Question

A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?

a. Restrict the patient to bed rest.
b. Encourage 4000 mL of fluids daily.
c. Institute routine seizure precautions.
d. Assess for positive Chvostek's sign.

Answer 1

In a patient with primary hyperparathyroidism and hypercalcemia, the nursing action to be included in the plan of care should be encouraging 4000 mL of fluids daily to prevent kidney stone formation and help with the excretion of excess calcium.

Step-by-step explanation:

The patient's symptoms of primary hyperparathyroidism with high serum calcium levels and low serum phosphorus levels suggest a classic presentation of hypercalcemia due to overproduction of parathyroid hormone (PTH). In managing such a patient, critical nursing actions include preventing complications related to hypercalcemia and the disease process itself. Considering the options provided, the most appropriate action would be:

• Encourage 4000 mL of fluids daily. This is important to prevent kidney stone formation due to hypercalcemia and to help with the excretion of excess calcium.

Seizure precautions and assessing for Chvostek's sign (which indicates hypocalcemia) would not be relevant in hypercalcemic states. Bed rest would be contraindicated unless there were other complicating factors, as it can exacerbate hypercalcemia.

Regulation of Calcium and Phosphate

Calcium homeostasis is critical for normal body functions and is affected by several factors, including PTH, vitamin D, and calcitonin. Hypercalcemia, as seen in this patient, can lead to harmful effects and should be managed appropriately. Hypophosphatemia may accompany hypercalcemia in primary hyperparathyroidism due to PTH-promoting renal phosphate excretion. Therefore, managing fluid intake is key in preventing further complications.