A nurse is caring for a client who has had thyroid surgery. The client’s calcium result has returned at 7.5 mg/dL. Which nursing interventions are necessary based on this calcium level? Select all that apply.

 

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Correct

- Implement seizure precautions

- Assess for signs of hypocalcemia

- Assess for signs of hypercalcemia

- Administer intravenous furosemide

- Administer intravenous calcium gluconate

Rationale

-"Implement seizure precautions", "Assess for signs of hypocalcemia" and "Administer intravenous calcium gluconate" are correct. The client who has had thyroid surgery is at risk for hypocalcemia due to possible trauma to the parathyroid. Normal calcium levels are 8.4-10.2 mg/dL, so a level of 7.5 mg/dL indicates hypocalcemia. The nurse should assess for signs of hypocalcemia, which include numbness or tingling of the face and extremities, muscle cramps, cardiac dysrhythmias, and a positive Chvostek's sign. Chvosteks' sign occurs when you tap the facial nerve and the facial muscle twitches on the respective side.) Calcium gluconate is given to increase the serum calcium level.
-"Assess for signs of hypercalcemia" is incorrect because the client has a low calcium level.
-"Administer intravenous furosemide" is incorrect because IV diuretics can further lower serum calcium levels which is contraindicated in this client.

References:
Sofronescu, A. (2018, April 11). Serum Calcium: Reference Range, Interpretation, Collection and Panels. Retrieved July 3, 2018, from https://emedicine.medscape.com/article/2087447-overview
Goyal, N. (2018, May 08). Thyroidectomy: Overview, Preparation, Technique. Retrieved July 3, 2018, from https://emedicine.medscape.com/article/1891109-overview#a4

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