Need help with Careplan (hyperphosphatemia)

YOu patient has HUGE reasons for hyperphosphatemia.......like the gunshot wound, immobility....have they received tube feedings or TPN?

Patients with hyperphosphatemia most commonly complain of muscle cramping secondary to low calcium levels. This may progress to tetany, delirium, and seizures. A search for the following historical clues may help identify those patients at risk for increased phosphorus levels.

• Renal disease
  
  • Past or present hemodialysis
    
  • Adherence to renal (low phosphorus) diet
    
  • Use of oral phosphate binders
    

  [*]Cancer

  • Leukemia
    
  • Lymphoma
    
  • Bone tumors
    
  • Other cancers
    
  • Chemotherapy treatment
    

  [*]Endocrinopathies

  [*]Trauma

  [*]Burns or heat-related illnesses

  [*]Prolonged immobilization

  [*]Metabolic or hematologic disorders including genetic predisposition

  [*]Medications

  • Oral phosphate binders
    
  • Potassium phosphate
    
  • Antacid use
    
  • Bisphosphonate therapy
    

  [*]Use of laxatives (oral/rectal) and enemas

  [*]Use of nutritional supplements or hyperalimentation

  [*]Ischemic bowel (possible phosphorus elevation)

The most common cause of hyperphosphatemia is renal failure. Less common causes can be classified according to pathogenesis, ie, increased intake, decreased output, or shift from the intracellular to the extracellular space. Often, several mechanisms contribute. Impaired renal excretion is most frequently the major factor, with relatively increased intake or cell breakdown contributing to the problem. http://emedicine.medscape.com/article/241185-clinical#a0218

• Increased intake
  
  • Excessive oral or rectal use of an oral saline laxative (Phospho-soda)
    
  • Excessive parenteral administration of phosphate
    
  • Milk-alkali syndrome
    
  • Vitamin D intoxication
    

  [*]Decreased excretion

  • Renal failure, acute or chronic
    
  • Hypoparathyroidism
    
  • Pseudohypoparathyroidism
    
  • Severe hypomagnesemia
    
  • Tumoral calcinosis
    
  • Bisphosphonate therapy
    

  [*]Shift of phosphate from intracellular to extracellular space

  • Rhabdomyolysis
    
  • Tumor lysis
    
  • Acute hemolysis
    
  • Acute metabolic or respiratory acidosis
    

  [*]Spurious

  • Blood sample taken from line containing heparin or alteplase^{[28, 29]}
    
  • High concentrations of paraproteins^[30]
    
  • Hyperbilirubinemia^[31]
    
  • In vitro hemolysis
    
  • Hyperlipidemia^[32]
    

You're welcome....:)