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Module 4 > UNIT 4- PARATHYROID DISORDERS > Flashcards

UNIT 4- PARATHYROID DISORDERS Flashcards

1
Q

What does the parathormone (PTH) regulate?

A

Calcium balance

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2
Q

Increased PTH levels means ___ phosphorus?

A

Decreased

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3
Q

If serum calcium is decreased what happens to the PTH level?

(normal functioning parathyroid)

A

Parathyroid increases PTH level and calcium is drawn from the bone and increases the serum calcium level

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4
Q

If serum calcium is increased what happens to the PTH level?

(Normal functioning)

A

Thyroid increases calcitonin which decreases serum calcium

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5
Q

What are the 3 types of hyperparathyroidism?

A
  1. Primary
  2. Secondary
  3. Tertiary
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6
Q

What is happening in primary hyperparathyroidism?

A
  1. Enlargement of parathyroid glands
    • increased PTH = Increased blood calcium
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7
Q

What is happening in secondary hyperparathyroidism?

A
  1. Excess PTH 2nd due to low CA level
  2. Possible causes:
    • vit. D deficiency
    • Ca not absorbed from intestines
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8
Q

What is happening in tertiary hyperparathyroidism?

A
  1. Renal failure
    • Decreased ability to excrete phosphate
    • decreased ability to activate vit. D into usable dihydroxyvitamin D
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9
Q

What labs would you expect to see in a patient with hyperparathyroidism?

A
  1. Increased CA & PTH
  2. Decreased Phosphorus
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10
Q

What might you find on your assessment of a hyperparathyroid patient? ( CV, MS, GI, Renal, CNS, Psychological)

A

CV: increased BP, dysrhythmia
MS: Bone pain/ fracture, muscle weakness
GI: Anorexia
Renal: polyuria, or renal calculi
CNS: decreased DTR, paresthesia
Psychological: Depression, psychosis, cognitive dysfunction

Hypercalcemic crisis

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11
Q

Hyperparathyroidism uses the acronym WEAK… what does that stand for?

A

W- Weakness
E- EKG
A- Absent Reflex
K- Kidney stone

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12
Q

Increased calcium puts patients at risk for what?

A

Kidney stones

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13
Q

How do we manage mild hyperparathyroidism?

A
  1. increased fluids & wt. bearing exercise
  2. Avoid Ca supplements, large doses vit. A & D
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14
Q

How do we manage acute hyperparathyroidism?

A
  1. Ns gtt, loop diuretics, phosphates, calcitonin
  2. Dialysis
    • if level is greater than 15
  3. Surgery
    • won’t happen unless patient is stabilized.
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15
Q

What nursing problems should the nurse be watching for with a patient with hyperparathyroidism?

A
  1. Pain
    • Bone pain
  2. Knowledge deficit
  3. Risk
    • injury, mobility, cardiac, neurological, urinary or bowel elimination, fluid & electrolyte
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16
Q

What is the treatment for hyperparathyroidism?

A
  1. Monitor- if not symptomatic
    • Ca intake 1000mg/day
    • Vit D. 400-600 IU/day
    • Bisphosphonates- ibandronate
      & risedronate
    • Calcitonin
  2. Surgery
17
Q

What is the MOA ibandronate & risedronate for treatment of hyperparathyroidism?

A
  1. Osteoporosis 2nd to hyperparathyroidism
18
Q

What are adverse effects of ibandronate & risedronate for tx of hyperparathyroidism?

A
  1. GI upset
  2. Musculoskeletal pain
19
Q

Caution using ibandronate & risedronate with what patients?

A
  1. Pt with upper GI disorders, pt who cannot sit/stand upright for 30 mins
20
Q

What should we teach a patient taking ibandronate & risedronate for hyperparathyroidism?

A
  1. Take in the AM
  2. Remain upright for 30mins
  3. Do not take with ca supplements, antacids, caffeine or OJ
    • can interfere with absorption
  4. Call if difficulty swallowing or develop heartburn
21
Q

As the nurse we should monitor what labs for hyperparathyroidism?

A
  1. Monitor serum ca, phos, PTH, & bone density
22
Q

Why would use with calcitonin?

A
  1. Hypercalcemia
23
Q

What is the MOA of calcitonin for hyperparathyroidism tx?

A
  1. Increases deposition of CA & Phos in bone; lowers CA levels in blood,
24
Q

What are the adverse effects of calcitonin for hyperparathyroidism tx?

A
  1. nausea, nasal dryness
25
Q

Caution using calcitonin for hyperparathyroidism tx in patients with….

A
  1. Allergy to fish protein
  2. Renal disease
26
Q

What are the different route of calcitonin which is used for hyperparathyroidism tx?

A
  1. Nasal spray
  2. IM
  3. SC
27
Q

What should we teach patients taking calcitonin?

A
  1. Nasal spray- alternate nostrils
  2. Rotate sites inj. sites
  3. Monitor- serum Ca, bone density
  4. Diet- high Ca & Vit. D
28
Q

What pre-op things should a nurse consider prior to a parathyroidectomy?

A
  1. Monitor electorlytes– Ca, Phos, Mg
  2. see thyroidectomy notes
29
Q

What post-operative things do we need to know regarding parathyroidectomy?

A
  1. See thyroidectomy notes
  2. Monitor electrolytes
  3. Monitor for tingling in extremities or face
  4. Monitor voice pattern and quality
    • whisper? call if you cant get cleared up w/ little h2o & ice chip
30
Q

What is hypoparathyroidism?

A

Deficiency of PTH leading to decreased calcium

31
Q

What causes hypOparathyroidism?

A
  1. Acquired- damage/removal
  2. Hereditary- not present or poor function
  3. Radiation- external or RAI
  4. Autoimmune- not hashimotos
32
Q

Upon assessment of CV, RESP, GI, CNS, MS, LAB of a hypoparathyroidism patient what might you expect to see?

A

CV: decreased bp, dysrhythmias
RESP: bronchospasms, laryngeal spasm, hoarseness
GI: N/V/D, abd. pain, diff. swallowing
CNS: Paresthesia, anxious, irritable
MS: Muscle cramps, seizure, + trousseau/Chvostek’s
LAB: Decreased PTH & Serum CA, Increased phos

33
Q

S/S of hypoparathyroidism uses the acronym CRAMPS what does that mean?

A

C: Confusion
R: Reflexes hyperactive
A: Arrythmias
M: Muscle spasms
P: + Trousseau
S: Signs of Chvostek

34
Q

How is hypoparathyroidism managed?

A

GOAL: Increased serum ca to 9-10mg/dL

  1. immediate treatment: Calcium gluconate IV then CA carbonate
  2. Vitamin D
    • cheese, margarine, butter, fermented milk, healthy cereals, fatty fish
35
Q

What are nursing problems of hypoparathyroidism to be aware of?

A
  1. imbalance- electrolyte, nutrition
  2. Knowledge deficit
  3. Anxiety
  4. Risk
    • airway clearance, breathing patten, dysrhythmia, injury
36
Q

What should we teach hypoparathyroidism patients?

A
  1. Monitor serum ca & phos
  2. Prevent constipation
  3. Nutrition- high Ca & low Phos.
  4. IV calcium- telemetry monitoring

Module 4 (29 decks)

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