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28 Cards in this Set

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What do the parathyroid glands maintain?
calcium
phosphate balance
Increased levels of PTH act directly on which organ?
kidneys
How do increased levels of PTH affect kidney function?
cause increased kidney reabsorption of calcium and increased phosphate excretion
What conditions may increased levels of PTH cause in patient with hyperparathyroidism?
hypercalcemia (excessive
calcium)
hypophsphatemia (inadequate
phosphate)
What does excessive PTH levels in bone cause?
increased bone resorption (bone loss of calcium) by decreasing osteoblastic activity and increasing osteoclastic activity

(long-standing hypercalcemia may cause calcium to go from blood deposit to tissue deposit)
What might a nurse ask patient when assessing for
hyperparathyroidism?
bone fractures?
recent weight loss?
arthritis?
psychological distress?
radiation therapy to head or
neck (ever received?)
waxy pallor of skin? (if
long-standing disease)
bone deformities of back and
extremities? (if long-
standing disease)
kidney stones?
bone lesions?
pathologic fractures?
bone cysts?
osteoporosis?
anorexia?
nausea,
vomiting?
epigastric pain?
constipation?
weight loss?
elevated serum gastrin levels
peptic ulcer disease?
fatigue
lethargy
What diagnostic studies and results are indicated with hyperparathyroidism?
serum calcium level check
serum PTH level check
serum phosphate level check
urine cAMP lab tests (most
common)
xrays for kidney stones,
calcium deposits, bone
lesions

Others:
arteriography
CT
venous cath of thyroid veins
ultrasonography
Nonsurgical management interventions for hyperparathyroidism include?
First choice: diuretic and fluid therapy

If above not working then
drug therapy consisting of:
phosphates
calcitonin
calcium chelators
The most common nonsurgical management intervention in patients who are not surgical candidates is?
hydration and furosemides in the form of Lasix or Uritol
Lasix and Uritol are furosemide diuretics which work by?
increasing kidney excretion of calcium

(also IV saline in large volumes promote renal calcium excretion)
During hydration therapy, it's important to monitor intake and output as well as ________ _________ every 2-4 hours. Also monitor _____ _____ _______.
CARDIAC FUNCTION

serum calcium levels, as sudden drops may cause numbness and tingling in muscles
If diuretic and fluid therapy doesn't work, how does phosphate drug therapy work?
oral phosphates inhibit bone resorption and interfere with calcium absorption...used only when serum calcium levels must be lowered rapidly
If diuretic and fluid therapy doesn't work, how does calcitonin work?
decreases release of skeletal calcium and increases kidney excretion of calcium. Has short duration of action so use with glucocorticoids to enhance effects
If diuretic and fluid therapy doesn't work, how do calcium chelators work?
bind (chelate) calcium, which reduces levels of free calcium...
ex: Mithramycin (most potent)
a single IV dose of 10 to 15 mg/kg of body weight by slow infusion can lower serum calcium levels within 48 hours...toxic effects limit its use to two or three doses
What should the nurse look out for after first dose of Mithramycin?
thrombocytopenia
kidney and liver toxicity
What studies are run while taking Mithramycin?
liver function studies
blood urea nitrogen
creatinine
CBC
serum calcium levels
Surgical management of hyperparathyroidism involves a?
parathyroidectomy
What is the surgical preop care for a parathyroidectomy?
get calcium levels to near normal..
if taking mithramycin, determine bleeding and clotting times (check for thrombocytopenia)
get CBC to determine bone marrow function..
educate on coughing and deep-breathing exercises..
talking may be painful for first day or two..
teach neck support by having client place both hands behind neck to assist in elevating head
What is thrombocytopenia?
decreased circulating platelets and an increased tendency to bleed
What are the operative procedures for parathyroidectomy?
general anesthesia
transverse incision in lower neck
examine all 4 glands for enlargement
get frozen section if only one gland is enlarged

if tumor present on one side but other side is normal, surgeon removes tumor and leaves remaining gland intact
Postop care following parathyroidectomy?
is patient having
respiratory distress?...
have suction, oxygen, and tracheostomy equipment handy...
monitor VS..
identify change in status..
check neck dressing..
right after surgery check serum calcium levels and recheck every 4 hours thereafter until calcium levels stabilize....
look for hypocalcemia symptoms such as tingling and twitching in extremities and face...
check for Trousseau's and Chvostek's signs...
look for hoarseness due to possible damage to laryngeal nerve
Why might respiratory distress occur following parathyroidectomy?
from compression of the trachea by hemorrhage of swelling of neck tissues
If severe swelling occurs following parathyroidectomy, what should the nurse do?
contact surgeon to remove clips from incision to preserve airway
How much drainage is acceptable from the neck following a parathyroidectomy?
1 to 5 mL
Why might a hypocalcemic episode occur following a parathyroidectomy?
because the remaining glands may have atrophied as a result of PTH overproduction, and require several days to several weeks to return to normal function...an episode may occur during this time
If hyperplasia (tissue overgrowth) is the reason for hyperparathyroidism, what percentage of glands are removed?
three glands plus half of the fourth...a small portion of a gland may be implanted in the forearm, where it produces PTH and maintains calcium homeostasis
If nonsurgical and surgical management fails, what's the last resort?
patient will need lifelong treatment with calcium and vitamin D because the resulting hypoparathyroidism is permanent
7 causes of hyperparathyroidism include?
parathyroid adenoma
parathyroid carcinoma
congenital hyperplasia
neck trauma or radiation
vitamin D deficiency
chronic renal failure with
hypocalcemia
parathyroid hormone-
secreting carcinomas of
the lung, kidney, or GI
tract