PREVENTION. Teach the importance of adequate fluids. Explain the importance of notifying the physician at the first signs of inability to void or of urinary infection, such as burning or painful urination, cloudy urine, rusty or smoky urine, blood-tinged urine, foul odor, flank pain, or fever.
MEDICATIONS. Be sure the patient, family, or other caregiver understands all medications, including the dosage, route, action, and adverse effects. Encourage the patient to take the entire course of antibiotics as prescribed.
CARE OF INDWELLING CATHETERS. Teach the patient, family, or other caregiver how to drain a Foley catheter or nephrostomy tube and to examine the insertion site for infection. Encourage older male patients with a family history of benign prostatic hypertrophy or prostatitis to have annual medical checkups.
DRG Category: 296 Mean LOS: 5.4 days Description: MEDICAL: Nutritional and
Miscellaneous Metabolic Disorders, Age > 17 with CC
I I ypercalcemia occurs with a serum calcium level above 10.5 mg/dL in the bloodstream, although clinical manifestations generally occur at concentrations exceeding 12 mg/dL. It develops when an influx of calcium into the circulation overwhelms the calcium regulatory hormones (parathyroid hormone [PTH] and metabolites of vitamin D) and renal calciuric mechanisms or when there is a primary abnormality of one or both of these hormones.
Calcium is vital to the body for the formation of bones and teeth, blood coagulation, nerve impulse transmission, cell permeability, and normal muscle contraction. Although 99% of the body's calcium is found in the bones, three forms of serum calcium exist: free or ionized calcium, calcium bound to protein (primarily albumin), and calcium complexed with citrate or other organic ions. Ionized calcium is resorbed into bone, absorbed from the gastrointestinal (GI) mucosa, and excreted in urine and feces as regulated by the parathyroid glands. When extracellular calcium levels rise, a sedative effect occurs within the body, causing the neuromuscular excitability of cardiac and smooth muscles to decrease and impairing renal function. The calcium precipitates to a salt, causing calculi to form, and this leads to diuresis and volume depletion.
At levels above 13 mg/dL, renal failure and soft tissue calcification may occur. Hypercal-cemic crisis exists when the serum level reaches 15 mg/dL. Serious cardiac dysrhythmias and hypokalemia can result as the body wastes potassium in preference to calcium. Hypercalcemia at this level can cause coma and cardiac arrest. It is considered to be a serious electrolyte imbalance, with a mortality rate as high as 50% when not treated quickly. Hypercalcemia is a common metabolic emergency, and approximately 10% to 20% of patients with cancer develop it at some point during their disease. Prognosis of hypercalcemia associated with malignancy is also poor, with a 1-year survival rate of 10% to 30%.
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