NCLEX - Hypocalcemia Management

Here are key facts for NCLEX from the Hypocalcemia Management tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

• --

1. Definition: Identify hypocalcemia as serum Ca < 8.5 mg/dL 2. Classification:

• Chronic/Mildly Symptomatic: Ca > 7.5 mg/dL
• Acute/Symptomatic: Ca ≤ 7.5 mg/dL

3. Clinical manifestations: Assess for muscle spasms, tingling, lethargy, seizures, and QT interval prolongation 1. Acute care management:

• Administer IV bolus of 1-2 g calcium gluconate as prescribed
• Follow with 1000 ml infusion of 1 mg/ml elemental calcium at 50mg/hr

2. Chronic care management:

• Administer oral calcium supplementation: 1-2 g calcium gluconate daily in divided doses

1. Acute cases: Measure serum calcium levels daily 2. Chronic cases: Monitor serum calcium weekly 3. Post-acute care: Assist with transition from IV to oral calcium supplementation after stabilization

• --

1. Medication administration: Teach proper timing of oral calcium in divided doses 2. Symptom recognition: Educate about signs of worsening hypocalcemia requiring medical attention 3. Dietary considerations: Provide information about calcium-rich foods and vitamin D sources 1. Related conditions: Recognize common causes including hypoparathyroidism, vitamin D deficiency, and chronic kidney disease 2. Special medication regimens: Administer calcitriol with oral calcium for patients with hypoparathyroidism 3. Associated electrolyte imbalances: Monitor for and implement orders to correct hypomagnesemia 1. IV administration: Ensure proper rate of calcium infusion to prevent adverse reactions 2. Cardiac monitoring: Observe for normalization of QT interval with treatment 3. Neurological status: Frequently assess for improvement in neuromuscular symptoms

• --

Below is information not explicitly contained within the tutorial but important for NCLEX. 1. Assessment: Techniques for evaluating Chvostek's and Trousseau's signs 2. Nursing diagnosis: Risk for injury related to neuromuscular excitability 3. Expected outcomes: Patient will maintain serum calcium within normal limits and remain free of symptoms 1. Seizure precautions: Implementing safety measures for patients at risk 2. IV site care: Preventing infiltration of calcium solutions which can cause tissue damage 3. Medication compatibility: Avoiding simultaneous administration of calcium with certain drugs 1. Intake and output: Accurate recording of IV fluid volumes containing calcium 2. Medication administration: Precise documentation of calcium doses, routes, and patient response 3. Patient education: Recording teaching provided and patient's understanding 1. Discharge planning: Ensuring continuity of calcium supplementation after hospitalization 2. Multidisciplinary communication: Reporting calcium levels to healthcare team 3. Follow-up scheduling: Arranging appropriate outpatient monitoring based on severity