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Module 4 (MedSurg 2) > Parathyroid > Flashcards

Parathyroid Flashcards

1
Q

Parathyroid Hormone regulates

A

Ca balance

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2
Q

Relationship between PTH and Phosporus

A

inverse
low = high

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3
Q

If serum Ca low

A

parathyroid high PTH level & Ca is drawn from bone & low serum Ca level

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4
Q

If serum Ca high

A

thyroid high Calcitonin which lowers serum Ca

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5
Q

The parathyroid acts up when

A

2+ glands don’t function correctly

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6
Q

Calcitonin

A

tones down Ca and returns to the bone

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7
Q

Regulation of blood Calcium

A

High serum Ca
thyroid lets out Calcitonin
buildup of bone by osteoblasts
Blood Ca decreases
-Low Ca serum
parathyroid releases PTH
BREAKDOWN BY OSTEOCLASTS
Blood Ca increases

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8
Q

Primary Hyperparathyroidism

A

Enlargement of parathyroid gland(s)
High PTH = high blood Ca

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9
Q

Secondary Hyperparathyroidism

A

Excess PTH 2nd due to low Ca level
Possible causes:
- Vit. D deficiency
- Ca not absorbed from intestines

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10
Q

Tertiary Hyperparathyroidism

A

renal failure
low ability to excrete phosphate
and low Vitamin D

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11
Q

Hyperparathyroidism Labs

A

high Ca and PTH
low Phosphate

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12
Q

Hyperparathyroidism CV

A

HTN
dysrhythmias torsades de pointes

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13
Q

Hyperparathyroidism MS

A

bone pain
fracture
muscle weakness

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14
Q

Hyperparathyroidism GI

A

anorexia
constipation
N/V
abd pain

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15
Q

Hyperparathyroidism Renal

A

polyuria
renal calculi

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16
Q

Hyperparathyroidism CNS

A

Delusion of grandeur
low DTR
paresthesia

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17
Q

Hyperparathyroidism Psycho

A

depression
psychosis
cog dysfunction

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18
Q

Hyperparathyroidism mnemonic

A

Bones
stones
abd groans
psychic moans

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19
Q

If Ca is greater than _____, hypercalcemic crisis

A

15

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20
Q

Hypercalcemic s/s

A

“W”eakness of muscles
“E”KG changes-(shortened QT interval & prolonged PR interval)
“A”bsent reflexes, “a”bsent minded (disoriented), “a”bdominal distention from constipation
“K”idney stone formation

21
Q

Mild Hyperparathyroidism mgmt

A

high fluid and wt bearing exercise
avoid Ca supplements AND large doses Vit A and D

22
Q

Acute/Severe Hyperparathyroidism

A

NS gtt, loop diuretics, phosphates, Calcitonin
Dialysis (greater then 15)
Surgery (not unless stabilized)
-irrigate and excrete Ca-

23
Q

Hyperparathyroidism NURSING PROBLEMS and risks

A

Pain (bone), OTC analgesics
Knowledge deficit (why, when
Risk – Injury, Mobility
Risk – Cardiac, Neurological confusion
Risk – urinary or bowel elimination, kidney stones, contipation
Risk – fluid & electrolyte

24
Q

Hyperparathyroidism needs

A

2-3 L of water a day with high fiber diet

25
Q

Hyperparathyroidism Tx

A

Monitor if not symptomatic
Ca intake 1000mg/day
Vit. D 400-600 IU/day
Biphosphonates – ibandronate & risedronate
Calcitonin
Surgery

26
Q

Biphosphonates – ibandronate & risedronate goal

A

osteoporosis 2nd to hyperparathyroid

27
Q

Biphosphonates – ibandronate & risedronate adverse effects

A

GI upset, musculoskeletal pain

28
Q

Biphosphonates – ibandronate & risedronate cautions

A

pt with upper GI disorders, pt who cannot sit/stand upright for 30 min. (irritating if GERD)

29
Q

Biphosphonates – ibandronate & risedronate not if

A

caffeine
OJ

30
Q

Biphosphonates – ibandronate & risedronate teachings

A

Monitor serum Ca, Phos, PTH & bone density
Take in AM
Remain upright for 30 min.
Do not take with Ca supplements, antacids, caffeine or OJ
Call if difficulty swallowing or develop heartburn – esophageal irritation

31
Q

Calcitonin
used for

A

hypercalcemia

32
Q

Calcitonin
goal

A

increases deposit of Ca and Phosphate in bone
lowers Ca levels in blood

33
Q

Calcitonin
adverse effects

A

nausea
nasal dryness

34
Q

Calcitonin
caution

A

allergy to fish protein, renal diseases

35
Q

Calcitonin
route

A

nasal spray
IM
SC

36
Q

Calcitonin TEACHINGS

A

Nasal spray – alternate nostrils
Injection – rotate sites
Monitor – serum Ca, bone density
Diet: high Ca & Vit. D**

37
Q

Parathyroidectomy Pre-op

A

Monitor electrolytes–Ca, Phos, Mg
See thyroidectomy notes

38
Q

Parathyroidectomy Post-op

A

See thyroidectomy notes
Monitor electrolytes
Monitor for tingling in extremities or face
Monitor voice pattern & quality

39
Q

Hypoparathyroidism

A

deficency of PTH and low Ca

40
Q

Hypoparathyroidism Causes

A

Acquired - Damage/removal
Hereditary – not present or poor function
Radiation – external or RAI
Autoimmune – not Hashimoto’s

41
Q

Hypoparathyroidism monitor

A

Mg levels

42
Q

Hypoparathyroidism Assessments

A

CV:  BP, dysrhythmias**
Resp: bronchospasm, laryngeal spasm, hoarseness
GI: N/V, diarrhea, abd pain, diff. swallowing
CNS: paresthesia, anxious, irritable
MS: muscle cramps**, seizure, + Trousseau / Chvostek **
Lab:  PTH & serum Ca and Mg, high serum Phos

43
Q

Bronchospasms

A

loud and harsh coughs
difficult to tx and needs to be quick

44
Q

s/s of hypocalcemia

A

Confusion
Reflexes hyperactive
Arrhythmias
Muscle spasms
Positive Trousseau’s
Signs of Chvostek’s

45
Q

Hypoparathyroidism mgmt

A

Goal: high serum Ca to 9 – 10 mg/dL
Immediate treatment: Calcium gluconate IV then Ca carbonate
Vitamin D
Quiet environment

46
Q

Hypoparathyroidism mgmt

A

Imbalance – electrolyte, nutrition
Knowledge deficit
Anxiety
Risk - airway clearance, breathing pattern
Risk – dysrhythmia
Risk – injury

47
Q

Foods high in Ca

A

milk, cheese, avocados, turnips, collared greens, almonds, and peanuts, soy products, dark greeny

Not spinach

48
Q

Hypoparathyroidism teachings

A

Monitor serum Ca & Phos.
Prevent constipation
Nutrition – high Ca & low Phos.
IV calcium – telemetry monitoring

Module 4 (MedSurg 2) (36 decks)

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