Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Calcium supplements

Varies by drug

Electrolyte supplement. Emergency supplementation: Calcium gluconate 2 g IV over 10 min followed by an infusion of 6 g in 500 mL D5W over 4-6 hr; oral calcium gluconate, calcium lac-tate, or calcium chloride. Asymptomatic hypocalcemia can be alleviated with oral calcium citrate, acetate, or carbonate.

Correct deficiency: IV calcium is given cautiously to patients who are receiving epineph-rine or digitalis; note that calcium can be irritating to veins when given by the IV route

Vitamin D

Ergocalciferol (Calciferol, Drisdol) 50,000-100,000 U/day PO/IM

Vitamin supplement

Stimulates absorption of calcium and phosphate from small intestine; promotes release of calcium from bone

Phosphate binders

Varies by drug

Aluminum hydroxide, aluminum carbonate

Assist in the excretion of phosphates; as phosphate levels decrease, calcium levels increase

Independent

The primary nursing goal is the prevention of hypocalcemia in the high-risk population: those patients with recent neck surgery. In addition to a careful ongoing assessment for the symptoms of hypocalcemia, the patient should have a calm environment. Tell the patient to notify you immediately if he or she has difficulty swallowing or has tightness in the throat. To prepare for emergency airway obstruction from tetany, have intubation or tracheostomy equipment available, as well as IV calcium supplements.

Once the acute phase is over, and the patient has been switched to oral medications and foods, begin patient teaching about a diet high in calcium and medications. The neuromuscular irritability and weakness place the patient at increased risk for falls. Evaluate the patient's ability to ambulate, and remove any obstructions in the patient's room. Assist the patient to identify both stressors and coping mechanisms to deal with the stressors. In particular, the patient needs to learn to avoid stressors such as fatigue and infection. Encourage the patient to ventilate feelings of anger or fear.

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