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Nursing Adult I > Parathyroid Study Questions > Flashcards

Parathyroid Study Questions Flashcards

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1
Q

Where are the parathyroid glands?

A

4 small paired glands located in the back of each thyroid lobe

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2
Q

What does the parathyroid secrete?

A

Parathyroid hormone (PTH)

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3
Q

What does PTH do?

A

Regulates calcium
Stimulates bone resorption & inhibition of bone formation -> Ca+ & PO4 release into blood
In kidneys: Increases Ca+ reabsorption & PO4 excretion
Stimulates renal conservation of Vit. D (enhances absorption)

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4
Q

What happens when serum Ca+ levels are low?

A

PTH secretion increases

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5
Q

What happens when serum Ca+ levels are high?

A

PTH secretion is inhibited

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6
Q

What other high level can inhibit PTH?

A

Vitamin D

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7
Q

What other low level can stimulate PTH?

A

Magnesium

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8
Q

If calcium levels rise above the set point, what does the thyroid gland secrete to inhibit PTH?

A

Calcitonin

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9
Q

What is hyperparathyroidism?

A

Increased levels of PTH

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10
Q

What is the most common cause of hyperparathyroidism?

A

Benign adenoma

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11
Q

What are the main s/s of hyperparathyroidism?

A

Osteoporosis
Constipation
Risk for renal calculi

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12
Q

How are the symptoms tx?

A

No tx for hyper; symptomatic tx only

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13
Q

What type of hyperparathyroidism is due to hyperplasia of the glands?

A

Primary

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14
Q

What type of hyperparathyroidism is due to disorders causing hypocalcemia?

A

Secondary (vit D deficiency, malabsorption, CRF, hyperphosphatemia)

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15
Q

What type of hyperparathyroidism is due to an increased release of PTH even though Ca+ levels are normal?

A

Tertiary (often seen after kidney transplant following long standing dialysis tx for CRF)

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16
Q

What can chronic hypercalcemia in hyperparathyroidism cause?

A 
Bones (skeletal changes / osteoporosis / fx)
Stones (renal damage/ kidney stones)
Groans (Abd/GI malfunction)
Moans (psychiatric developments)
Neuromuscular changes
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17
Q

Remember the tx for risk of renal calculi?

A

Strain urine; force fluids (cranberry juice)

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18
Q

What is the goal of hyperparathyroid tx?

A

Relieve symptoms; prevent complications

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19
Q

Since hyperparathyroidism is linked to hypercalcemia, what should tx include?

A

Drink 4-5 liters water daily
Limit Ca+ & Vit D
Give Phosphorus supplements (except w/ CRF)

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20
Q

What needs to be increased in the diet?

A

Na+ (8-10 grams/day)

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21
Q

What tx measures should be taken for hyperparathyroidism?

A 
IV saline
Lasix (NOT thiazides)
Steroids (decrease GI absorption of Ca+)
Anti-resorption agents (inhibit bone resorption/loss)
Calcitonin
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22
Q

What are the two types of Calcitonin?

A

Salmon (2x stronger)

Human (used when sensitive to non-human)

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23
Q

What are other anti-resorption agents?

A 
Mithramycin
Etidronate disodium (Didronel)
Pamidronate sodium (Aredia)
24
Q

What are calcimimetic agents [Cinacalcet (Sensipar)] used for?

A

To ↑ sensitivity to Ca+ receptor on parathyroid gland

Increases PTH secretion & Ca+ serum levels (spares Ca+ stores in bone)

25
Q

What other disorders are this drug used for?

A

Pagets disease
Postmenopausal osteoporosis
Hypercalcemia

26
Q

Who should NOT take Salmon Calcitonin?

A

Allergic to salmon & fish

27
Q

How can therapeutic effects of salmon calcitonin be alleviated?

A

Ensure adequate diet & do small frequent feedings

Alternate nostrils daily if intranasal form

28
Q

What levels should be checked prior to starting & then ongoing?

A

Calcium & Vit D levels

NOTE: Calcitonin’s are sub-Q & IM drugs – Teach pt how to do injections

29
Q

What may be done to prevent injury r/t osteoporosis with the hyperparathyroid pt?

A

Keep bed low
Assist w/ activity
Implement exercise program to prevent bone loss

30
Q

What kind of diet should the hyperparathyroid pt be on?

A

Low Ca+ diet; avoid milk/dairy products

31
Q

What may be done to prevent constipation?

A

Fluids, increased activity, fiber, stool softeners

32
Q

What may be given to decrease the risk of peptic ulcers?

A

Antacids or H2 receptor antagonists

33
Q

What disorder may be seen when T3 levels are increased?

A

Pancreatitis

34
Q

What is the most effective tx of primary & secondary hyperparathyroidism?

A

Parathyroidectomy

35
Q

What is the criteria for a parathyroidectomy?

A

Calcium level > 12mg/dL
Hypercalciuria (> 400 mg/day)
Marked reduced bone density
Overt symptoms (i.e. renal calculi, neuro changes)

36
Q

What is usually done when a parathyroidectomy is performed to allow for continued PTH secretion?

A

Autotransplantation of normal parathyroid tissue in Forearm or near sternocleidomastoid muscle)

37
Q

If autotransplantation isn’t possible or fails, what must be done?

A

Lifelong calcium supplements

38
Q

What is the greatest risk after a parathyroidectomy?

A

Same as thyroidectomy – HYPOcalcemia

39
Q

What needs to be at bedside in case tetany occurs?

A

IV Calcium gluconate

40
Q

What signs should you be monitoring post-parathyroidectomy?

A

Chvosteks, Trousseaus

41
Q

What drug should be administered with caution?

A

Digitalis (Lanoxin)

42
Q

What causes “hungry bone syndrome”?

A

Rapid bone rebuilding post-parathyroidectomy

43
Q

What is hypoparathyroidism?

A

Decreased PTH secretion

Failure to respond despite normal to high PTH levels (pseudohypoparathyroidism)

44
Q

What are iatrogenic causes of hypoparathyroidism?

A

Accidental removal, infarction, strangulation

45
Q

What are idiopathic causes of hypoparathyroidism?

A

Autoimmune

46
Q

What other abnormal electrolyte can cause hypoparathyroidism?

A

Hypomagnesemia (alcoholic, prolonged TPN use, malabsorption disorders)

47
Q

What occurs with lowered levels of PTH?

A

Serum Ca+ levels fall
PO4 levels increase
May have calcification of eyes (irreversible)

48
Q

What manifestations may be seen with hypoparathyroidism? (Focused assessment)

A

Hypocalcemic s/s – Tetany,seizures, laryngeal spasm, neuromuscular excitability

49
Q

How is hypoparathyroidism diagnosed?

A

Low serum Ca+
Low serum PTH
High serum PO4

50
Q

What may be used for maintenance therapy in the pt with hypoparathyroid?

A

Calcium Supplements

51
Q

When should calcium supplements be given?

A

30 minutes to 1 hour after meals with a FULL glass of water

52
Q

What may need to be administered to decrease PO4 & increase Ca+?

A

PO4 binders (Amphogel/Basogel)

53
Q

What is the tx for acute hypocalcemia?

A

Tx tetany w/ IV calcium gluconate

Monitor for hypotension & cardiac arrest

54
Q

What drugs are given for long-term mgt of hypoparathyroidism?

A 
Antihypocalcemics: Vitamin D analogues
Calcitriol
Oral Ca+ supplements 
Calcium carbonate
Oyster shell Ca+
PTH replacement
55
Q

What do vitamin D analogues do?

A

Promote Ca+ absorption from GI/renal tubules

Promote secretion of Ca+ from bone

56
Q

What education should pt be given about Calcitriol?

A 
Swallow tablets whole
High Ca+/Low PO4 diet
Normal sunlight exposure
Avoid Vit D!
Avoid Mg containing antacids
Have Ca+ level assessed weekly at first
S/S dehydration

Nursing Adult I (6 decks)

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