Patient Care and Monitoring Hypercalcemia

1. Determine the disease status of the patient—Is the patient newly diagnosed or has the patient had multiple episodes of hypercalcemia and is becoming refractory to calcium-lowering therapy?

2. Assess the patient's symptoms and serum calcium level to determine appropriate therapy. Is the patient taking any medications that may elevate the calcium level, inhibit its excretion, or affect renal function?

3. Educate the patient regarding the importance of oral hydration and ambulation if an outpatient. Counsel to immediately report any worsening signs or symptoms.

4. Develop a plan to maintain normocalcemia chronically using monthly bisphos-phonates.

• Monitor patients for relief of symptoms and restoration of fluid balance.

• Monitor the serum calcium level, serum albumin, serum BUN and creatinine, and electrolytes daily during therapy.

• Assess the fluid balance by daily input/output, weights, and signs of fluid overload.

• Monitor the ECG in patients with cardiac manifestations until normalized.

• Repeat doses of bisphosphonate after 5 to 7 days if the patient does not become normocalcemic.

• Reassess patient status in terms of refractoriness to treatment to determine if treatment should be changed

5. Evaluate the patient for drug interactions, allergies, and adverse effects with calcium-lowering therapy.

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