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63 Cards in this Set
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Disorders of the Parathyroid Gland
Hyperparathyroidism results when? |
when 1 or more parathyroid glands do not respond to the normal feedback of serum calcium.
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Disorders of the Parathyroid Gland
hyperparathyroidism -what is the most common cause? what are some other causes? |
The most common cause is a benign tumor in one parathyroid gland.
Other reasons are caused by hyperplasia, neck trauma, radiation, vitamin D deficiency, chronic renal failure. |
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Hyperparathyroidism
-increased levels of parathyroid hormone (PTH), act directly on the kidney, causing what? |
increased kidney reabsorption of calcium and increased phosphate excretion. These processes cause hypercalcemia (excessive calcium), and hypophosphatemia (inadequate phosphate) in the pt with hyperparathyroidism
These processes cause: hypercalcemia and hypophosphatemia |
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Hyperparathyroidism
in bone, excessive PTH levels increase what? |
bone resoprtion (bone loss of calcium) by decreasing bone production activity and increasing bone destruction activity. This process releases calcium and phosphate into the blood and reduces bone density.
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Hyperparathyroidism
Serum levels: -Calcium: -Phosphate: |
These processes cause: hypercalcemia and hypophosphatemia
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Hyperparathyroidism – Assessment
-skeletal system effects |
-Fatique & muscle weakness due to a rise in serum calcium
-Skeletal pain & tenderness -Bone deformities with pathologic fractures |
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Hyperparathyroidism – Assessment
-Anorexia, nausea, vomiting, epigastric pain, weight loss and constipation are common when _____ levels are high |
calcium
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Hyperparathyroidism – Assessment
BP? fast or slow? |
hypertension
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Hyperparathyroidism – Assessment
-High levels of PTH cause what with the amount of calcium in the kidney? |
renal calculi (kidney stones) and deposits of calcium in the soft tissue of the kidney.
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Hyperparathyroidism – Assessment
what causes elevated serum gastrin???? which can lead to what? |
-hypercalcemia causes elevated serum gastrin, which can lead to peptic ulcer disease
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Hyperparathyroidism – Interventions
MONITOR what? 3 |
VS,
cardiac rhythm (look for changes in the T waves and QT interval), I & O (every 2-4 hrs) |
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Hyperparathyroidism – Interventions
monitor calcium & phosphorous levels. Immediately report any sudden drops in calcium levels which may cause what feeling? |
tingling and numbness in the muscles
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Hyperparathyroidism – Interventions
Move patient slowly & carefully , why? |
because the patient often has significant bone density loss and is at risk for pathologic fractures (use a lift sheet to reposition the patient)
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Hyperparathyroidism – Interventions
encourage what? administer what PRN? |
Encourage fluids
-Administer phosphates prn to interfere with calcium absorption (inhibit bone resorption and interfere with calcium absorption) |
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Hyperparathyroidism – Interventions
what is most often used for reducing serum calcium levels in patients who are not candidates for surgery |
diuretic and hydration therapies, such as:
Lasix, a diuretic that increases kidney excretion of calcium, is often used together with IV NS to promote renal Ca excretion |
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Interventions for hyperparathyroidism
Administer Calcitonin, which does what? |
decrease skeletal calcium release & increases kidney excretion of calcium
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Interventions for hyperparathyroidism
Calcitonin is not effective when used alone, why? what is given along with it? |
because of its short duration of action.
Its action is enhanced if it is given along with glucocorticoids) |
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Interventions for hyperparathyroidism
-Administer Phosphates which inhibit what? 2 |
bone resorption & interfere with calcium reabsorption
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Interventions for hyperparathyroidism
Calcium Chelators, do what? |
-lower calcium levels by binding (chelating) calcium which reduces levels of free calcium.
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Mithramycin, a cytotoxic agent, is used for what???
what is it?? 2 side effects? |
hyperparathyroidism
the most effective and potent calcium chelator used to lower serum calcium levels. SE: thrombocytopenia (decreased circulating platelets and increased tendency to bleed) and kidney and liver toxicity can result |
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Parathyroidectomy is used in managing what????
before surgery, the patient is stablized (what is decreased or near normal) |
hyperparathyroidism
(it's the removal of 1 or more of the parathyroid glands) calcium levels |
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Parathyroidectomy / Hyperparathyroidism
monitor for what? |
Monitor for hypocalcemic crisis
check serum calcium levels immediately after surgery and every 4 hrs thereafter until calcium levels stabilize. manifestations of hypocalcemia include what: numbness and tingling and twitching in the extremities and the face (check for Trousseau’s and Chvostek’s sign which may signal tetany |
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Parathyroidectomy / Hyperparathyroidism
what position do you put them in? |
semi-fowler’s
-30 degrees or higher to keep fluids draining down and not accumulate |
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Assess for S/S of hypocalcemia , which include:
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–anxiety,
confusion, irritability, paresthesia of toes, fingers, face, especially around the mouth, twitching, muscle cramps, tremors, laryngeal spasms |
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Assess for S/S of hypocalcemia
-Prepare for possible _________________ |
parathyroidectomy
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Assess for S/S of hypocalcemia
Elicit Chvostek’s sign, which is what |
tap the face just below and in front of the ear (over the facial nerve) with a finger to trigger facial twitching of 1 side of the mouth, nose, and cheek. if the facial muscles contract toward the ear, the test is positive for hypocalcemia
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Assess for S/S of hypocalcemia
Elicit Trousseau’s sign |
place a BP cuff on the patient’s arm and inflate it above its systolic pressure. In a positive test, the patient will exhibit a spasm in palmar flexion (ventral contraction of the thumb and digits)
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Hypoparathyroidism
caused by what (3) |
surgical or radiation-induced thyroid ablation,
parathyroidectomy, hypomagnesemia |
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Hypoparathyroidism
Problems are directly related to a lack of what hormone?? or to decreased effectiveness of what on target tissue. Regardless of the problem, the result is the same: which is? |
of parathyroid hormone (PTH) secretion
PTH hypocalcemia |
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Hypoparathyroidism
Hypomagnesaemia (decreased serum magnesium levels) may also cause hypoparathyroidism. Hypomagnesaemia is seen in -4 |
alcoholics and in patient’s with malabsorption syndromes, chronic kidney disease, and malnutrition.
It causes impairment of PTH secretion and may interfere with the effects of PTH on the bones, the kidneys, and calcium regulation |
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Hypoparathyroidism
can be caused by 4 things: |
-Caused by hyposecretion of the parathyroid gland
-Can occur after thyroidectomy because of “accidental” removal of parathyroid glands -Hypomagnesemia can also cause this! -radiation therapy (treatments can cause hypoparathyroidism) |
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Hypoparathyroidism
hypomagnesium and PTH what happens? |
Hypomagnesium causes impairment of PTH secretion & interferes with PTH effects on bones and kidneys.
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Hypoparathyroidism - Assessment
Serum levels: Calcium Phosphate |
Hypocalcemia
hyperphosphatemia (when less PTH is synthesized, less phosphorous is excreted from the kidneys; |
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Hypoparathyroidism - Assessment
s/s include |
Anorexia
Chvostek’s or Trousseau’s sign conjunctivitis decreased mental status, cramps muscle weakness paresthesia (mild tingling and numbness) tetany hypotension irritability hyperreflexia excessive or inappropriate muscle contractions that cause finger, hand, and elbow flexion |
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Hypoparathyroidism – Interventions
medical management focuses on what 3 things |
corrective hypocalcemia, vitamin d deficiency, and hypomagnesemia
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Hypoparathyroidism – Interventions
administer what through an IV to treat severe hypoglycemia? |
Administer IV Calcium Gluconate prn to treat severe hypocalcemia.
Acute vitamin D deficiency is treated with calcitriol (Rocaltrol) PO daily. |
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Hypoparathyroidism – Interventions
what kind of diet |
a high calcium, low phosphate diet (no milk, yogurt, or processed cheeses)
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Hypoparathyroidism – Interventions
-phosphate binders do what |
lowers serum phosphate levels by binding to phosphorus present in food
allows calcium to bind to phosphate and rise calcium??? |
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Pituitary gland rests where?
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-in the sella turcica, a depression in the sphenoid bone at the base of the brain.
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Pituitary gland
-this pea size gland has 2 regions: Posterior lobe - secretes what 2 hormones |
The posterior pituitary lobe stores and releases: oxytocin and vasopressin (antidiuretic hormone), which are produced in the hypothalamus. They are stored in the posterior pituitary and are released into the blood when needed.
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Pituitary gland
Anterior lobe -secretes what 6 "tropic" hormones |
which are hormones that stimulate other endocrine glands
1. Growth hormone (GH), or somatotropin 2.Thyroid-stimulating hormone (TSH), or thyrotropin 3.Corticotropin 4Follicle-stimulating hormone (FSH) 5.Luteinizing hormone (LH) 6) Prolactin |
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Anterior pituitary hormone
Thyroid stimulating hormone –TSH: Target tissue: Actions: |
Thyroid stimulating hormone –TSH:
Target tissue: Thyroid Actions: Stimulates synthesis and release of T3 and T4 |
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Anterior pituitary hormone
Adrenocorticotropin hormone- ACTH: Target tissue: Actions: |
Target tissue: Adrenal cortex
Actions: stimulates synthesis and release of corticosteroids |
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Anterior pituitary hormone
Luteinizing hormone –LH Target tissue: Actions: |
Luteinizing hormone –LH
Target tissue: ovary and testis Actions: stimulates ovulation and progesterone secretion. Stimulates testosterone secretion. |
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Anterior pituitary hormone
Follicle-stimulating hormone – FSH Target tissue: Action: |
Follicle-stimulating hormone – FSH
Target tissue: ovary and testis Action: stimulates spermatogenesis, |
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Anterior pituitary hormone
Prolactin –PRL: Target tissue: Actions: |
Prolactin –PRL:
Target tissue: mammary glands Actions: stimulates breast milk production |
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Anterior pituitary hormone
Growth hormone – GH: Target tissue: Action: |
Growth hormone – GH:
Target tissue: bone and soft tissue Action: promotes growth through lipolysis, protein anabolism, and insulin antagonism |
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Posterior pituitary hormone
Vasopressin (antidiuretic hormone –ADH: Target tissue: Actions: |
Vasopressin (antidiuretic hormone –ADH:
Target tissue: kidney Actions: promotes water reabsorption |
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Posterior pituitary hormone
Oxytocin Target tissue: Action: |
Oxytocin
Target tissue: uterus and mammary glands Action: stimulates uterine contractions and ejection of breast milk |
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4 Disorders of the Pituitary Gland:
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-Hypo-pituitarism
-Hyper-pituitarism too much -Diabetes Insipidus -SAIDH |
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Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
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(working against dieresis-urination- pulling fluid out of the body. So this is working against pulling fluid out of the human body. The body retains the fluid. |
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-hormones secreted from the anterior pituitary gland regulate what 4 changes:
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growth,
metabolism, pigment changes, sexual development |
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the posterior pituitary problems result in (2)
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fluid and electrolyte imbalance
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Causes of Hypopituitarism (6)
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-Pituitary Tumor
-Partial or Total surgical hypophysectomy (removal of the pituitary gland) -Radiation -Infarction – a piece of gland has been killed off. Reduce blood flow and tissue dies. -Cancer -Trauma |
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-A person with _____________________has a deficiency of 1 or more anterior pituitary hormones, resulting in metabolic problems and sexual dysfunction.
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Hypopituitarism
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Hypopituitarism
Hyposecretion of what 3 hormones: |
growth hormone,
LH, & FSH (aka: gonadotropins) |
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Hypopituitarism
Assessment: |
Retarded physical growth (shorter)
- Premature aging, hair loss - Low intellectual development - Poor development of secondary sex characteristics; impotence, amenorrhea, infertility –won’t have breast development, no hair distribution that you would see normally during puberty, testes may not descend |
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Hormone Deficiency
Adrenocorticotrophic (ACTH) hormone Acute: |
Fatigue, weakness, dizziness, nausea, vomiting, circulatory failure. Similar to Addison’s disease, except lack of hyperpigmentation, absence of hyperkalaemia
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Hormone Deficiency
Adrenocorticotrophic (ACTH) hormone -Chronic: |
Tiredness, pallor, anorexia, nausea, weight loss, myalgia, hypoglycaemia
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Hormone Deficiency
Gonadotrophins (LH and FSH) Men |
delayed puberty
Impaired fertility, impotence, reduced libido, decreased muscle mass and strength, decreased bone mass, decreased erythropoiesis and hair growth, fine wrinkles, testicular hypotrophy |
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Hormone Deficiency
Gonadotrophins (LH and FSH) Women |
delayed puberty
Amenorrhoea, oligomenorrhoea, infertility, loss of libido, dyspareunia, fine wrinkles, breast atrophy, osteoporosis, premature atherosclerosis |
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Hormone Deficiency
Thyroid-stimulating hormone children: |
Growth retardation
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Hormone Deficiency
Thyroid-stimulating hormone adults: |
Fatigue, cold intolerance, constipation, weight gain, dry skin, slow relaxing reflexes
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