Last updated on May 18th, 2022 at 08:23 am
Hypercalcemia and Hypocalcemia Nursing Care Plans Diagnosis and Interventions
Hypercalcemia and Hypocalcemia NCLEX Review and Nursing Care Plans
Hypercalcemia and hypocalcemia are conditions that both refer to abnormal calcium levels in the blood. The normal blood calcium level is 8.5-10.3 mg/dL.
Therefore, hypercalcemia refers to blood calcium level above 10.3mg/dL, while hypocalcemia occurs when the blood calcium level falls below 8.5 mg/dL.
Calcium is a critical mineral in the body. It plays a role in the contractility of nerves, muscles, and bones.
It also helps with blood coagulation and enzymatic processes and it binds with phosphorus to strengthen bones and teeth.
When there is an imbalance of calcium levels in the body such as hypocalcemia or hypercalcemia, malnutrition, gastrointestinal problems, and even neurological issues may arise.
Signs and Symptoms of Hypercalcemia and Hypocalcemia
The clinical manifestations of both hypercalcemia and hypocalcemia depend on the rate of rise or drop in levels and the degree of how low and how high the levels get.
Hypercalcemia
- Poor feeding
- Vomiting
- Constipation
- Abdominal pain
- Hypertension
- Altered mental status
In more severe cases, the following findings may be noted:
- Hypotonia – decreased muscle tone
- Hyporeflexia – muscles are less responsive to stimuli
- Paresis – muscular weakness
- Psychosis
- Hallucinations
- Lethargy and coma
- QT interval shortening
- Ventricular dysrhythmia
- Nephrogenic diabetes insipidus
Hypocalcemia
- Fatigue
- Cramps
- Weakness
- Paresthesia – commonly affecting the perioral and distal extremities.
- Myoclonic jerk
In severe cases of hypocalcemia, the following may be noted:
- Laryngospasms and stridor
- Confusion or memory loss
- Apnea
- Seizures
- Hypotension
- Decreased myocardial contractility
- Arrhythmias
Causes of Hypocalcemia and Hypercalcemia
Hypocalcemia
- Inadequate intake of calcium-rich food
- Medications intake that decreases calcium such as high doses of bisphosphonates
- Intolerance of food rich in calcium
- Hormonal changes in women
- Genetic factors
- Hypoparathyroidism – mostly caused by surgery or an autoimmune disease
- Renal diseases leading to vitamin D inadequacy
- Abnormal blood magnesium levels
- Critical illness
Hypercalcemia
- Hyperparathyroidism or overactive thyroid – the parathyroid gland secretes hormones that trigger the bones to release calcium into the blood, the digestive system to absorb more calcium, and the kidneys to excrete less calcium and activate Vitamin D.
- Cancer – some cancers such as bone, lungs, and breast cancers can increase calcium levels in the blood.
- Other diseases such as tuberculosis and sarcoidosis can increase the levels of vitamin D which increases calcium absorption in the digestive tract.
- Heredity – familial hypocalciuric hypercalcemia is a genetic disorder involving faulty calcium receptors.
- Immobility
- Severe dehydration
- Medications that increase the release of parathyroid hormone
- Intake of calcium and vitamin d supplement
Complications of Hypocalcemia and Hypercalcemia
1. Hypocalcemia
- Spinal fractures or bone fractures
- Disability
- Difficulty walking
2. Hypercalcemia
- Osteoporosis. This condition may occur when the bones continue to release calcium.
- Kidney stones. Excessive levels of calcium in the urine can lead to crystal formations and form kidney stones.
- Kidney failure. High levels of calcium in the kidneys can cause damage to the organs and reduce their functions.
- Nervous system problems. High blood calcium levels can cause confusion, dementia, and coma.
- Arrhythmia. Calcium acts on the nerves and muscles including the beating of the heart. Irregular heart rhythms may occur due to the effects on electrical impulses.
Diagnosis of Hypocalcemia and Hypercalcemia
The signs and symptoms of hypocalcemia and hypercalcemia may be non-indicative.
Some cases are diagnosed due to routine blood tests. The following are the diagnostic procedures that help diagnose hypocalcemia and hypercalcemia.
- Blood test – blood samples are tested for calcium, free or ionized calcium, and albumin levels. It may also include testing for the parathyroid hormone levels. A blood calcium level indicating a higher or lower than normal calcium levels is indicative to make a diagnosis. However, further tests may be requested by doctors to rule out possible causes of the abnormal levels of calcium.
Normal calcium levels in adults:
Serum calcium / blood calcium level: 8.5-10.3 mg/dL
Ionized calcium (calcium bound to other minerals such as albumin): 4.4-5.4 mg/dL
- Imaging tests – scans of the bones and/or lungs may be performed to rule out cancer or sarcoidosis as causes for abnormal calcium levels.
Treatment of Hypocalcemia and Hypercalcemia
Mild cases of hypocalcemia and hypercalcemia do not always require treatment.
Regular monitoring of calcium levels and kidney function is commonly the treatment of choice in these instances.
Hypocalcemia
- Calcium supplementation. Intake of oral calcium supplements is recommended in cases of low calcium levels. The recommended dose must be taken to avoid rebound hypercalcemia and kidney stones.
- Calcium carbonate
- Calcium citrate
- Calcium phosphate
- Calcium injections. Oral supplementation of calcium tablets may not always work. When this happens, injectable calcium is given intravenously under close monitoring. Rapid injections of calcium can cause serious dysrhythmia.
Hypercalcemia
- Medications. A range of medications such as calcitonin can be used to lower blood calcium levels depending on the cause of the condition.
- Surgery. A surgical procedure to remove overactive parathyroid glands can be performed. Only one of four glands is commonly affected in most cases. The use of a special scanning device can identify the overactive gland through the help of a small amount of radioactive contrast.
Nursing Diagnosis for Hypercalcemia and Hypocalcemia
Hypercalcemia and Hypocalcemia Nursing Care Plan 1
Nursing Diagnosis: Electrolyte Imbalance related to hypocalcemia as evidenced by serum potassium level of 7.5 mg/dL, fatigue, muscular cramps, weakness, paresthesia in the perioral and distal extremities, and myoclonic jerk.
Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
| Hypercalcemia and Hypocalcemia Nursing Interventions | Rationale |
| Obtain daily blood sample from the patient. | Biochemistry is needed to check for the level of serum calcium. |
| Encourage the patient to meet the daily recommended intake of dietary calcium and vitamin D. | To replace calcium lost by the body. It is recommended for an adult to have 500 to 700 mg a day of calcium and 800 to 1,000 IU of vitamin D. This can be achieved by taking 1 to 2 servings of dairy products per day. |
| Administer calcium supplements as prescribed. | Intake of oral calcium supplements is recommended in cases of low calcium levels. |
| Educate the patient about calcium injections and administer if prescribed. | Oral supplementation of calcium tablets may not always work. When this happens, injectable calcium is given intravenously under close monitoring. Rapid injections of calcium can cause serious dysrhythmia. |
| Assist the patient in performing activities of daily living as required. | Hypocalcemic patients usually experience fatigue and body weakness, and therefore may require help in performing ADLs. |
Hypercalcemia and Hypocalcemia Nursing Care Plan 2
Nursing Diagnosis: Activity intolerance related to hypotonia and abdominal pain secondary to severe hypocalcemia, as evidenced by decreased muscular tone, pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
| Hypercalcemia and Hypocalcemia Nursing Interventions | Rationales |
| Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. | To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance. |
| Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest. | To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest. |
| Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. | To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room. |
| Refer the patient to physiotherapy / occupational therapy team as required. | To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity. |
Hypercalcemia and Hypocalcemia Nursing Care Plan 3
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.
| 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. |
Hypercalcemia and Hypocalcemia Nursing Care Plan 4
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. |
More Hypercalcemia and Hypocalcemia Nursing Diagnosis
- Constipation (Hypercalcemia)
- Confusion (Hypercalcemia)
- Fatigue (Hypocalcemia)
- Impaired Physical Mobility (Hypocalcemia)
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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