A nurse was called to see a patient with noisy breathing. She suspects laryngospasm with stridor and it occurs commonly with

Appeared in: JIPMER Nursing Officer-2017

Explanation

Laryngospasm with stridor is a classic and life-threatening manifestation of severe hypocalcemia.
Low serum calcium levels lead to increased neuromuscular excitability, a condition known as tetany.
This hyper-excitability causes involuntary spasms of muscles, including the laryngeal muscles, which obstructs the airway and produces stridor.
Calcium's role is to stabilize nerve membranes; a deficit removes this stabilizing effect, making nerves fire more easily.

Option A: Hyperkalemia (high potassium) primarily affects cardiac function, causing arrhythmias and muscle weakness, not the hyper-excitability and tetany seen in laryngospasm.
Option B: Hypercalcemia (high calcium) has the opposite effect of hypocalcemia; it decreases neuromuscular excitability, leading to symptoms like muscle weakness, lethargy, and diminished reflexes.
Option C: Hypokalemia (low potassium) typically causes muscle weakness, fatigue, cramps, and cardiac arrhythmias (like prominent U waves). It does not cause the severe muscle spasms characteristic of tetany and laryngospasm.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical Manifestations of Electrolyte Imbalances to guide bedside assessment, documentation, and the next nursing action.
Recognizing laryngospasm as a sign of severe hypocalcemia is critical for nurses, as it represents a medical emergency requiring immediate airway management and calcium replacement.
Nurses should proactively assess for early signs of hypocalcemia, such as perioral tingling and positive Chvostek's/Trousseau's signs, in at-risk patients (e.g., post-thyroidectomy, pancreatitis, kidney disease).
What if? If the patient presented with muscle weakness and peaked T-waves on the ECG instead of laryngospasm, the priority concern would shift from hypocalcemia to hyperkalemia, requiring different interventions like administering insulin and glucose or calcium gluconate for cardiac protection.

How to Approach the Question

First, identify the key clinical signs presented in the question: 'noisy breathing,' 'laryngospasm,' and 'stridor.'
Recognize that these signs indicate a severe, spasmodic contraction of the larynx, which is a form of tetany.
Next, recall the primary functions of the electrolytes listed in the options (Potassium and Calcium).
Evaluate how an excess or deficit of each electrolyte affects neuromuscular function.
Calcium is the key regulator of neuromuscular excitability. A deficit (hypo-) leads to hyper-excitability and tetany.
Potassium imbalances primarily affect cardiac conduction and general muscle strength (weakness).

Concept Tested & Keywords

Concept Tested: Clinical Manifestations of Electrolyte Imbalances
Stem keywords: noisy breathing, laryngospasm, stridor
Lead-in keywords: occurs commonly with
Clinical cues: The patient's presentation with noisy breathing, laryngospasm, and stridor points towards a critical airway issue caused by severe muscle spasms.
Negative lead-in flag: false

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 52-54

Practise the full JIPMER Nursing Officer-2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.