Calciphylaxis: An Unusual Case with an Unusual Outcome GENERAL PURPOSE: To present information about calciphylaxis through a case study of a patient with the unusual presentation of normal renal and parathyroid function. LEARNING OBJECTIVES: After reading this article and taking this test, you will be able to • recognize the pathophysiology of and risk factors for calciphylaxis. • identify treatment strategies for calciphylaxis.

  1. Which of the following types of reac­ tions describes calciphylaxis? a. a localized cytotoxic reaction b. a systemic autoimmune reaction c. a localized enzymatic reaction d. a systemic hypersensitivity reaction   2. With calciphylaxis, deposits of cal­ cium and what other mineral form in the small arteries of the skin? a. phosphorus b. magnesium c. potassium d. iron   3. Mineral deposits result in vascular calcification with a. superimposed large-vessel thrombosis. b. medial arterial hypertrophy. c. superimposed small-vessel thrombosis. d. adventitial venous hypertrophy.   4. Calciphylaxis is characterized by iso­ lated or multiple lesions that first present with signs that include which of the following? a. bullae b. plaques c. nodules d. macules   5. Eventually, the initial lesions pro­ gress to which of the following? a. bullae b. plaques c. nodules d. macules


AJN ▼ October 2014

  6. Calciphylaxis has a prognosis that is a. excellent. b. good. c. variable. d. poor.   7. Risk factors for calciphylaxis include a. male sex. b. hypoparathyroidism. c. systemic use of corticosteroids. d. decreased erythrocyte sedimentation rate.   8. According to Maldonado, symptoms of hypoactive delirium include a. episodes of staring. b. elevated temperature. c. photophobia. d. hypervigilance.   9. Treatment options for calciphylaxis include a. thyroidectomy. b. chemical debridement. c. radioactive iodine. d. surgical debridement. 10. According to the article, which of the following solutions is often used for wound irrigation and cleansing in patients who have calciphylaxis? a. acetic acid b. chlorhexidine c. povidone–iodine d. hydrogen peroxide 11. Current evidence favors the use of which of the following types of dressings for wound healing? a. wet-to-dry b. alginate c. wet-to-moist d. collagen 12. Hyperbaric oxygen therapy is thera­ peutic for patients who have calci­ phylaxis because it can a. help prevent dehydration. b. break down necrotic tissue. c. revascularize damaged tissue. d. restore perfusion to compromised areas.

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13. According to Broussard, the most common adverse effect of hyper­ baric oxygen therapy is a. atelectasis. b. claustrophobia. c. hearing loss. d. migraine headaches. 14. In noncontact ultrasound therapy, an ultrasonic device delivers sound waves in which of the following fre­ quency ranges? a. 10 to 25 kHz b. 25 to 40 kHz c. 40 to 100 kHz d. 100 to 200 kHz 15. The greatest risk of mortality from calciphylaxis is a. infection. b. necrosis. c. seizures. d. stroke. 16. Whirlpool baths containing a potas­ sium permanganate solution may be used to decrease bacterial load. To ease a patient’s pain, which of the following might also be added? a. sodium bicarbonate b. epsom salts c. boric acid d. table salt 17. According to the article, there are reports of a strong association be­ tween the development of calciphy­ laxis and low serum a. albumin. b. hepcidin. c. amylase. d. lectin. 18. Which of the following methods was used to ensure that the patient in the case study received adequate calories and nutrition? a. total parenteral nutrition b. continuous nighttime feeding via a nasojejunal tube c. intermittent feeding via a gastrojejunal tube d. percutaneous endoscopic gastrostomy ▼



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AJN ▼ October 2014

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Vol. 114, No. 10

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A mobility program for an inpatient acute care medical unit.

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of...
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