hi guys it's me professor d and welcome back to my youtube channel on this video i'm going to be covering hypocalcemia now if you haven't watched hypercalcemia make sure you go back and watch it you don't have to necessarily watch it before this video but i encourage you to keep all of your fluid and electrolytes of hyper and hypo together don't just mix it up it's just confusing so make sure you go back and watch hypercalcimit if you haven't done so already also please like this video do it now so you don't forget you're going to love it just press that like button press the notification button so you'll be notified every time a new video is released because every sunday at 1 pm eastern standard time i always release a video where i'm covering questions but during the week i try to do teaching videos daily i try now if i have a spare 15 or 20 minutes that's what i'm doing making a video for you but the times are random so when you press that notification button you'll be notified as soon as a new video is released don't forget i have audio lessons available for you on my website nexusnursinginstitute.com and almost daily you guys can catch me covering a variety of nursing topics on my other social media platforms such as tik tok instagram and facebook so make sure you guys check that out without further ado guys let's get started hypo calcimia so patient that is hypocalcemic their blood calcium level is going to be a less than 8.6 okay hypocalcemia that's low serum calcium whenever we're talking about these uh electrolytes right we're talking about them in the blood is it high in the blood or is it low in the blood so when you see hypocalcemia don't think of calcium in the bone uh-uh emia e-m-i-a in the blood low calcium in the blood it can result from any condition that's associated with the parathyroid hormone deficiency the patient who receive multiple blood transfusions can become hypocalcemic because the citrate that's used to um keep that blood from clotting used as an anticoagulant the blood binds with calcium and it decreases ionized calcium levels so that's important to know that that patient with multiple blood transfusions that can cause that patient to be hypocalcemic let's keep going it says um being hypocalcemic this results in increased nerve excitability remember when we talked about hypercalcemia and how when um the patient was hypercalcemic those nerves and muscles were what weak but now that we're talking about hypocalcemia it's the opposite they're what excited they have sustained muscle contraction or tetany that is on nclex that is on hesi that is on ati it's going to be on your nursing exam you better know it that is important clinical manifestation of hypocalcemia okay clinical signs of tetany remember technique that's that muscle contraction right clinical signs of tetany include trospec and trusoci you guys have to recognize that so troll stack starts with a c and so does your cheek so trolls tech sign that's the one where you run your finger or put something along their cheek and they go like this right because of that increased contraction that's your chose tech your true i can't pronounce that word you see you know what i'm talking about now true souls true souls is the one when you take that patient's blood pressure and then you see their hand like going like this okay that's that true souls that's the technique that's the increased muscle contraction take a look up here here goes the tro stick that's the cheek one you see how they're going like that right choice deck starts with a c so does your cheek and then here goes true souls true souls is that twitching where the hand goes like this or it goes like this when you take the blood pressure make sure you understand and recognize that they go with hypo calcimia and not hyper because you're gonna see this again don't say i didn't warn you so let's keep going so trustax contraction of facial muscles in response to tap over the facial nerve in front of the ear truso sign refers to carpal spasms induced by inflating blood pressure cuff on the arm two very important signs i don't know why i don't have them highlighted let me highlight them now other uh manifestations of tetany are laryngeal strider guys you see laryngeal strider that is a medical emergency okay strider that sound that strider lets you know that their airway is about to close up very shortly laryngeal strider dysphagia paresthesia and numbness and tingling around the mouth or in the extremities you have to know all of these signs and symptoms you have to recognize that they are they go with hypocalcemia you see i put a star next to it nursing interventions let's talk about some nursing diagnosis diagnosis for that patient that's hypocalcemic that has all of this increased muscle and nerve excitability risk for electrolyte imbalance of course because they don't have enough calcium in the blood ineffective breathing pattern of course an effective breathing pattern hello laryngeal strider absolutely acute pain that acute pain is because those muscles are contracted and it's not giving that patient a break that hurts imagine your muscle staying contracted the whole time and not relaxing yes that's painful risk for injury why because everything the nerves and the muscles are excited that can cause that patient to go um into a seizures that can cause that patient to have um uh uh tetany right so that is risk for injury and potential complications those contractions can be so strong we got fracture breaking of the bones respiratory rest from that laryngeal strider that you better be able to recognize so these are important nursing diagnoses for hypocalcemia and if you've been following my videos you know um not too often do i go over the nursing diagnoses i just skip over that let you guys read it on your own the reason i'm covering it in this video is because when it comes to hypocalcemia um these test writers tend to ask about nursing diagnoses in related to hypo calcium so i wanted to make sure that you guys understood this nursing implement implementation matter of fact before we hit the implementations let's take a look at um the clinical manifestations again for hypocalcemia because i can't stress this enough how important it is for you to know the difference between hypo and hyper i already covered this in my video for hypercalcemia let's talk about hypo okay primary hypo parathyroidism remember guys you have your thyroid gland then you have your parathyroid gland the thyroid gland when you think about the thyroid gland you think about metabolism but when you think about the parathyroid gland what do you think of calcium if the patient has hyper parathyroidism they're going to have hypercalcemia if they have hypo parathyroidism they're going to have hypocalcemia so what else elevated phosphorus yes because we know phosphorus pulls the um calcium out of the blood and back into the bone so if the phosphorus is elevated yeah that's going to make the patient hypocalcemic biofaffiness we talked about biophosphates in um um in hypercalcemia okay biophosphates do what make that bone stronger that calcium that was in the blood goes where into the bones to make that bone stronger loop diuretics okay in loop diuretics you lose potassium but you also lose other electrolytes such as calcium chronic alcoholism that's an important one absolutely signs and um so these are what excuse me these weren't clinical manifestations these were um what can cause hypocalcemia excuse me so now let's talk about clinical manifestations again hyper reflexia muscle spasms numbness and tingling in the extremities and region around the mouth that numbness and tingling that's what that's called what the paresthesias okay chosetech sign true soul sign laryngeal and bronchial spasms it can even lead to strider tetany seizures these are very important for you to know now let's talk about the limiting interventions nursing interventions so treating mild or asymptomatic hypocalcemia involves so let's stop right there so if it's only mild and it's amount to the point that it says asymptomatic so patient's not really exhibiting any symptoms they have hypocalcemia but it's just mild they're not symptomatic we're going to start with diet we're going to teach them about diet that's high in calcium-rich foods and vitamin d supplementation why you need vitamin d to absorb the calcium if they're symptomatic they can be treated with iv calcium gluconate gluconate measures to promote co2 retention such as breathing into a paper bag or sedating the patient can control muscle spasms and other symptoms of tetany because remember technique is a very serious problem patients taking loop diuretics may have to change to thiazide diuretics to reduce the excretion of that calcium because they're taking the loop diuretics yeah we're getting rid of the potassium but we're also getting rid of calcium so they might have to switch to another type of diuretic such as thiazide diuretics closely observe any patient who had thyroid or neck surgery in the immediate post-operative period for peer uh manifestations of hypocalcemia because of the proximity of the surgery to the parathyroid gland think about it your thyroid glands right here and those four little nodules that sit right there behind the thyroid gland are your parathyroids so absolutely you better be checking them very closely if they have thyroid surgery just like it says because of the proximity to the parathyroid gland you're going to be watching for signs and symptoms of hypocalcemia matter of fact that patient had thyroid surgery you better believe you're going to have an airway kit right there at that patient's bedside and that's it for hypocalcemia guys it wasn't that hard it is not as hard as you think and the way that you see i'm reading the book and i'm explaining it to you and i'm stopping at things that are important that's how you're supposed to think when you're studying guys i know because i see your comments i see this all the time in your mind you think you need me right next to you reading and you don't i'm teaching you how to do it yourself take those skills and make sure you're reading your book anyway don't forget guys please like this video if you haven't done so that's already please help my channel grow how can you help my channel grow if what i'm doing for you guys if this is having a positive impact on your life all i'm asking you is to please help support me how can you support me share my videos refer my videos to somebody you know maybe a nursing instructor maybe a co-worker maybe another nursing student maybe a whole cohort please help my channel girl i asked that of you um don't forget i have audio lessons available for you on my website nexusnursinginstitute.com guys thank you so much for watching this video you guys will catch me on the next video