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26 Cards in this Set

  • Front
  • Back
Parathyroid Gland
*Normally four glands
*Embedded in posterior aspect of thyroid
*Parathormone: Protein hormone from the parathyroid
*Regulates Ca & PO4 metabolism
*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
*Primary - Overproduction of PTH by parathyroid gland (85%=benign neoplasm of one gland
-Familial-diffuse hyperplasia of all 4 glands
*Secondary-Occurs when glands are chronically stimulated by decreased Ca
-Malabsorption Syndrome
*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
Effects of Increased Ca+
*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)
Effects of Increased Ca+
*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
Conservative treatment
*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.
Surgical Treatment
*For Cancer = Remove all parathyroid glands (calcium supplement for life)
*For adenoma = remove single gland

-National Institute Health Guide
*Serum Ca>12mg/
*Marked reduced bone density (Z score of less than 2)
*<50 years old
*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
Post-Op Complications
*Respiratory obstruction
*Laryngeal nerve damage
*Hypocalcemia and tetany
*Hyperthyroid storm
*Fluid and electrolyte disturbances
-Calcium, potassium, magnesium, phosphate
Nursing Care post-op (recall thyroidectomy)
*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
Drug therapy to lower calcium
See drug therapy to lower calcium
-Lehne chapter 73
Emergent treatment Ca >13 (9-10.5) >15 Crisis
*Normal saline to hydrate
*Lasix IV
*Phosphate therapy to correct hypopphosphatemia and decrease GI abs. of calcium
*EDTA (many toxic effects)
Nursing Goals
*Maintain activity level
*Keep hydrated
*Safe effective care
-Assess for tetany
-Fluid & electrolytes
-Chvostek's & Troussea's sign
-Mobility - improve bone density
Nursing Process
*See Careplan
*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
Clinical Manifestations
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
Clinical Manifestations
*Chronic=gradual manifestations
-May only have impaired vision from calcification of cornea
-Personality changes
-Dry, scaly skin
-Cardiac dysfunction, heart failure
*Decreased calcium
*Decreased PTH
*Increased Serum Phosphate
*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
Safe Effective Care
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
Life Long Care
*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
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
-B. Increase fluid to 3000cc per day
Normal lab values for Serum Calcium
9.0 - 10.5 mg/dl
Normal lab values for Serum Phosphorus
2.5 - 4.7 mg/dl