How would you answer this question?
Your patient Ms. Selye was diagnosed with calciphylaxis. As her nurse you know that checking which diagnostic data is most important?
a. Blood urea nitrogen.
b. 12-lead electrocardiogram.
c. Doppler ultrasound.
d. Serum calcium level.
The correct answer is "d" serum calcium level.
Calciphylaxis is a rare condition that occurs almost exclusively in patients with chronic renal failure, who are on dialysis. It can also occur rarely in patients with hyperparathyroidism, alcoholic liver disease, or connective tissue disease. Obesity, diabetes, malnutrition, and non-compliance may pose additional risks for the development of the disease.
Calciphylaxis is caused by uremic disruption of the normal metabolic activity of the bone and results in calcification of the arteries in the large vessels leading to organ dysfunction, and to fibrosis in the smaller vessels leading to tissue ischemia and poor wound healing. Skin lesions develop suddenly and progress rapidly. Calciphylaxis has a high mortality rate and most patients die from sepsis from infected skin lesions.
Treatment is primarily supportive, by controlling the calcium level in the blood and avoiding further tissue trauma. Intravenous sodium thiosulfate is given to suppress calciphylaxis by increasing the solubility of calcium deposits, making them less likely to create calcifications in the vasculature.
This is a painful disease so adequate pain management strategies are essential. Meticulous skin care will help prevent additional lesions from forming. Also, watch for diastolic heart failure that can occur due to cardiac calcification.
Reference:
Guerrs, G. Shah, R.C. & Ross, E.A. (2005). Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: Case report. Nephrology Dialysis Transplantation, 20: 1260-2.
Congratulations to Lisa Schaubroeck who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Lisa!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
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