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395 Cards in this Set

  • Front
  • Back
Bouchard's Nodes
raised bony growths over the proximal phangeal joint of the hand, less frequent than heberdean's nodes in osteoarthritis
Cancellous Bone
a spongy bone resulting from structural units fitting loosly together leaving many spaces between bone tissue.
Compact bone
a dense structured bone resulting from structural units fitted closely together,
Compartments Syndrome
occurs when circulation to a compartment is impeded due to excessive pressure against the non elastic fascia
What does Compartments syndrome result in?
tissue death and nerve injury
a pulling force exerted in the opposite direction to prevent the client from sliding to the end of the bed
a grading or popping sound caused bones rubbing together
degenerative joint disease
a slowly progressive disorder or articulating joints esp weight bearing, primarily affecting middle aged to older adults
a metabolic disorder char by elevated uric acid levels in the blood resulting in deposition of uric crystals in synovial fluid and joint tissues
Heberden's nodes
raised bony growths over distal interphalangeal joints that occur freq. in osteoarthritis and are a common manifestation of the disease in women.
Internal fixation
a surgical implanted fracture immobilization device to realign a fracture
a surgical incision of the lamina, done to relieve symptoms related to intervertebral disk
a acute or chronic infection of the bone usually caused by staph aureus organism
disease char by low bone mass and deteroration of bone tissue causing the bone to become fragile and susceptible to fractures
a stretch and/or tear of a ligament
a stretch or tear of muscle fibers
direct pulling force applied to a fractured extremity that results in realignment of bone
what are the two classifications of bones?
compact (dense) cancellous (spongy)
Why is a fracture worse than a tear?
fracture takes longer to heal, reduction in calcium, RBC production
a decreased H and H means?
RBC prod down, O2 to RBC's down, # RBC's down
What is the most common test of musculoskeletal problems?
X Ray
Post arthroscopy nsg implications
take pain meds, limit activity, look for hemotoma or bleeding, NV assessment, temp color cap refill sensation, teach S/S of infect
contrast media injection, series of pics taken while ct. moves joint
Pre op edu for arthrogram
feeling of warmth, nausea, H/A, itching, hives, rash, salty tast
post op edu arthrogram
temp discolor of skin and urine normal , ck NV status of site
CT Scan
combines Xrays with comp. tech to get cross section of structures of body
ct edu for CT scan
if dye is used, increase fluid intake, monitor evac of contrast media, white stools normal,
Bone scan
tech used to create images of bones on a comp screen or film using a sm amt of radioactive material traveling through blood stream
What in a bone scan details blood flow to a bone
the amount of dye absorption
What are the 4 types of bones?
long, short, flat, irregular
What type of tissue is bone?
What is responsible for laying down new bone?
What are the 5 functions of bone?
support, protection, movement, hematopoiesis, mineral homeostasis
In what way do bones provide support?
provide skeletal framework, and give form and shape of body
How do bones provide protection?
protect body organs
How do bones provide movement?
muscular attachments to one and by joint movement
What is hematopoiesis?
formulation of RBC's
Where are RBC's formed
bone marrow
If the RBC's are being formed outside of the marrow what is this a sign of?
how do bones provide mineral homeostasis
bones store CA, phosphate, carbonate, magnesium
what is remodeling?
process by whcich existing bone is resorbed and new bone replaces the old
Where is 99 percent of the bodies calcium found?
What is necessary for bone formation
What has an inverse relationship with calcium?
What controls calcium and phosphorus
What results in the release of phosphorus?
bone resorption
What inhibits bone resorption
What vitamin elevates calcium and phosphorus?
vitamin D
Where is Growth hormone secreted?
anterior lobe of pituitary gland
What is a manifestation of decreased levels of GH?
What is a manifestation of increased levels of GH?
what regulates the metabolism of proteins
What stimulates osteoblast activity and inhibits PTH?
What happens if a bone is not stressed?
bone resorption
what are the three types of muscle?
visceral, cardiac, skeletal
what is each skeletal muscle covered in?
tonic contraction
continual partial contraction that is vital in the maintenance of posture
Isotonic contraction
tension within the muscle is constant but the length of muscle changes
Isometric contraction
tension within the muscle increases, but muscle does not shorten
a twitch contraction
jerky reaction to a single stimulus
tetanic contraction
more sustained contraction than the twitch produced bhy a series of stimuli in rapid succession
spasm contraction
involuntary contraction caused by stimulation of an entire motor unit
treppe contraction
stronger twitch contractions in response to regularly repeated
Fibrillation contraction
a synchronous contraction of individual fibers
convulsive contractions
abnormal uncoordinated tetanic contractions cocurring in varying groups of muscles
what sets off the contraction of a muscle?
What is the most common type of cartilate
what is cartilage?
composed of fibers embedded in a firm gel, strong but flexible
What are ligaments?
parallel angds of flexible, dense fibrous connective tissue
What is the primary function of ligaments
connect the ends of bones and provide stability
Ligaments and movements
ligaments permit movement in some directions but limit it in others
What are tendons?
bands of dense fibrous tissue that ofrm the origin of muscle to bone
What is bursae?
small sacs of connective tissue located wherver pressure is exerted over moving parts.
what are joints
places where bones come together and allow movement
What happens with cartilege when you age?
it becomes more rigid
How much bone mass has a women usually lost by age 70
when does muscle strength reach its peak
25 to 30 years
what is sarcopenia
age-related skeletal muscle loss
How does bone change with aging?
decreased total bone mass, impaired osteoblastic activity, resorption exceeds growth, erosion of haversian systems, corticol bone changes to cancellous bone
What are potential problems with bones and aging?
osteoporosis, pathologic fracture, delayed healing
Changes in muscles with aging?
decline in strength past 70 years, decline in # of muscle fibers, decrease in muscle mass, atrophy of muscle cells
What are some potential problems with muscles and aging
weakness, uncoordination, disuse atrophy, slow unsteady gait, poor posture, falls, contractures
Changes with joints and aging
decreased elasticity of cartilage, increased susceptibility to tears in cartilage
potential problems with joints and aging
arthritis, decreased range of motion, contractures
What races are at a greater risk for osteoporosis?
asians, caucasians
what is posture indicative of?
char of specific prob like scoliosis, kyphosis
What does being overweight possible indicate
diminished ability to perform reg. exercise or activity, excess weight causes increased stress on joints
Underweight risk factors
inability to make nutricious meals, may relate to anorexia, N/V or malabsorption of food
a malnourished female is at risk for?
What happens to skin with aging?
down turgor, thinner skin,
What are individuals with limited mobility subject too?
skin breakdown, pressure ulcers, watch for shearing forces
what does warmth over a joint possible indicate
inflammation or infection in a joint
What does a bony enlargment in a joint show?
disease process
What are subcutaneous nodules indictative of?
rheumatoid arthritis,
What are tophaceous deposits indictative of?
what is a swan neck deformity?
flexion and hyperextension of joints in hand
In what disease is a swan neck deformity found?
rheumatoid arthritis
What is a ulnar deviation
fingers deviate at the metacarpophalangeal joints toward ulnar aspect of hand
What is a valgus deformities
distal arm of the angle of the joint points away from the midline of the body
hallux valgus
great toe turn towards other toes
genu valgum
knock knees
talipes valgus
eversion of the foot
genu varum
bowing of knees
talipes varus
inversion of foot
lateral curvature of spine
throacic spinal curvature, posterior
reduction in size of extremity or body part
abnormal enlargement of an organ or body part
pes planus
flat feet
pes cavus
high instep
range of motion
normal arc of movement provided for by the structure of a joint
What ROM is performed independently?
What ROM is performed with the assistance of someone else
scoliosis screening
forward bend test to observe symmetry and height of scapulae, shoulders, iliac crests, rib cage
what is a myelography
radiologic examination of the spinal canal
What is elevated in serum muscle enzymes
muscle diseases
What levels are most commonly used to diagnose and monitor treatmetn of muscular dystrophy
What should be avoided when aldolase is being monitored
IM injections
What are enzyme levels an index of?
both the progress of myopathic disorders and effectiveness of treatment
normal values of AST
8-20 U/L
normal aldolase values
3-8.2 U/dl
CPK-MM normal value
90 to 97%
What does the FTA-ABS exclude
presence of syphalis
what is the rheumatoid factor?
found in individuals with rheumatoid artritis
What is the level of RA to be considered positive
titrations of 1:40 or more
erythrocypte sedimentation rate
ESR indicates what?
increased rate of settling of erythrocypes is an important index or presence of inflammation
Serum complement
low levels show rheumatoid arthritis
Normal vales of ESR?
< 15mm/hr men and < 20 mm/hr female
What are symptoms of anemia?
extreme tiredness, fatigue, weakness,
normal hematocrit levels
45-50 men, 40 - 45 female
normal values of calcium
total 9 - 10.5
What is monitored in treatment for osteoporoisis
What does ALP stand for?
alkaline phosphatase
What with calcium plays a vital role in bone metabolism
normal phosphorus levels
What is used as nonspecific indicator of infection and inflammation
C reactive protein
24 hour urine test is used to determine
creatine creatinine ratio
with muscle disease the ability of muscle to convert creatine is
the amount of creatine excreted by kidneys is ? in muscle disease
Urinary uric acid levels are helpful in ?
diagnosis and decisions regarding treatment modialities for gout
What is the normal value in urinary uric acid levels?
not exceeding 900 mg uric acid excretion a day
what type of biopsy is used on the skin?
punch biopsy
What type of procedure is a muscle biopsy
operative procedure
how does inadequate immobilization effect bone healing?
movement of fragments
how does poor approximation of fracture fragment impede bone healing
inaccurate reduction or malalignment of fracture fragments
How does a compromised blood supple impede bone healing?
damage to nutrient vessels, periosteal or muscular injury, severe comminution, avascularity
How does excessive edema at fracture site impede bone healing?
tissue swelling impedes supply of nutrients to area of fracture
how does bone necrosis impede bone healing
injury to blood vessels impedes supple of nutrients to involved bone
how does an infection at the fracture site impede bone healing
an infection disrupts normal clalus formation
how do metabolic disorders or diseases impede bone healing
retard osteogenesis
how does soft tissue injury impede bone healing
disruption of blood supply
how does medication use impede bone healing
steroids cause osteoporosis
what can long term use of heparin cause?
What type of film can be used to document healing
1st step in treating a fx
maintinaing airway and assessing for signs of shock
2nd step in treating a fx
splint the fracture
why do you splint the fracture
to prevent movement that may cause further injury, also can decrease pain
What is the 3rd thing you do in tx of a fracture
preserve correct body alignment
What is the 4th things you do in tx of a fracture
what do you do after you elevate a fracture
apply cold packs
What does applying cold packs to a fracture do?
reduces hemorrhage, edema and pain
How long after a fracture are cold packs useful?
24 hours
What do you observe for after all other steps of treating a fx are completed?
color, sensation, circulation, movement and temp
What is the most common type of external fixation device
What is the mechanism by which a steady pull is exerted on a part or parts of the body
When is traction used?
reduce a fracture, maintain correct alignment of bone frag, immob. a limb, overcome muscle spasm, stretch adhesions, correct derformities
What is countertraction
a force that counteracts the pull of traction
What is generally the thing that provides countertraction
the body
What type of traction uses the body as countertraction
What is suspension?
use equip to suspend not pull on a body part
What are the two types of traction?
skin and skeletal
What are the two most common types of skin traction?
bucks and russells
What is traction applied directly to the bone
skeletal traction
What is used in conjuction with skin or skeletal traction to give the pt more movement
balanced supension
In traction, should ropes be straight and run straight through pulleys?
What do you do when you are adjustion traction for a pt.
remove the weights
when a person is in traction, should you encourage them to change positions as much as possible
What are the guidelines for positionng a pt with a fx?
maintain align, maintin direction of pull of traction, integrity of cast, positioning,
What are guidelines for pt in a cast?
see page 148
what is leading cuase of nonunion and delayed nion
What is the primary symptom of infection
What is pseudoarthrosis
impaired fx healing
complex regional pain syndrom
what are fracture blisters
skin bullae and blisters representing areas of epidermal necrosis with separaion of the stratified squamous cell layer by edema fluid
Can fracture blisters be caused by compartmetn syndrome
fat embolism syndrom
when is FES most common
fractures of the pelvis, femur and tibia
what are some symptoms of FES
hypoxemia, tachypena, tachycardia, petechiae, fever, lipuria, chest pain, etc
pathophysiology of FES
fat globules released from marrow following fracures enter the bloodstream and obstruct pulmonary circulation
Pato of PE
DVT dislodges and obstructs pulmonary circulation
When does a FES usually occur?
1-4 days after injury
when does a PE usually occur?
4-10 days after trauma of devel of thrombophlebitis
What are some symptoms of a PE?
dyspnea, chest pain, apprehension, anxiety, cough, hemoptysis, fever
What are some risk factors of FES?
hypovolemia, shock, delayed immobilization of fracture, multiple fractures
What are some risk factors of PE
venous stasis, immobility, obesity, trauma, major sx, hx heart disease, older than 40, hx of DVT
What is compartment syndrome
complication of trauma in which increased pressure within a limited anatomic space compromises circulation, and fx
Waht is acute compartment syndrom usually a complication of?
What is chronic compartment syndrome caused by
people active in sports,
What are the bleeding causes of compartment syndrome?
vascular injury, coagulation defect
What are the excessive muscle use causes of compartment syndrom?
exercise, seizures, tetany eclampsia
what are the trauma causes of compartment syndrome
fractures, crush injuries, hypothermia, frostbite, burns, snake or spider bites
What is the leading cause of morbidity and mortality in the elderly population
hip fractures
risk factors for osteoporosis
advanced age, female and white, down estrogen levels, alzheimers, institutional residence
intracapsular hip fracture
femoral neck, iwthin the hip join t and capsule
outside the hip joint and capsule to an area 5 cm below lesser trochanter
S/S of hip fracture
severe pain at fracture site, inability to move leg, external rotation, shortening,
Nsg management of hip fx
pt teaching, NV checks, anticoagulants, read pgs 1491 to 1493
Mild Class one soft tissue injuries
stretching ligament without tear
moderate class 2 injuries
several ligament fibers torn with a partial loss of function
severe, class 3 injuries
sever or complete disruption of the ligament with resulting instability
S/S class 1 injuries
mild pain, and swelling
S.S class II injuries
moderate pain and swelling,
Class III injuries S/S
sever pain, swelling joint instability and disability loss of fx
rest, ice, compression, elevation
how long should you ice a soft tissue structures
48 to 72 hours
early symptoms of RA
fatigue, weight loss, fever, malaise, morning stiffness, pain at rest and with movment, night pain, edema
late symptoms of RA
pallor, anemia, color changes, muscle weakness, joint deformities, decreased joint mobility, contractures,
in RA how long does morning stiffness last
greater than an hour and at least 6 weeks in duration
how long will a pt have swelling of joints for RA
6 weeks
Medications for RA
PG 1511
endoscopic examination of a joint
opening of a joint
reconstruction of a joint
interposition arthroplasty
replacement of part of a joint with a prosthesis or with soft tissue
replacement of one articulating surface
total knee arthroplasty
removal of part or all of the synovial membrane
cutting a bone to change its alignment
surgical fusion of a joint
tendon transplants
moving a tendon from its anatomic position
degenerative joint disease
PG 1523
DJD and pain
worse with weight bearing, improves with rest, paresthesia
Pain meds for OA
PG 1525
Pt with Total knee
PG 1531
review preop and post op care for pts
chp 47
post op care
home instructions for total hip pts
review complications of total joint arthroplasties
pg 1541
causes of secondary gout
what is podagra
food pain
lab studies and gout
increased uric acid levels usually 24 hours
good choice for therapy for pts with gout
red wold
systemic lupus erythematous
Who does SLE usually affect?
women of childbearing age
what is the most common cause of death in lupus
kidney failure
risk factors for osteoporosis
aging, female, nulliparity, family hx, vit D deficiency, sedentary lifestly,
what is the most common bone disorder in the western world
What are the two types of osteoporosis
type 1: post menopausal
Type 2: senile
DIFFERENCES BETWEEN TYPES 1 and 2 osteoporosis
PG 1556
single photon absorptiometry
single xray absorptionmetry
dual photon absorptionmetry
dual energy absorptiometry
quantitative CT
quantitative ultrasound
common meds for osteoporosis
PG 1560
nsg management of pt with osteoporosis
starts pg 1562
what is another name for infectious bone disease?
What are contiguous focus or exogenous osteomyelitis caused by?
pathogen from outside the body
what is the most common offending organism for exogenous osteomyelitis
staph aureus
what type of osteomyelitis is caused by bloodborne pathogens originating from infectious sites iwthin the body
hematogenous osteomyelitis
which type of osteomyelitis is most commonly found in infants, children and older adults
hematogenous osteomyelitis
What is stage 1 osteomyelitis called
what is stage 2 osteomyelitis called?
what is stage 3 osteomyelitis called?
what is stage 4 osteomyelitis called?
in osteomyelitis, what happens to WBCs ESRs and C reactive protein levels
what are the goals of treatment of osteomyelitis
complete removal of dad bone and affected soft tissue, control of infection, elimination of dead space
what is external fixation?
transfixing pins are inserted through the bone above and below the fracture and then attached to a rigid external frame
what is orthopedic sx?
various sx procedures involving the skeletal system and its joints, muscles, and associated structures
what is a bone graft?
taking one part of a bone and placing it somewhere else to help another bone heal
what are the purposes of orthopedic sx
reconstruction, replacement, removeal, repair
what type of hip fracture occurs at the head and neck
what type of hip fracture occurs at the trachanter
what type of hip fracture occurs under the trochanter
what are most hip fractures caused by
are hip fractures medical emergencies
what are some nsg interventions for a person with a hip fracture
prepare sx, traction care, abductor pillow, trochanter roll, pain control, reorient
what is a stretch or tear of a ligament
what is a twist, pull and or tear that may involve muscles or tendons
what is the etiology of a sprain or a strain
direct or indirect trauma, overuse or prolonged repetive motion, inadequate rest during intensive training
how are sprains classified
based on degree of ligament injury
what is a chronic progressive disease involving inflammation of synovial joints
at what age does RA occur
all ages
What is the known cause for RA
there is not one, thought to be autoimmune
when is RA exacerbated
increased physical or emotional stress
what does RA affect
may affect only joints, or may extend to body organs and blood value
for RA how is nsg care directed?
relievign painand maintaining function
another name for osteoarthritis
degenerative joint disease
what is a slowly progresive disorder of articulation joints esp weight bearing joints
Where is osteoarthritis common?
feet knees hips back
what areas are damage from osteoarthritis limitied too?
to joint and surrounding tisse
what is the etiology of osteoarthritis
cartilage degeneration causes bones to rub against each other, pain and decreased function of joints
what refers to reconstruction or replacement of a diseased or damaged joint
what does an arthroplasty do?
reduces or eliminates pain, restores fx, provides joint stability, prevent complications,
what are the common sites of arthroplasty
hip knee
what type of blood transfusion can you do with an arthroplasty
what are some nsg interventions of hip fx's
avoid extremes of internal rotation
what are some home instructions for hip care
pain management, dsg changes, monitor for infection, monitor and adjustment of coagulation studies, exercise programs
What type of antibiotics are given with a hip
prophylactic antibiotics
What do you do when positioning a knee
avoid hyperflexion, and use pillows
what type of machine to some people wake up in after a TKA
CPM machine
What are the home instructions for a knee sx
weight bearing restrictions, exercises, prophylactic antibiotics, routine follow up
what is a metabolic disease marked by urate crystal deposits in joints that cause local irritation and inflammatory responses
what is the primary form of gout caused by
how is the secondary form of gout received
what is gout char. by?
recurring attacks of acute joint inflammation
Gout is the inherited abnormality in the bodies ability to process what?
uric acid
what is hyperuricemia caused by?
increased purine synthesis and or decreased renal excretion of uric acid
what can an elevated serum uric acid level be caused by
prolonged fasting and excessive alcohol intake
what are some risk factors for gout
increased alcohol intake, chemo and a decreased renal system
what are some symptoms of gout
inflammation, pain, no pressure
what are some precipitating factors of gout
dehydration, and stress
what lab test are used to dx gout
WBC, CBC renal panel
what meds are used for Gout
anti inflammatory, colchicines, NSAIDS, corticosteroids,
What is a chronic systemic inflammatory disease affecting multiple body systems
lupus SLE
a form of lupus affecting the skin only
what is the more common form of lupus
when do you have a good prognosis with lupus
early detection and treatment
what do most pts with lupus usually die from
renal failure
what is a disease char by low bone mass and structural deterioratoion of bone tissue causing the bone to becomefragile and more susceptible to fxs
factors that influence osteoporosis
again, bone resorption greater than bone formation
what electrolye decreases with osteoporosis
who is at the greatest risk for osteoporosis
what are some common meds for osteoporosis
estrogen, calcitronin, fosamax, evista, actonel
what is an acute or chronic infection of the bone usually caused by staph aureus org
what causes a direct osteomyelitis
invasive procedures
what is another name for indirect osteomyelitis
hematogenous dissemination
what type of osteomyelitis is spread of the infectious organism through the blood
what are some medical interventions for osteomyelitis
debridement, grafts, flaps, stabilization, antibiotic beads, revascularization procedures, hyperbaric O2
what are solutes that are found in body fluids
what happens when solutes dissolve
form ions
what are some sources of electrolytes
all food and fluids are normal, meds, IV and hyperalimentation abnormal
what are the roles of electrolytes
conduct electricity across cell membranes, maintain osmolality, reg bal of acid and bases, adi in neurologic and neuromuscular conduction, enzyme reaction
What do electrolytes balance
electrical neutrality, move from one side of the cell membrane to another to maintain neutral state
potassium, phosphorus
sodium, protein, bicarb, chloride
how are the concentrations of electrolytes expressed as
mEq/L or mg/dL
what increased renal excretion
increased GI eliminiation increases
hydrogen and potassium loss
decreased GI elimination decreases
bicarbonate lost
what are the types of renal electrolyte regulation
glmerular, tubular, secreion
what is secretion electrolyte regulation
electrolyte moves from the blood into the tubule
what type of renal regulation is like a sponge
what type of renal regulation is like a coffee filter
what enhances the release of aldosterone
what acts to reabsord Na
when aldosterone acts to reabsorb sodium, what happens to potassium
it is excreted
where are electrolypes secreted, absorbed, and exchanged
GI tract
where does exchange between anions and cations occur
small bowel
what is the normal range for sodium
what are the functions of sodium
impulse transmission, influences level of K+ and Cl, assist with acid/base balance
what determines osmolarity of the ECF and regulates body water
what does sodium regulate in the renal systen
filtration and reabsorption
what does sodium regulate in the endocrine system
secretes aldosteron and ADH
what is hyponatremia
sodium deficiency less than 135 meg/l resulting from excessive sodium loss or excessive water gain
what is hypernatremia
sodium excess, na level above 145, gain in na in excess of water or a loss of water in excess of sodium
what is the etiology of hypernatremia
water loss, inadequate water replacement, inability to swallow, excessive sodium intake
nsg management for hypernatremia
maintian normal fluid balance, protect from injury, prevention
what is the normal range for potassium
3.5 to 5.5
what does K+ exchange with to regulate osmolarity of ECF
what balances the electrical potential b/t ICF and ECF
what causes neuromuscular contractions
what type of muscle activity does potassium control
skeletal, smooth, cardiac
what maintains the acid-base level
what mechanism dos potassium regulate
renin-aldosterone mechanism
what is hypokalemia
K+ deficiency
what is the cause of hypokalemia
inadequate dietary K+ intake, excessive ions, metabolic akalosis, hyperaldosteroneism
what is hyperkalemia
K+ excess
what is the etiology of hyperkalemia
decreased renal excretion, hypoaldosteroneism, acidosis, severe tissue trauma, excessive intact
nsg management of hyperkalemia
therapy to reduce level, kayexalate, calcium gluconate, sodium bicarb, reg insulin, glucose hemodialisis
normal range for calcium
8.5-10 mg/dl or 4.5 to 5.5 meq/l
what is calcium regulated with
magnesium and phosphate
what controls bone and teen strength and rigidity
what is calcium bound to
what is the enzymatic co factor for blood clotting
what regulates cell membrane structure and function
what helps K+ to reg. the contraction of skeletal smooth and cardiac muscle
what does calcium regulate
GI absorption and Vit. D,
how is calcium handled in the renal system
filtered and reabsorbed
how does the endocrine system interact with calcium
calcitonin and parathyroid gland
what is hypocalcemia
calcium deficiency
what is hypocalcemia primarily caused by
surical removal of the thyroid
what disease causes abnormal absorption of calcium in the GI tract
what can inadequate levels of Vit D cause
can renal failure cause hypocalcemia
nsg management for hypocalcemia
calcium replacements, precautions, admin Vit D, patient teach, monitor level
excess level of calcium
etiology fo hypercalcemia
excessive admin or intake, prolonged immobilization, decreased renal excretion, hyperparathyroidism
what can help reduce calcium levels
iv saline, iv phosphate, lasix,