Nursing Diagnosis: Imbalanced Nutrition Less than Body requirements related to

hypercalcemia as evidenced by nausea, vomiting, weakness, loss of appetite, and

verbalization of decreased energy levels

Desired Outcome: The patient will be able to achieve a weight within his/her normal
BMI range, demonstrating healthy eating patterns and choices.

terns and choices.

Hypercalcemia and Hypocalcemia Nursing Interventions Rationale

Explain to the patient the relation of increased calcium levels to nausea and vomiting
and loss of appetite. To help the patient understand why nausea and vomiting
associated with loss of appetite are signs of hypercalcemia.
Create a daily weight chart and a food and fluid chart. To effectively monitory
the patient’s daily nutritional intake and progress in weight loss goals.
Administer calcium-lowering medication as prescribed. A range of medications
such as calcitonin can be used to lower blood calcium levels depending on the cause
of the condition.
Prepare the patient for surgery if indicated. A surgical procedure to remove
overactive parathyroid glands can be performed. The use of a special scanning device
can identify the overactive gland through the help of a small amount of radioactive
contrast.

Nursing Diagnosis: Disturbed Thought Process related to altered mental status

secondary to severe hypercalcemia, as evidenced by episodes of hallucinations and/or
psychosis, difficulty handling complex tasks, confusion and disorientation, and
inability to do activities of daily living (ADLs) as normal

Desired Outcome: The patient will be able to establish optimal mental and physical
functioning.

Hypercalcemia and Hypocalcemia Nursing Interventions Rationales

Assess the patient’s level of confusion. To monitor effectiveness of treatment
and therapy.
Assist the patient performing activities of daily living. Consider one-to-one nursing.
To maintain a good quality of life and promote dignity by allowing the patient
to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions. Label the
drawers with simple words and big letters, and use written notes when necessary.
Severe hypercalcemia patients may have difficulty handling complex tasks.
Provide opportunities for the patient to have meaningful social interaction, but never
force any interaction. To prevent feelings of isolation. However, forced interaction
can make the patient agitated or hostile due to confusion.
Administer calcium-lowering medications and/or prepare the patient for surgery. To
treat the underlying cause of disturbed thought process which is severe hypercalcemia

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Hypercalcemia
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Hypercalcemia

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Hyperkalemia
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Hypocalcemia Causes
Hypercalcemia
Hiker-calcified-cow

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Hypercalcemia is the condition in which a person’s serum calcium level is higher than
normal. It can result from increased calcium intake and absorption, shift of calcium
from bones into the extracellular fluid (ECF), or decreased calcium output. Patients
display lethargy, hypercoagulation, constipation, pathologic fractures, and possible
ECG changes.
14 KEY FACTS
ASSESSMENT
> 10.5 mg/dL Ca2+
Greater than (10) Tin (.5) Hand
Hypercalcemia is defined as a serum calcium level higher than 10.5 mg/dL. Because
the normal range is narrow, even slight increases can have severe effects.

Pathologic Fractures
Fractured Bone
In most cases, the excess calcium in the blood is leached from the bones, which
weakens them. This can lead to pathologic fractures.
Lethargy
Leather-jacket
Hypercalcemia decreases neuromuscular excitability, with the most common
symptom presenting as lethargy. Fatigue, confusion, and a decreased level of
consciousness may be observed with severe cases leading to coma.

Hypercoagulation
Hiker-clogs
Hypercoagulation, otherwise known as the formation of blood clots, can occur more
easily in states of hypercalcemia because calcium is a cofactor in the coagulation
cascade. The patient is at increased risk for developing deep vein thrombosis (DVT)
of the lower extremities or in areas where venous obstruction occurs.

Constipation
Corked Con-toilet
Hypercalcemia can cause constipation due to decreased peristalsis. Patients may also
experience nausea, vomiting, anorexia, and abdominal pain.

ECG Changes
Delta ECG
Hypercalcemia results in changes on electrocardiogram (ECG/EKG), which includes
a shortened QT interval and shortened ST segment. Cardiovascular changes are the
most serious and life-threatening problems of hypercalcemia and should be treated
immediately.

QT Shortening
QT-heart Shortened
Hypercalcemia causes increased cardiac contractility, and increases heart rate. This
translates into shorter ventricle depolarization and repolarization times, which when
viewed on ECG/EKG is a shortened QT interval.

INTERVENTIONS
No Calcium Intake
No Calcium Sign
Interventions for hypercalcemia aim to reduce serum calcium levels thus, no calcium
intake should be permitted. This includes stopping IV solutions containing calcium
such as Ringer’s lactate and oral drugs containing calcium.

Chelating Drugs
Cleats-on Drugs
Calcium chelating drugs are those that bind to calcium thereby lowering serum levels.
Examples include plicamycin (Mithracin) and penicillamine (Cuprimine,
Pendramine).

Calcitonin
Cow-throne
Calcitonin is a drug used to inhibit calcium resorption from bone and thereby helps to
prevent hypercalcemia. It is often administered intravenously in cases of severe
hypercalcemia (hypercalcemic crisis, serum calcium greater than 14 mg/dL) since it is
relatively fast-acting.

Bisphosphonates
Bike-phosphate-P
After adequate fluid resuscitation and down-trending serum calcium levels,
bisphosphonates (e.g. zoledronic acid, pamidronate) are administered intravenously to
combat excessive bone resorption. These drugs can take 2-4 days to be effective so
they are useful in the long-term.

Loop Diuretics instead of Thiazide Diuretics

Loop-hen on Die-rocket overpowering Tarzan Die-rocket
Although falling out of favor, loop diuretics (e.g. furosemide, Lasix®) may be used in
the management of hypercalcemia especially in patients who are volume overloaded
e.g. renal or heart failure. Loop diuretics promote calcium excretion whereas thiazide
diuretics promote calcium reabsorption. For this reason, thiazide diuretics (e.g.
hydrochlorothiazide) should be discontinued/avoided in patients with hypercalcemia.