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26 Cards in this Set
- Front
- Back
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Parathyroid Gland
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*Normally four glands
*Embedded in posterior aspect of thyroid *Parathormone: Protein hormone from the parathyroid *Regulates Ca & PO4 metabolism |
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Hyperparathyroidism
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*Epidemiology - occurs 2-4 times more often in females usually 50-60 years old
*Incidence - 0.1% general population (100 in 100,000) *Most common cause of hypercalcemia |
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Etiology
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*Primary - Overproduction of PTH by parathyroid gland (85%=benign neoplasm of one gland
-Familial-diffuse hyperplasia of all 4 glands -Carcinoma-rare *Secondary-Occurs when glands are chronically stimulated by decreased Ca -CRF -Malabsorption Syndrome |
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Pathophysiology
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*BONES - Increased PTH effect osteoclastic (bone resorption) and osteoblastic (bone formers) decreased bone density
*KIDNEYS - Excess calcium cannot be reabsorbed=hypercalciuria (w/urine phosphate may = calculi) *GI - PTH stimulates syn. of Vit D and increases GI absorption of calcium = increased level |
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Effects of Increased Ca+
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*At least one half of clients are asymptomatic
*Painful bones (and tenderness) *Renal stones *Abdominal groans (abd. pain) *And psychic moans (change in mental status) |
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Effects of Increased Ca+
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*Renal
*GI *Skeletal *Mental |
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Diagnosis
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*Lab Values=
-Increased PTH -Increased Calcium -Decreased Phosphorus -Increased urinary Ca -May have Incr. amylase or alk phos (bone disease) *MRI or CT to show adenoma *Bone density tests to detect bone loss |
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Conservative treatment
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*Annual blood levels
*Renal Function Tests *Avoid dehydration-high fluid intake 2000-3000cc qd *Calcium intake 1000mg/day *8-10 grams sodium to replace urinary loss from increased u.o. |
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Surgical Treatment
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*For Cancer = Remove all parathyroid glands (calcium supplement for life)
*For adenoma = remove single gland -National Institute Health Guide *Serum Ca>12mg/ *Hypercalciuria *Marked reduced bone density (Z score of less than 2) *<50 years old |
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Surgery
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*Open approach losing favor
*Endoscopic day surgery *Minimally invasive radioguided parathyroidectomy (MIRP)-use light anesthesia and nuclear mapping using radioactive probe to locate faulty gland -Day surgery, quick -One-inch incision |
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Post-Op Complications
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*Respiratory obstruction
*Hemorrhage *Laryngeal nerve damage *Hypocalcemia and tetany *Hyperthyroid storm *Fluid and electrolyte disturbances -Calcium, potassium, magnesium, phosphate |
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Nursing Care post-op (recall thyroidectomy)
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*Assess Resp. status (Trach @ bedside)
*VS q2-4 hrs, TCDB *HOB increase 30 degrees *Encourage fluid to 3L., I&O, weigh qd *Assess calcium, eletrolytes *Assess for tetany, parasthesias (calcium gluconate @ bedside) *Strain urine for renal calculi *Teach all of the above |
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Drug therapy to lower calcium
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See drug therapy to lower calcium
-Lehne chapter 73 |
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Emergent treatment Ca >13 (9-10.5) >15 Crisis
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*Normal saline to hydrate
*Lasix IV *Phosphate therapy to correct hypopphosphatemia and decrease GI abs. of calcium *EDTA (many toxic effects) |
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Nursing Goals
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*Maintain activity level
*Keep hydrated *Safe effective care -Assess for tetany -Fluid & electrolytes -Chvostek's & Troussea's sign -Mobility - improve bone density |
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Nursing Process
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*See Careplan
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Hypoparathyroidism
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*Uncommon disorder
*Most common cause is Iatrogenic (accidental removal or damage to vascular supply of the glands *Hypomagnesemia also a cause of decreased PTH (seen in ETOH abuse or malabsorption) *Chronic - usually idiopathic |
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Clinical Manifestations
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S&S of decreased calcium
*Tetany=syndrome characterized by tingling of lips, fingertips, feet and increased muscle tension, painful tonic spasms of smooth & skeletal muscles. Dysphagia, laryngospasms *Positive Chvostek's sign; light tap on cheek=contraction of facial muscles *Positive Trousseau's sign; carpal spasm induced by BP cuff over SBP |
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Clinical Manifestations
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*Chronic=gradual manifestations
-May only have impaired vision from calcification of cornea -Lethargy -Personality changes -Dry, scaly skin -Cardiac dysfunction, heart failure |
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Diagnosis
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*Decreased calcium
*Decreased PTH *Increased Serum Phosphate |
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Treatment
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*Treat tetany
-10% calcium gluconate IV (slowly) -Rebreathing CO2 (Paperbag) creates a mild acidosis which helps calcium to be more actively available - helps alleviate neuromuscular symptoms -Muscle relaxants to control neuromuscular irritability |
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Safe Effective Care
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Nursing Care
-Keep environment free of noise, bright lights -Assess for tetany, seizures, respiratory difficulty -Keep Calcium Gluconate at bedside -Rebreathing into paper bag to lower body PH -padded side rails |
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Life Long Care
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*Teach diet
-Avoid foods w/ oxalic acid (spinach, rhubarb) & phytic acid (bran, whole grain) & phos. = decrease in Ca absorption -Eat high Ca foods-green leafy veg, soy -Take Ca supp=1gr<40, 2gr>40, Vit D -Assess blood Ca 3-4 times/year -Cataract screening q1-2 years |
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The most important treatment for a client with hyperparathyroidism includes
-A. Pad side rails -B. Increase fluid to 3000cc per day -C. Maintain bed rest to prevent fractures -D. Assess for Trousseau's and Chvostek's sign |
Answer
-B. Increase fluid to 3000cc per day |
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Normal lab values for Serum Calcium
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9.0 - 10.5 mg/dl
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Normal lab values for Serum Phosphorus
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2.5 - 4.7 mg/dl
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