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♥Jaclyn Yap♥Sheena Cogo
HyperPhosphatem
ia
Phosphorus(Phosphate)
Function:• Essential for function of Muscle and RBC• Essential for formation of ATP and 2,3-
diphosphoglycerate(facilitates release of oxygen from hemoglobin)
• Maintenance of acid-base balance as well as Nervous system
• Metaboliism of CHON, CHO, Fats
Risk Factors1. Excessive Intake of phosphorous
Food rich in phosphorous Laxatives and enemas containing phosphate Intravenous phosphate supplementation
Manifestation:Serum level above 4.5 mg/dL in adults
And 6 mg/dL in children
HYPERPHOSPHATEMIARepresents a plasma phosphorus
concentration in excess of 4.5 mg/dL in adults.
VALUESExtracellular – 2.5-4.5 mg/dLIntracellular – 4 meq/kg
Risk Factors2. Rhabdomyolysis3. Chemotherapy
Tumor lysis syndrome
Manifestation (neuromuscular)ParesthesiasTetany
Risk Factors4. Renal Insufficiency
Kidney Failure
5. Hypoparathyroidism deficiency of PTH
Manifestations Hypotension Cardiac Dysrythmias
Risk Factors
6. Vitamin D intoxication
7. DKA (diabetic ketoacidosis)
8. Trauma
Signs & Symptoms
• Neuromuscular manifestation– Paresthesias & Tetany– bone and joint pain due to calcification– muscle weakness– hyperflexia
Signs & Symptoms
• Cardiovascular manifestations• Hypotension
– cardiac Dysrythmias– tachycardia
• GI– anorexia– nausea & vomiting
Nursing Mngt.
• Dietary restriction of foods that are high in phosphate– Hard cheese– Cream– Nuts– Meats– Whole-grain cereals– Dried fruits– Dried vegetables– Sardines– Food made with milk– Poultry
Nursing Mngt.
• Explain to the patient the importance of a balanced diet.
• Monitor daily food intake• Weight daily• Maintain adequate fluid intake(2-3L/day)• Instruct patient to avoid phosphate containing
substance such as laxatives and enemas.
Nursing Mngt
Safety• Keep side rails raised, bed in low postion and open
airway(windows) at bedside• Avoid use of restraints• Monitor serum calcium level• Provide a quiet environment and seizure precaution as
appropriate • Administer phosphate binding agents, helpful in lowering
elevated phosphorous levels associated with hypocalcemia.• Teach the patient to recognize signs of impending hypocalcemia
Medical Mngt.
• Vitamin D preparation such as calcitriol– Oral = Rocaltrol– Parenteral = Calcijex, Paricalcitol (Zemplar)
• Hemodialysis• Phosphate binders• Resin binders– Sevelamer (Renagel)
Medical Mngt.
• Diuretics• Surgery may be indicated for removal of large
calcium phosphorus deposits
Diagnostic Test
• Serum CalciumUseful for diagnosing the primary D/O and
assessing the effects of treatment. Serum calcium < 9 mg/dl
• Serum phosphorusSerum phosphorus levels exceeds 4.5 mg/dL in adults, 5.4 mg/dL in children
• Urine phosphorus– < 0.9 g/24 hours
Nursing Diagnosis
• Knowledge deficit r/t excessive intake of phosphorus and Vit. D
• Decreased cardiac output r/t shifting of fluid from blood to muscles secondary to rhabdomyolysis.
• Imbalanced Nutrition: less than body requirements r/t insufficient intake to meet metabolic demands due episodes of nausea & vomiting, and anorexia.
Nursing Diagnosis
• Activity intolerance r/t muscle weakness secondary to hyporcalcemia
• Risk for injury r/t increased neural excitability secondary to hypocalcemia
END
Reference:•Books:
Ignatavicius (2006), Medical Surgical Nursing 5th Edition, volume 1, pg 243Porth, Carol (2005), Pathophysiology 7th Edition, pg 746, 782-783Smeltzer, Suzzane (2008), Brunner & Suddarths Text Book of Medical Surgical Nursing 11th edition, volume 1, pg 331-333
•Internet:•http://Emedicine.medscape.com/article/767010-overview