hey everyone its air with registered nurse Orion dot column and in this video I'm going to be going over hypocalcemia in the previous video I covered hypercalcemia now what I want to cover is I'm going to cover the signs and symptoms and give you a clever pneumonic to help you remember I want to cover the causes and the nursing interventions and I want to highlight for you things that you're going to need to know for your lecture exams and for the NCLEX exam now after this video be sure to go to my website register nurse Orion calm and take the free quiz that's going to test you on hypocalcemia and hypercalcemia in the description below you can access that link or a card should be popping up where you can take that free quiz so let's get started before we start let's talk about hypocalcemia the meaning of the word what normal levels are and things like that okay anytime I have big words like this I like to break them down because you have a lot of hypo and hyper you have calcium in the tree Mia everything like that so we need to know what electrolyte we're talking about ok hypo means underneath or beneath so it's low Cousy ALC is the prefix for calcium so we know that we're talking about the electrolyte calcium and emia means blood so when you put all that together what do you get the meaning is low calcium in the blood now what is a normal calcium level a normal level is eight point six to ten milligrams per deciliter and anything less than eight point six milligrams per deciliter is considered hypocalcemia what is the role of calcium because in order for you to understand the causes and the signs and symptoms you need to know how calcium works on the body and how it affects everything okay it plays a huge role in your bone and your teeth um health your muscles and your nerve cell function and blood clotting and whenever the calcium level messes up these areas in the body start messing up now also how kind of person would get high calcia well let's look and see how the body absorbs it it's absorbed in your GI system so if you have any problems with malabsorption like Celie acts or Crohn's or anything like that you're probably going to have a low calcium level because that's where calcium's absorb it's stored in your bone so if you have low calcium level it's in your bones you're more at risk for bone fractures so you're really going to watch safety with these patients and it's excreted in your kidney so kidneys play a huge role in getting rid of calcium so if you have some renal issues the kidneys may all of a sudden just start excreting too much calcium and then you're going to have low calcium so that right there helps you understand how it plays and you're going to understand more about the signs and symptoms now also another thing vitamin D helps calcium in absorbing calcium in the body so remember that because vitamin D and calcium are friends and they help each other out now calcium and phosphorus I want to put this as a side note because it's part of one of the causes they affect each other in opposite ways I remember a nursing school I remembered it like calcium and phosphorus we're sisters but they competed in everything and they did the opposite of everything because whenever your calcium level goes high your phosphorus level will go down or vice versa so you all want to remember that okay let's talk about the causes of hypocalcemia I think one of the best ways to help you remember all these causes is to develop a pneumonic so this mnemonic that we have here is remember the word low calcium and each letter in this word is going to represent a cause it's really important I suggest you write this down if you're preparing for a test because a lot of your professors are going to give you a scenario and maybe throw out this patient has a low parathyroid hormone what are they at risk for and you'll have all these options for hypocalcemia hypercalcemia or maybe hypernatremia and things like that so you mean - remember the causes okay so let's get started okay l4 the first letter low parathyroid hormone and your parathyroid plays a huge role in calcium and if you ever have destruction or removal of the parathyroid or any type of neck surgeries or a thyroidectomy the calcium level is at risk for decreasing and this is a huge test question so any time a teacher throws out a two-hour patients had neck surgery or the Heather thyroid removed think calcium level because parathyroid hormone plays a huge role in regulating the calcium and you're also going to see that in hypercalcemia you're actually going to be seeing the calcium level going high because it's going to be a high parathyroid hormone which I talked about in the other video okay Oh for oral intake in adequate this is seen mainly in patients who aren't taking enough calcium in for instance patients who have alcoholism maybe bulimia things like that w-4 wound drainage especially the GI system because remember it comes back to calcium you absorb being absorbed in the GI system so if you are losing a lot of wound drainage and so you have a wound back on a on the intestines or in the belly or something like that they're at risk for losing calcium so that's one cforce lax disease and Crohn's disease that is back to the malabsorption because their villi and everything in their stomach is messed up so they're not absorbing those electrolytes that they should so they're at risk for that a for acute pancreatitis l4 low vitamin D intake remember vitamin D as I pointed out the beginning allows calcium to be reabsorbed so if you don't have a lot of vitamin D the body's not going to intake the calcium and that's a lot of times why physicians like to prescribe calcium and vitamin D together because they help each other the other C for chronic kidney disease and if the kidneys aren't working properly they can excrete too much calcium and waste it so that will come back and give them a low calcium level I for increase phosphorus level if they have high falls in their blood remember calcium and phosphorus or sisters and they like to do the opposite so you're going to have a low calcium level you for using medications such as magnesium supplements the patient already has a lot Oh calcium level and they take magnesium it can draw for them even more any types of lace laxatives loop diuretics and calcium binder drugs and then m4 mobility issues they're not getting up they're not moving around they're not using that calcium the bones aren't getting the exercise that they need and it throws everything off so now let's talk about the signs and symptoms of hypocalcemia for the signs and symptoms try to remember the word cramps each letter correlating with either a sign or symptom okay the first one see confusion patients with low calcium levels are going to have confusion our reflexes are going to be hyperactive if you use the hammer and hit on those deep tendon reflexes you're going to notice that they're really reactive a arrhythmias this is a really big test question and you may see prolong QT intervals that's really the big one that they like to hit on on in exams they're going to say patient has a calcium level of 7.3 which of the following is indicated of an EKG change and the option is either prolonged QT interval or prolong s T interval so remember that one M for muscle spasms in the cab feet you can have seizures as well and P for a positive truth shows um sign this is big so commit this to memory because this and chivitz Keys is what a lot of professors and in CLECs likes to test you on because anything that's like a sign or a positive is positive that that's a lot of a test question so what is a true so sign okay usually this is going to present before Shabbat ski sign and how you initiate this response is that you put a blood pressure cuff on the upper arm just like how you're going to take a normal blood pressure and and you're going to inflate the cuff above the patient's systolic a little bit greater than what it is and you're going to hold it there nice and tight for three minutes and then what you're looking for why that cuff is on the patient's arm you're watching their hand and all of a sudden the patient after three minutes well involuntarily their hand will start just crunchy sort of flexing like this and they can't really control it at all and if you see that sign of that reflexing of that that is a positive true so sign okay next is the sign of the savants keys this is where you have hyperexcitability of your facial nerve and to initiate that what you do is you tap on the job there's a muscle right there called the masseter and you hit on that and what happened on that affected side that you hit at the angle of the doll you will see either the lips twitch towards that side or the nose twitch so that is a positive and ibattz key sign so remember how you would do that because it may ask you how you perform that or the pay you've seen the patient do that what is it showing so make sure you commit that to memory now let's talk about the nursing interventions things that you would do for this patient as the nurse now this is again where teachers love to hit on for exam questions and on the NCLEX with NCLEX loves to know what are you going to do as the nurse okay number one safety because this patient has a low calcium level if they fall anything like that they are at a huge risk for a bone fracture so make sure you're doing everything you can to prevent bone fractures and also that you're watching out for laryngeal spasms because this can happen if the calcium level is really low and next the doctor may order for you to administer IV calcium usually I'm 10 percent calcium gluconate some things you need to know about this is that you give it slowly according to the instructions you need to monitor their heart rhythm have them on them a bedside monitor watch for any an infiltration or phlebitis because this is really hard on the veins and if it infiltrates or anything like that you can have tissue of sloughing next it's really best to give this through a central line but look at your Hospital protocol you want to use that or a really big vain and if the patient is on the medication digoxin you want to watch this as well sometimes physicians won't even order this if they are all ended but sometimes they will and because they can cause ditch toxicity so remember that as well calcium 10% calcium gluconate and did don't go well together okay next administer the doctor may order you to administer a oral form of calcium with vitamin D supplement remember vitamin D and calcium likes to go together and you would give this after a meal because remember calcium is absorbed in the GI system you want to make sure that there's some food on the stomach or at bedtime with a full glass of water also if the patient has a high false level remember phosphorus and calcium like to do opposite so if they're false level is high in order to get the calcium level to come up the physician may order medications like tums which are aluminum hydroxide sodium to increase that level and you're going to encourage foods rich in calcium another big thing that tests like to hit on they'll give you a selection of food and which one would be best for that patient to eat so I've developed this little saying to help you remember it and remember this same each letter correlates with what is rich in calcium so remember young Sally's calcium serum continues to randomly mess up she has problems with calcium so why would be yogurt s would be sardines C would be cheese s would be spinach C would be collard greens tea tofu ar-rooh bar and M milk okay so that is an overview of hypocalcemia now don't forget to take that quiz on my website register nurse Orion comm and test your knowledge how well you know this material and please check them out my other teaching tutorials on fluid and electrolytes and please consider subscribing to this YouTube channel