, which increases calcium concentration inside the blood. Next is calcitonin hormone, which decreases blood calcium and puts a ton of calcium into the bone. Third is calcitrol, which controls blood calcium by inhibiting the release of calcitonin. Basically it reverses that ton of calcium in the bone so calcium gets released into the bloodstream.
Now here's a little fun fact about calcium. His BFF, his best friend forever, is Magnum Magnesium. So calcium helps fill job functions for magnesium, often when magnesium is low.
His worst enemy is friendly frat boy phosphate. So you'll often see when phosphate is low, calcium is high, and when calcium is low, phosphate is high. So what are the main causes that keep high calcium in the body and not in the body? Well, we use our nifty acronym HAM because cocky calcium is going all HAM in the gym, making your body swollen and slow.
So H is for hyperparathyroidism. Remember, parathyroid increases calcium concentrations in the blood. A is for anti-acids containing calcium like Tums, usually given for heartburn.
M stands for malignant cancer cells, which release excess calcium into the body. Hmm, didn't know that one. Also, don't forget about low phosphate as well.
Because every time phosphate is low, calcium is high. Now what's going on in hypercalcemia? Well, high, high calcium, right?
So cocky calcium is making your body so swollen and slow. And since cocky calcium makes the three B's strong, bones, blood, and beats, well then these will be slow and swollen as well. So the heart's going to be swollen and slow.
Vital signs you'll have decreased heart rate, decreased respiratory rate, and decreased blood pressure. EKG will have heart blocks, shortened QT waves, and wide T waves. Also spastic contraction of the heart muscles.
Wait a minute, you said QT wave? What a sissy man! Look at me, I'm the QT wave! Basically your heart is way too swollen and super flexed and contracted like a big old cramp.
So the lungs are swollen and slow as well. You'll have shortness of breath and weak respirations. GI, also swollen and slow. Constipation will set in.
Also nausea and vomiting because your body's trying to get rid of that extra calcium. As far as GU, our urinary system, you'll have big fat kidney stones. Also called renal calculi. Big NCLEX tip right there.
Neurologically the brain will be swollen and slow. Basically a lot of strain on the brain. So loss of consciousness, ALOC or altered level of consciousness, as well as decreased deep tendon reflexes, DTRs.
Now the muscles will be swollen and slow, so decreased excitability in muscles and nerves. Now a severe sign will lead into muscle weakness for being so swollen and so contracted. Now a big NCLEX tip is bone pain, because in most cases this excess calcium in the blood was taken out of the bones, which weakens them.
So now that we know what's wrong with the patient, what are we going to do about it? So we use the acronym SLIMFAST for our nursing interventions for high calcium, hypercalcemia. So S we have safety from falls or basically fall precautions. L stands for Lasix, known as furosemide or loop diuretics.
It will excrete electrolytes like mainly potassium, but it also excretes calcium too. I is for IV phosphate. Remember his worst enemy. will decrease calcium when phosphate is high. M is for monitor EKGs, the I's and O's, input and output, as well as kidney stones.
F is for fluids like normal saline, which will dilute the blood and will decrease the chance of renal stone formation. A is for avoid high calcium foods. We use the acronym LSD. So L for leafy greens like spinach, collard greens, and even rhubarb.
S is for sardines and tofu. And D is for dairy products like cheese, milk, and yogurt. Now S is for serious case.
We use dialysis. Basically our kidney machine to wash out that excess calcium. from the blood.
T is treatment with calcium reabsorption inhibitors. Remember that calcitonin which puts a ton of calcium into the bones? Well it takes it from the bloodstream. We'll also give biphosphates because again guys whenever phosphate is high it decreases calcium. Also prostaglandin inhibitors like aspirin or NSAIDs like ibuprofen will also decrease calcium in the blood.
Alright guys that wraps up hypercalcemia.