Week 1 - Parathyroid Disorders Flashcards
what is the fnxn of parathyroid hormone
- helps regulate calcium and phosphate levels by stimulating bone resorption of calcium, renal tubular reabsorption of calcium, and activation of vitamin D
what is the most common cause of hyperparathyroidism
- tumour in the PTH gland
how does hyperparathyroidism effect electrolytes (3)
causes:
- hypercalcemia
- hypophosphatemia
- hypercalciuria
what can hypercalciuria lead to
- calculi formation
what are the clinical manifestations of hyperparathyroidism associated w
- hypercalcemia
what are the major manifestations of hyperparathyroidism (7)
- muscle weakness
- loss of appetite
- constipation
- fatigue
- emotional disorders
- shortened attention span
- decreased bone density
what are complications of hyperparathyroidism (6)
- renal failure
- pancreatitis
- cardiac changes
- fractures
- osteoporosis
- kidney stones
how is hyperparathyroidism diagnosed (4)
- increased PTH lvls
- increased calcium lvls (>2.5 mmol/L)
- low phosphate lvl (under 0.1 mmol/L)
- bone density measurements
what effect does hyperparathyroidism have on the cardio system (2)
- hypotension
- dysrhythmias
what effect does hyperparathyroidism have on the GI tract (3)
- anorexia
- abdominal pain
- constipation
what does calcium play a role in (3)
- bone health
- muscle contraction
- nerve function
how does too much calcium impact the bones, muscles, and nerves?
too much calcium =
- bones become fragile (bc they have left the bones)
- slowed muscle and nerve contraction
what effect hyperparathyroidism have on the integumentary system (2)
- moist skin
- skin necrosis
what effect does hyperparathyroidism have on the musculoskeletal system (8)
- skeletal pain
- weakness
- pain on weight baring
- fractures
- decreased muscle tone
- muscle atrophy
- osteoporosis
- muscle aches
what effect does hyperparathyroidism have on the neurological system (6)
- personality changes
- memory impairment
- poor coordination
- emotional irritability
- confusion
- parathesias
- fatigue
what effect does hyperparathyroidism have on the renal system (4)
- hypercalciuria
- kidney stones
- UTI
- polyuria
what effect does hyperparathyroisim have on the eyes
- corneal calcification
what is the goal of treatment for hyperparathyroidism (2)
- relieve manifestations
- prevent complications caused by excess PTH
what are the 2 types of treatment for hyperPTH
- surgical
- nonsurgical
what type of surgery is done for hyperPTH
- parathyroidectomy
what may be done after parathyroidectomy? why?
- autotransplantation of normal parathyroid tissue into the forearm or near the sternocleidomastoid
- this allows PTH secretion to continue with normalization of calcium lvls
if autotransplantation cannot be done after parathyroidectomy, what teaching must be done to the pt
- must take calcium supplements for the rest of their lives
describe nursing care for a pt after parathyroidectomy (9)
similar to thyroidectomy: - pain - ambulate same day - HOB elevated, head supported - monitor airway - hoarse throat - monitor for hemorrhage - fluids asap - soft foods post-op - monitor fluids & electroylytes etc.
what are some potential postop complications after parathyroidectomy (3)
- hemorrhage
- fluid & electrolyte disturbances
- tetany (due to sudden decrease in Ca)
when might tetany occur after parathyroidectomy?
- usually apparent early in the postop period
what is the treatment is tetany becomes severe post-parathyroidectomy
- IV calcium
what should the nurse monitor/encourage post parathyroidectomy (7)
- Ca lvls
- K
- phosphate
- magnesium
- chvosteks sign
- trousseas sign
- encourage mobility to promote bone calcification
what is chvosteks sign
- twitching of facial muscles in response to tapping the cheek
what is trousseaus sign
- spasm of the hand & wrist in response to the pt wearing a BP cuff
what is non surgical treatment for hyperparathyroidism (3)
- continued ambulation & avoidance of immobility
- phosphorus supplements
- drugs to lower serum Ca and prevent boneresorption
what is to be assessed in a pt with hyperparathyroidism who doesnt get surgery (3) ? how often?
- annual exam w tests fo Ca and creatinine clearance
- eval of bone density every 1-2 years
what drug can be used to normalize serum Ca lvls and prevent bone resorption
- bisphosphonates (fosamax)
list pt education for a pt with hyperparathyroidism who does not get surgery (3)
- the importance of exercise
- signs of hypo & hypercalcemia
- assist w meal plan/refer dietician
what are dietary measure for a pt with hyperparathyroidism (3)
- high fluid intake
- moderate calcium intake
- phosphorus supplements
what is hypoparathyroidism
- condition associated w inadequate PTH lvls
what effect does hypoparathyroidism have on electrolytes (2)
- hyperphosphatemia
- hypocalcemia
what is the most common cause of hypoparathyroidism
- accidental damage or removal during thyroidectomy or other neck surgery
what are most of the manifestations of hypoparathyroidism due to
- the hypocalcemia
what effect does hypoPTH have on the cardiac system (3)
- dysrhythmias
- decreased contractility of the heart
- decreased CO
what effect does hypoPTH have on the GI tract (3)
- abdominal cramps
- fecal incontinence in older adults
- malabsorption
what effect does hypoPTH have on the integ system (4)
- dry, scaly skin
- hair loss on scalp and body
- brittle nails
- changes in developing teeth
what effect does hypoPTH have on the musculoskeletal system (6)
- fatigue
- weakness
- painful muscle cramos
- osteosclerosis
- soft tissue calcification
- difficulty walking
what effect does hypoPTH have on neuro system (6)
- personality changes
- irritability
- headache
- seizures
- tremor
- hyperactive deep tendon reflexes
what effect does hypoPTH have on the renal system (2)
- urinary frequency
- urinary incontinence
what effect does hypoPTH have on the eyes (3)
eye changes like:
- lenticular opacites
- cataracts
- papilledema
sudden decreases in calcium cause…
- tetany
what is tetany characterized by (7)
- tingling sensations in the lips, fingertips, feet
- increased muscle tension
- parasthesias
- circumoral tingling
- harsh vibration sounds when breathing
- stiffness
- painful tonic spasms of smooth and skeletal muscles
what can the spasms of smooth and skeletal muscle cause (2)? what is the concern w this?
- dysphagia (constricted feeling in the throat)
- laryngospasms
both can compromise breathing
what can be used to diagnose hypoPTH (3)
- decreased serum Ca
- decreased PTH
- increased phosphate
what else can cause hypoPTH (3)
- vitamin D deficiency
- hypomagnesia
- chronic renal failure
what is the goal of treatment for hypoPTH (3)
- treat acute complications like tetany
- maintain normal serum Ca
- prevent long-term complications
emergency treatment of tetany required
- IV calcium
how should IV calcium be administered? why?
- infuse slowly
- high Ca could cause hypotension, dysrhythmias, cardiac arrest
what should be monitored when a pt is taking IV calcium
- ECG monitoring
- monitor for extravasation
why is it important to monitor for exttravasation with IV calcium
- IV calcium can cause venous irritation & inflammation
what kind of diet should a pt with hypoPTH be on
- high calcium –> at least 1.5-3g/day
what are good sources of calcium (3)
- dark green veggies
- soybeans
- tofu
when is vitamin D used as a treatment for hypoPTH
- if the pt has chronic and resistant hypocalcemia
what is the treatment for mild hypoPTH (2)
- oral calcium
- vitamin D
what foods should pts with hypoPTH avoid (5)
foods w oxalic acid - spinach - rhubarb foods w phytic acid - bran - whole grains and phosphorus
- all reduce calcium absorption
what should you teach pts with hypoPTH (3)
- need for lifelong treatment and follow up care
- monitoring of Ca 3-4/year
- diet needs
why is PTH replacement therapy not a recommended drug therapy for hypoPTH (2)
- expensive
- need for parental admin
