Sign of hypocalcaemia

VSSC Nursing Officer - 2021

Medical & Surgical Nursing

Easy

Appeared in: VSSC Nursing Officer - 2021

Explanation

Trousseau's sign is a specific clinical finding used to identify latent tetany in patients with hypocalcemia (low blood calcium).
It is elicited by inflating a blood pressure cuff on the upper arm above systolic pressure for up to 3 minutes.
A positive sign, as seen in the image, is a carpopedal spasm: flexion of the wrist and metacarpophalangeal joints, extension of the fingers, and adduction of the thumb.
This response occurs because the ischemia induced by the cuff exacerbates the neuromuscular irritability caused by low calcium levels.
It is considered more specific for hypocalcemia than Chvostek's sign.

Option A: Cullen's sign is not related to calcium levels. It indicates retroperitoneal hemorrhage, where blood pools in the subcutaneous fat around the umbilicus.
Option B: Homan's sign is not a sign of hypocalcemia. It was historically used to screen for Deep Vein Thrombosis (DVT).
Option C: Goodell's sign is an indicator of pregnancy, not an electrolyte imbalance. It is a physiological change in the reproductive system.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical assessment for electrolyte imbalances (Hypocalcemia) as background academic context rather than a clinical decision trigger.
Early recognition of Trousseau's and Chvostek's signs is critical for prompt intervention in hypocalcemia, preventing life-threatening complications like laryngeal spasm or seizures.
Patient safety is paramount. A nurse observing a positive Trousseau's sign must immediately implement seizure and airway precautions and notify the primary healthcare provider.
When administering IV calcium for severe hypocalcemia, it must be given slowly and the patient monitored on a cardiac monitor, as rapid infusion can cause hypotension, bradycardia, and cardiac arrest.

How to Approach the Question

First, analyze the question stem: it asks for a 'sign of hypocalcaemia'. This is a direct recall question about a specific medical condition.
Next, examine the provided image. Identify the key actions and results. You see a blood pressure cuff on an arm and a distinct hand spasm. Recognize this as a clinical test.
Connect the visual information to your knowledge. The specific hand position (carpopedal spasm) induced by the cuff is the classic presentation of Trousseau's sign.
Evaluate the options. Look for the option that matches your identification. 'Trousseau's sign' is listed.
Mentally review the other options to confirm they are incorrect. Cullen's sign (bruising), Homan's sign (calf pain/DVT), and Goodell's sign (cervical softening/pregnancy) are all associated with different conditions, confirming Trousseau's sign is the only plausible answer for hypocalcemia.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1096-1098

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