- Electrolyte Imbalance related to Changes in the regulation of calcium and Conditions that affect the movement of calcium in the cellular space as evidenced by alterations in the electrical conductivity of the heart and muscle irregularities (such as muscle tetany and seizures for hypocalcaemia, muscle weakness for hypercalcemia)
- Imbalanced Nutrition related to Improper use of calcium supplements and lacking vitamin D as evidenced by Neuromuscular alterations and Changes in bowel habits
- Ineffective Tissue Perfusion related to Impaired oxygen transport and Insufficient knowledge of hypocalcaemia/hypercalcemia and its management as evidenced by muscle cramping and Hyperactive reflexes
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Objective data: -Alterations in the electrical conductivity of the heart and muscle irregularities (such as muscle tetany and seizures for hypocalcaemia, muscle weakness for hypercalcemia) -Neuromuscular alterations -Changes in bowel habits | Electrolyte Imbalance related to Changes in the regulation of calcium and Conditions that affect the movement of calcium in the cellular space as evidenced by alterations in the electrical conductivity of the heart and muscle irregularities (such as muscle tetany and seizures for hypocalcaemia, muscle weakness for hypercalcemia) | Patient will maintain normal electrolyte levels (serum potassium, sodium, calcium, magnesium, and phosphorus). Patient will maintain normal fluid balance. Patient will maintain adequate hydration. Patient will maintain normal kidney function. Patient will maintain normal sinus rhythm. Patient will have decrease/absent edema. Patient will verbalize understanding of nutritional status and ways to maintain normal electrolyte levels. | 1. Discontinue medications as ordered. Aluminum hydroxide raises calcium levels as a result of lowering phosphorus levels. Discontinue thiazide diuretics (calcium-sparing) and replace them with diuretics that enhance calcium excretion. 2. Administer medications as prescribed. Calcium from the digestive system can be absorbed more easily with vitamin D. Give calcium supplements with vitamin D for hypocalcemia. 3. Treat underlying conditions. Malignancy, hypoparathyroidism, renal, and skeletal diseases can all contribute to calcium imbalances. Monitoring and preventing hypo/hypercalcemia are essential parts of treating these disorders. 4. Refer the patient to an endocrinologist. The most frequent reason for changes in calcium levels is an endocrine disorder. Endocrinologists can identify and classify the numerous causes of calcium imbalances and assist with treating and managing these conditions. | Patient maintained normal electrolyte levels (serum potassium, sodium, calcium, magnesium, and phosphorus). Patient maintained normal fluid balance. Patient maintained adequate hydration. Patient maintained normal kidney function. Patient maintained normal sinus rhythm. Patient has decreased edema. Patient verbalized understanding of nutritional status and ways to maintain normal electrolyte levels. |
| Subjective data: Verbalizes weakness of Muscle and aches in body Objective data: -Alterations in the electrical conductivity of the heart -Ineffective respirations -Muscle irregularities (such as tetany, paraesthesia, weakness) -Neuromuscular alterations -Changes in bowel habits | Imbalanced Nutrition related to Improper use of calcium supplements and lacking vitamin D as evidenced by Neuromuscular alterations and Changes in bowel habits | Patient will maintain weight in desired goal range. Patient will recognize factors that are contributing to being under or overweight. Patient will identify appropriate nutritional needs/requirements. Patient will consume adequate nutrition. Patient will verbalize appropriate management of nutrition at home. | 1. Encourage or avoid calcium in the diet. Calcium is associated with dairy products; milk, yogurt, and cheese are excellent sources of calcium. Encourage or avoid calcium depending on the condition. 2. Instruct the patient to take the recommended calcium supplements as ordered. Calcium carbonate and calcium citrate are the two most common calcium supplements. 3. Teach the patient about calcium sources and have them teach back. Calcium sources include: Cheese, milk, yogurt, and other dairy products Green leafy vegetables Soy beverages with calcium Fish with bones, such as sardines 4. Refer the patient to a dietitian. Dietitians can provide information about the recommended calcium intake for the patient and help them plan meals. 5. Encourage sunlight. Sunlight is a natural source of vitamin D, which is necessary to absorb calcium. Encourage safe sun exposure. | Patient maintained weight in desired goal range. Patient recognized factors that are contributing to being under or overweight. Patient identified appropriate nutritional needs/requirements. Patient will consume adequate nutrition. Patient verbalized appropriate management of nutrition at home. |
| Subjective data: Chest Pain Dyspnea Sense of impending doom Objective data: -Arrhythmias -Capillary refill >3 seconds -Altered respiratory rate -Use of accessory muscles to breathe -Abnormal arterial blood gases -Unstable blood pressure -Tachycardia or bradycardia -Cyanosis | Ineffective Tissue Perfusion related to Impaired oxygen transport and Insufficient knowledge of hypocalcaemia/hypercalcemia and its management as evidenced by muscle cramping and Hyperactive reflexes | Patient will maintain adequate peripheral perfusion as evidenced by strong pedal pulses, warm skin temperature, and intact skin without edema. Patient will maintain cardiopulmonary perfusion as evidenced by normal sinus heart rhythm, heart rate within normal limits, no complaints of shortness of breath and normal Sa02. Patient will demonstrate appropriate lifestyle modifications to support adequate tissue perfusion. Patient will have an improvement in cerebral perfusion as evidenced by intact orientation to person, place, and time. | 1. Consider the cause. Hypoparathyroidism responds well to IV calcium gluconate. Patients with chronic hypocalcaemia may need to take a combination of oral calcium with vitamin D. Patients with renal failure benefit from calcitriol. 2. Magnesium supplementation may be required. Hypomagnesemia causes hypocalcemia and IV or oral magnesium may be necessary. 3. Administer IV calcium gluconate as ordered. IV calcium gluconate is the therapy of choice for acute symptomatic hypocalcaemia. 4. Aid in excreting calcium. Hypercalcemia may require methods to eliminate excess calcium through IV saline infusions, diuretics, haemodialysis, and steroids. | Patient maintained adequate peripheral perfusion as evidenced by strong pedal pulses, warm skin temperature, and intact skin without edema. Patient maintained cardiopulmonary perfusion as evidenced by normal sinus heart rhythm, heart rate within normal limits, no complaints of shortness of breath and normal Sa02. Patient demonstrated appropriate lifestyle modifications to support adequate tissue perfusion. Patient improved cerebral perfusion as evidenced by intact orientation to person, place, and time. |