Parathyroid Flashcards
Parathyroid Hormone regulates
Ca balance
Relationship between PTH and Phosporus
inverse
low = high
If serum Ca low
parathyroid high PTH level & Ca is drawn from bone & low serum Ca level
If serum Ca high
thyroid high Calcitonin which lowers serum Ca
The parathyroid acts up when
2+ glands don’t function correctly
Calcitonin
tones down Ca and returns to the bone
Regulation of blood Calcium
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
Primary Hyperparathyroidism
Enlargement of parathyroid gland(s)
High PTH = high blood Ca
Secondary Hyperparathyroidism
Excess PTH 2nd due to low Ca level
Possible causes:
- Vit. D deficiency
- Ca not absorbed from intestines
Tertiary Hyperparathyroidism
renal failure
low ability to excrete phosphate
and low Vitamin D
Hyperparathyroidism Labs
high Ca and PTH
low Phosphate
Hyperparathyroidism CV
HTN
dysrhythmias torsades de pointes
Hyperparathyroidism MS
bone pain
fracture
muscle weakness
Hyperparathyroidism GI
anorexia
constipation
N/V
abd pain
Hyperparathyroidism Renal
polyuria
renal calculi
Hyperparathyroidism CNS
Delusion of grandeur
low DTR
paresthesia
Hyperparathyroidism Psycho
depression
psychosis
cog dysfunction
Hyperparathyroidism mnemonic
Bones
stones
abd groans
psychic moans
If Ca is greater than _____, hypercalcemic crisis
15
Hypercalcemic s/s
“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
Mild Hyperparathyroidism mgmt
high fluid and wt bearing exercise
avoid Ca supplements AND large doses Vit A and D
Acute/Severe Hyperparathyroidism
NS gtt, loop diuretics, phosphates, Calcitonin
Dialysis (greater then 15)
Surgery (not unless stabilized)
-irrigate and excrete Ca-
Hyperparathyroidism NURSING PROBLEMS and risks
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
Hyperparathyroidism needs
2-3 L of water a day with high fiber diet
Hyperparathyroidism Tx
Monitor if not symptomatic
Ca intake 1000mg/day
Vit. D 400-600 IU/day
Biphosphonates – ibandronate & risedronate
Calcitonin
Surgery
Biphosphonates – ibandronate & risedronate goal
osteoporosis 2nd to hyperparathyroid
Biphosphonates – ibandronate & risedronate adverse effects
GI upset, musculoskeletal pain
Biphosphonates – ibandronate & risedronate cautions
pt with upper GI disorders, pt who cannot sit/stand upright for 30 min. (irritating if GERD)
Biphosphonates – ibandronate & risedronate not if
caffeine
OJ
Biphosphonates – ibandronate & risedronate teachings
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
Calcitonin
used for
hypercalcemia
Calcitonin
goal
increases deposit of Ca and Phosphate in bone
lowers Ca levels in blood
Calcitonin
adverse effects
nausea
nasal dryness
Calcitonin
caution
allergy to fish protein, renal diseases
Calcitonin
route
nasal spray
IM
SC
Calcitonin TEACHINGS
Nasal spray – alternate nostrils
Injection – rotate sites
Monitor – serum Ca, bone density
Diet: high Ca & Vit. D**
Parathyroidectomy Pre-op
Monitor electrolytes–Ca, Phos, Mg
See thyroidectomy notes
Parathyroidectomy Post-op
See thyroidectomy notes
Monitor electrolytes
Monitor for tingling in extremities or face
Monitor voice pattern & quality
Hypoparathyroidism
deficency of PTH and low Ca
Hypoparathyroidism Causes
Acquired - Damage/removal
Hereditary – not present or poor function
Radiation – external or RAI
Autoimmune – not Hashimoto’s
Hypoparathyroidism monitor
Mg levels
Hypoparathyroidism Assessments
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
Bronchospasms
loud and harsh coughs
difficult to tx and needs to be quick
s/s of hypocalcemia
Confusion
Reflexes hyperactive
Arrhythmias
Muscle spasms
Positive Trousseau’s
Signs of Chvostek’s
Hypoparathyroidism mgmt
Goal: high serum Ca to 9 – 10 mg/dL
Immediate treatment: Calcium gluconate IV then Ca carbonate
Vitamin D
Quiet environment
Hypoparathyroidism mgmt
Imbalance – electrolyte, nutrition
Knowledge deficit
Anxiety
Risk - airway clearance, breathing pattern
Risk – dysrhythmia
Risk – injury
Foods high in Ca
milk, cheese, avocados, turnips, collared greens, almonds, and peanuts, soy products, dark greeny
Not spinach
Hypoparathyroidism teachings
Monitor serum Ca & Phos.
Prevent constipation
Nutrition – high Ca & low Phos.
IV calcium – telemetry monitoring
