Page 251 - Saunders Comprehensive Review For NCLEX-RN

c. Malignancy (bone destruction from
metastatic tumors)
d. Immobility
e. Use of glucocorticoids
4. Hemoconcentration
a. Dehydration
b. Use of lithium
c. Adrenal insufficiency

C. Assessment (see Tables 8-3 and 8-5)

D. Interventions

A client with a calcium imbalance is at risk for a pathological fracture. Move the

client carefully and slowly; assist the client with ambulation.
1. Discontinue IV infusions of solutions containing
calcium and oral medications containing calcium or
vitamin D.
2. Thiazide diuretics may be discontinued and replaced
with diuretics that enhance the excretion of calcium.
3. Administer medications as prescribed that inhibit
calcium resorption from the bone, such as
phosphorus, calcitonin, bisphosphonates, and
prostaglandin synthesis inhibitors (acetylsalicylic
acid, nonsteroidal antiinflammatory medications).
4. Prepare the client with severe hypercalcemia for
dialysis if medications fail to reduce the serum
calcium level.
5. Move the client carefully and monitor for signs

of a pathological fracture.
6. Monitor for flank or abdominal pain, and

strain the urine to check for the presence of urinary
stones.
7. Instruct the client to avoid foods high in calcium (see
Box 11-2).
XI. Hypomagnesemia

The normal magnesium level is 1.8 to 2.6 mEq/L (0.74 to 1.07 mmol/L).

A. Description: Hypomagnesemia is a serum magnesium level
lower than 1.8 mEq/L (0.74 mmol/L).

B. Causes

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