thyroid and parathyroid disorders 2 Flashcards
Secretion of excess parathormone (PTH)
Hyperparathyroidism
cause of Hyperparathyroidism
Tumor (an adenoma); can be benign or malignant
Vitamin D deficiencies, malabsorption, chronic renal failure, and elevated serum phosphate
Elevation of serum calcium (hypercalcemia)
High levels of PTH cause calcium to shift from the bones into the bloodstream
If untreated, severe demineralization of bone tissue
Signs and Symptoms Hyperparathyroidism
Symptoms vague at first
Weakness, lethargy, depression, anorexia, and constipation
Other findings include mental and personality changes, cardiac dysrhythmias, weight loss, and urinary calculi
Medical Diagnosis Hyperparathyroidism
Elevated serum calcium and decreased serum phosphate (remember: PTH promoting renal tubular reabsorption of calcium and depression of phosphate reabsorption, thereby reducing calcium excretion and increasing phosphate excretion by the kidneys.)
Elevated PTH and 24-hour urine calcium
Skeletal radiographs and bone density studies
CT, MRI, ultrasound, fine-needle aspiration, and selective arteriography
Surgical intervention Hyperparathyroidism
Parathyroidectomy
Surgeon attempts to leave some parathyroid tissue to prevent hypoparathyroidism
Drug therapy
Hyperparathyroidism
Sodium and phosphorus replacements
Calcitonin (Calcimar), gallium nitrate (Ganite), bisphosphonates (etidronate, pamidronate), and plicamycin (Mithracin) inhibit release of calcium from bones
Furosemide (Lasix): promotes excretion of calcium in the urine
Propranolol (beta blocker) reduces PTH secretion
Assessment
Hyperparathyroidism
Monitor vital signs, urine output, weight, muscle strength, bowel elimination, and digestive disturbances
Interventions for Hyperparathyroidism
Activity Intolerance and Risk for Injury Impaired Urinary Elimination Constipation Disturbed Thought Processes Imbalanced Nutrition: Less Than Body Requiremen
Postoperative Care
Hyperparathyroidism
Airway obstruction from accumulated fluid and blood in surgical site compressing the trachea
Monitor and document the respiratory rate and effort and the pulse rate
Increasing pulse and respiratory rates, especially accompanied by restlessness, suggest inadequate oxygenation
Notify physician of indications of respiratory distress
Keep an emergency tracheotomy tray, suction, and O2 at the bedside in the event of acute obstruction
The remaining glands, which may have atrophied as a result of PTH overproduction, require several days to several weeks to return to normal function….observe for hypocalcemic crisis
Airway obstruction related to severe hypocalcemia
Be alert for tetany
Tingling around mouth and in the fingers
It may progress to severe muscle spasms or cramps and even to laryngospasm
Treated with oral or intravenous calcium supplements
Protect suture line from stress
Show patient how to support the head when changing positions
Inspect dressing and back of the neck for bleeding
Elevate patient’s head to reduce swelling
Deficiency of parathormone (PTH)
Uncommon condition
From accidental removal of/damage to parathyroid glands during surgery
Hypoparathyroidism
causes Hypoparathyroidism
Primary hypoparathyroidism can be caused by an autoimmune process and by several conditions, including Wilson’s disease (copper overload)
Inadequate secretion of PTH leads to hypocalcemia
Severe hypocalcemia can progress to convulsions and respiratory obstruction due to spasms of the larynx
Signs and symptoms Hypoparathyroidism
Painful muscle cramps, fatigue and weakness, tingling and twitching of the face and hands, mental and emotional changes, dry skin, and urinary frequency
With severe hypocalcemia, difficulty breathing, convulsions, and cardiac dysrhythmias
Hypocalcemia occurs when
Poor dietary intake of calcium and/or Vitamin D deficiency
- Loss via kidney
- Not absorbed from GI track
- Decrease in parathyroid hormone (hypoparathyroidism)
- Lab values < 4.3 mEq/L
Hypocalcemia S/S: are due to increased excitability
** tetany (muscle spasms
** sharp flexion of wrists & ankles,
cramps convulsions
** parathesias (numbness & tingling of finger, toes, and lips).
** Trousseau’s sign: shut of blood supply to hand with B/P cuff
and Pt. can’t open hand (or carpal spasm).
** Anxiety, irritability
** Altered bleeding and clotting time
Medical diagnosis Hypoparathyroidism
Low serum calcium, elevated serum phosphate, low urine calcium, and sometimes low serum magnesium
Chvostek’s sign (tap facial nerve = spasms) and Trousseau’s sign (pressure applied to nerve/vessels of upper arm causes muscular spasm)
