Unit 5 & 6 Chapter 58 Hypoparathyroidism and Hyperparathyroidism

Question 1

What is the function of the parathyroid?

Answer 1

This chemical regulates the amounts of calcium, phosphorus, and magnesium in the bones and blood. The minerals calcium and phosphorus are crucial for healthy bones.

Question 2

What is the normal range for calcium

Answer 2

9-10.5

Question 3

What is the normal range for magnesium

Answer 3

1.5-2.5

Question 4

What is hypoparathyroidism?

Answer 4

Hypoparathyroidism is a rare disorder in which parathyroid function is decreased and serum calcium levels cannot be maintained, and hypocalcemia (low serum calcium levels) results.

Question 5

Cause of Hypoparathyroidism

Answer 5

Iatrogenic hypoparathyroidism, the most common form, is caused by the removal of all parathyroid tissue during total thyroidectomy or surgical removal of the parathyroid glands.

Idiopathic hypoparathyroidism can occur spontaneously. The exact cause is unknown, but an autoimmune basis is suspected, and it may occur with other autoimmune disorders.

Hypomagnesemia (decreased serum magnesium levels) may cause hypoparathyroidism. Low magnesium levels are seen in patients with malabsorption syndromes, chronic kidney disease (CKD), and malnutrition. Low magnesium levels suppress PTH secretion and may interfere with the effects of PTH on the bones, kidneys, and calcium regulation.

Ask about any head or neck surgery or radiation therapy because these treatments may injure the parathyroid glands and cause hypoparathyroidism.

Question 6

S/s of Hypoparathyroidism

Answer 6

hypoparathyroidism, which may range from
mild tingling and numbness to muscle tetany.
Tingling and numbness around the mouth or in the hands and feet
Severe muscle cramps,
**Spasms of the hands and feet
Seizures
Tetany
irritability to psychosis.
Excessive or inappropriate muscle contractions that cause finger, hand, and elbow flexion

Question 7

Diagnostic tools for Hypoparathyroidism

Answer 7

Diagnostic tests for hypoparathyroidism include electroencephalography (EEG), blood tests, and CT scans. EEG changes revert to normal with correction of hypocalcemia. Serum calcium, phosphorus, magnesium, vitamin D, and urine cyclic adenosine monophosphate (cAMP) levels may be used in the diagnostic workup for hypoparathyroidism (see the Laboratory Profile: Parathyroid Function box). The CT scan can show brain calcifications, which indicate chronic hypocalcemia.

Question 8

TX for hypoparathroidism

Answer 8

Nonsurgical management of hypoparathyroidism focuses on correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia.

-Acute hypocalcemia, IV calcium is given as a 10% solution of calcium chloride or calcium gluconate over 10 to 15 minutes.

-Acute vitamin D deficiency is treated with daily oral calcitriol.

cute hypomagnesemia is corrected with IV magnesium sulfate. Long-term oral therapy for hypocalcemia involves the intake of calcium, 0.5 to 2 g daily, in divided doses.

Question 9

Should a patient with Hypothyroidism take food rich in Phosphate?
A. Yes
B. No

Answer 9

B. No

Nursing management includes teaching about the drug regimen and interventions to reduce anxiety. Teach the patient to eat foods high in calcium but low in phosphorus.

Long-term therapy for vitamin D deficiency is replacement with oral ergocalciferol daily. The dosage is adjusted to keep the patient’s calcium level in the low-normal range (slightly hypocalcemic), enough to prevent symptoms of hypocalcemia. It must also be low enough to prevent increased urine calcium levels, which can lead to stone formation.

AVOID because rich in phosphorus
Milk, yogurt, and processed cheeses are avoided because of their high phosphorus

Question 10

What foods are high in Calcium

Answer 10

rhubarb, spinach, tofu, broccoli, kale,

Question 11

Is treatment for hypocalcemia lifelong?

Answer 11

Stress that therapy for hypocalcemia is lifelong.

Question 12

Patient teaching for MAINTAINCE of hypoparathyroidism

Answer 12

Advise the patient to wear a medical alert bracelet.

With adherence to the prescribed drug and diet regimen, the calcium level usually remains high enough to prevent a hypocalcemic crisis.

No food high is phosphate, Milk, yogurt, and processed cheeses are avoided because of their high phosphorus

Question 13

What is hyperparathyroidism

Answer 13

Hyperparathyroidism is a disorder in which parathyroid secretion of parathyroid hormone is increased, resulting in hypercalcemia (excessive serum calcium levels) and hypophosphatemia (inadequate serum phosphorus levels).

Question 14

S/s of Hyperparathyroidism

Answer 14

-Hypercalcemia
-kidney stones
-cardiac dysrhymias
muscle weakness and pain
-bone weakness
-pathological fractures DUE TO WEAK BONES
-fatigue
-weakness
-difficulty thinking
-confusion
epigastric pain
-Hypercalcemia Crisis -Calcium level greater than 14

Question 15

S/s of hypercalcemia

Answer 15

Kidney Stones, Constipation, pathologic fractures, Stupor, Anorexia

Question 16

Tx of Hyperparathyroidism

Answer 16

• IV fluids 0.9 NS
  -Furosemide
  -Bumetadine
  -Calcitonin brings excess calciumIN THE BLOOD back into the bones
  -Avoid excess calcium
  -Glucocorticoids increase action of calcitonin

Question 17

Is ECG indicated for patients with hyperparathyroidism

A.Yes
B.No

Answer 17

Monitor cardiac function and intake and output every 2 hours during hydration therapy. Continuous cardiac monitoring may be necessary. Compare recent ECG tracings with the patient’s baseline tracings. Especially look for changes in the T waves and the QT interval, as well as changes in the rate and rhythm.

Question 18

Medical Management of Hyperparathyroidism?

Answer 18

Surgical management of hyper-parathyroidism is a parathyroidectomy. Before surgery the patient is stabilized, and calcium levels are decreased to near normal.

Question 19

What should you monitor for post Hyperparathyroidectomy

Answer 19

A hypocalcemic crisis can occur during this critical period, and the serum calcium level is assessed frequently after surgery. Check serum calcium levels whenever they are drawn until calcium levels stabilize. Monitor for indications of hypocalcemia, such as tingling and twitching in the extremities and face. Check for Trousseau and Chvostek signs, either of which indicates potential tetany
-bleeding
-infection
-hypocalcemia

Question 20

What does patients with Hypoparathyroisism need for life?

Answer 20

When hyperparathyroidism is caused by hyperplasia (tissue overgrowth), three glands plus half of the fourth gland are usually removed. If all four glands are removed, a small portion of a gland may be implanted in the forearm, where it produces PTH and maintains calcium homeostasis.

If all these maneuvers fail, the patient will need lifelong treatment with calcium and vitamin D because the resulting hypoparathyroidism is permanent.