Chvostek's sign
Chvostek's sign: Excerpt from Nursing: Interpreting Signs and Symptoms
Chvostek's sign is an abnormal spasm of the facial muscles that's elicited by lightly tapping the patient's facial nerve near his lower jaw. (See Eliciting Chvostek's sign, page 138.)
This sign usually suggests hypocalcemia, but can occur normally in about 25% of cases. Typically, it precedes other signs of hypocalcemia and persists until the onset of tetany. It can't be elicited during tetany because of strong muscle contractions.
Usually, eliciting Chvostek's sign is attempted only in patients with suspected hypocalcemic disorders. However, because the parathyroid gland regulates calcium balance, Chvostek's sign may also be tested in patients before neck surgery to obtain a baseline. Test the patient for Trousseau's sign, also a reliable indicator of hypocalcemia.
Action stat!
Closely monitor the patient for signs of tetany, such as carpopedal spasms or circumoral and extremity paresthesia.
Be prepared to act quickly if a seizure occurs. Perform an electrocardiogram to check for changes associated with hypocalcemia that can predispose the patient to arrhythmias. Place the patient on a cardiac monitor.
History and physical examination
Obtain a brief history. Find out if the patient has had his parathyroid glands surgically removed or if he has a history of hypoparathyroidism, hypomagnesemia, or a malabsorption disorder. Ask him or his family if they have noticed changes in the patient's mental status, such as depression or slowed responses, which can accompany chronic hypocalcemia. Ask the patient if he has experienced any numbness and tingling in his fingers, toes, or around his mouth. Also ask him about muscle twitching or cramping.
Medical causes
Hypocalcemia.The degree of muscle spasm elicited reflects the patient's serum calcium level. Initially, hypocalcemia produces paresthesia in the fingers, toes, and circumoral area that progresses to muscle tension and carpopedal spasms. The patient may also complain of muscle weakness, fatigue, and palpitations. Muscle twitching, hyperactive deep tendon reflexes, choreiform movements, and muscle cramps may also occur. The patient with chronic hypocalcemia may have mental status changes; diplopia; difficulty swallowing; abdominal cramps; dry, scaly skin; brittle nails; and thin, patchy scalp and eyebrow hair.
Other causes
Blood transfusion.A massive blood transfusion can lower serum calciumlevels and allow Chvostek's sign to be elicited.
Nursing considerations
▪ Collect blood samples for serial calcium studies to evaluate the severity of hypocalcemia and the effectiveness of therapy.
▪ Administer oral or I.V. calcium supplements.
▪ Assess for Chvostek's sign when evaluating a patient postoperatively.
Patient teaching
▪ Explain to the patient the early signs and symptoms of hypocalcemia that require immediate medical attention.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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