Week 1 - Parathyroid Disorders Flashcards
1
Q
what is the fnxn of parathyroid hormone
A
- helps regulate calcium and phosphate levels by stimulating bone resorption of calcium, renal tubular reabsorption of calcium, and activation of vitamin D
2
Q
what is the most common cause of hyperparathyroidism
A
- tumour in the PTH gland
3
Q
how does hyperparathyroidism effect electrolytes (3)
A
causes:
- hypercalcemia
- hypophosphatemia
- hypercalciuria
4
Q
what can hypercalciuria lead to
A
- calculi formation
5
Q
what are the clinical manifestations of hyperparathyroidism associated w
A
- hypercalcemia
6
Q
what are the major manifestations of hyperparathyroidism (7)
A
- muscle weakness
- loss of appetite
- constipation
- fatigue
- emotional disorders
- shortened attention span
- decreased bone density
7
Q
what are complications of hyperparathyroidism (6)
A
- renal failure
- pancreatitis
- cardiac changes
- fractures
- osteoporosis
- kidney stones
8
Q
how is hyperparathyroidism diagnosed (4)
A
- increased PTH lvls
- increased calcium lvls (>2.5 mmol/L)
- low phosphate lvl (under 0.1 mmol/L)
- bone density measurements
9
Q
what effect does hyperparathyroidism have on the cardio system (2)
A
- hypotension
- dysrhythmias
10
Q
what effect does hyperparathyroidism have on the GI tract (3)
A
- anorexia
- abdominal pain
- constipation
11
Q
what does calcium play a role in (3)
A
- bone health
- muscle contraction
- nerve function
12
Q
how does too much calcium impact the bones, muscles, and nerves?
A
too much calcium =
- bones become fragile (bc they have left the bones)
- slowed muscle and nerve contraction
13
Q
what effect hyperparathyroidism have on the integumentary system (2)
A
- moist skin
- skin necrosis
14
Q
what effect does hyperparathyroidism have on the musculoskeletal system (8)
A
- skeletal pain
- weakness
- pain on weight baring
- fractures
- decreased muscle tone
- muscle atrophy
- osteoporosis
- muscle aches
15
Q
what effect does hyperparathyroidism have on the neurological system (6)
A
- personality changes
- memory impairment
- poor coordination
- emotional irritability
- confusion
- parathesias
- fatigue
16
Q
what effect does hyperparathyroidism have on the renal system (4)
A
- hypercalciuria
- kidney stones
- UTI
- polyuria
17
Q
what effect does hyperparathyroisim have on the eyes
A
- corneal calcification
18
Q
what is the goal of treatment for hyperparathyroidism (2)
A
- relieve manifestations
- prevent complications caused by excess PTH
19
Q
what are the 2 types of treatment for hyperPTH
A
- surgical
- nonsurgical
20
Q
what type of surgery is done for hyperPTH
A
- parathyroidectomy
21
Q
what may be done after parathyroidectomy? why?
A
- autotransplantation of normal parathyroid tissue into the forearm or near the sternocleidomastoid
- this allows PTH secretion to continue with normalization of calcium lvls
22
Q
if autotransplantation cannot be done after parathyroidectomy, what teaching must be done to the pt
A
- must take calcium supplements for the rest of their lives
23
Q
describe nursing care for a pt after parathyroidectomy (9)
A
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.
24
Q
what are some potential postop complications after parathyroidectomy (3)
A
- hemorrhage
- fluid & electrolyte disturbances
- tetany (due to sudden decrease in Ca)
25
when might tetany occur after parathyroidectomy?
- usually apparent early in the postop period
26
what is the treatment is tetany becomes severe post-parathyroidectomy
- IV calcium
27
what should the nurse monitor/encourage post parathyroidectomy (7)
- Ca lvls
- K
- phosphate
- magnesium
- chvosteks sign
- trousseas sign
- encourage mobility to promote bone calcification
28
what is chvosteks sign
- twitching of facial muscles in response to tapping the cheek
29
what is trousseaus sign
- spasm of the hand & wrist in response to the pt wearing a BP cuff
30
what is non surgical treatment for hyperparathyroidism (3)
- continued ambulation & avoidance of immobility
- phosphorus supplements
- drugs to lower serum Ca and prevent boneresorption
31
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
32
what drug can be used to normalize serum Ca lvls and prevent bone resorption
- bisphosphonates (fosamax)
33
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
34
what are dietary measure for a pt with hyperparathyroidism (3)
- high fluid intake
- moderate calcium intake
- phosphorus supplements
35
what is hypoparathyroidism
- condition associated w inadequate PTH lvls
36
what effect does hypoparathyroidism have on electrolytes (2)
- hyperphosphatemia
| - hypocalcemia
37
what is the most common cause of hypoparathyroidism
- accidental damage or removal during thyroidectomy or other neck surgery
38
what are most of the manifestations of hypoparathyroidism due to
- the hypocalcemia
39
what effect does hypoPTH have on the cardiac system (3)
- dysrhythmias
- decreased contractility of the heart
- decreased CO
40
what effect does hypoPTH have on the GI tract (3)
- abdominal cramps
- fecal incontinence in older adults
- malabsorption
41
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
42
what effect does hypoPTH have on the musculoskeletal system (6)
- fatigue
- weakness
- painful muscle cramos
- osteosclerosis
- soft tissue calcification
- difficulty walking
43
what effect does hypoPTH have on neuro system (6)
- personality changes
- irritability
- headache
- seizures
- tremor
- hyperactive deep tendon reflexes
44
what effect does hypoPTH have on the renal system (2)
- urinary frequency
| - urinary incontinence
45
what effect does hypoPTH have on the eyes (3)
eye changes like:
- lenticular opacites
- cataracts
- papilledema
46
sudden decreases in calcium cause...
- tetany
47
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
48
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
49
what can be used to diagnose hypoPTH (3)
- decreased serum Ca
- decreased PTH
- increased phosphate
50
what else can cause hypoPTH (3)
- vitamin D deficiency
- hypomagnesia
- chronic renal failure
51
what is the goal of treatment for hypoPTH (3)
- treat acute complications like tetany
- maintain normal serum Ca
- prevent long-term complications
52
emergency treatment of tetany required
- IV calcium
53
how should IV calcium be administered? why?
- infuse slowly
| - high Ca could cause hypotension, dysrhythmias, cardiac arrest
54
what should be monitored when a pt is taking IV calcium
- ECG monitoring
| - monitor for extravasation
55
why is it important to monitor for exttravasation with IV calcium
- IV calcium can cause venous irritation & inflammation
56
what kind of diet should a pt with hypoPTH be on
- high calcium --> at least 1.5-3g/day
57
what are good sources of calcium (3)
- dark green veggies
- soybeans
- tofu
58
when is vitamin D used as a treatment for hypoPTH
- if the pt has chronic and resistant hypocalcemia
59
what is the treatment for mild hypoPTH (2)
- oral calcium
| - vitamin D
60
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
61
what should you teach pts with hypoPTH (3)
- need for lifelong treatment and follow up care
- monitoring of Ca 3-4/year
- diet needs
62
why is PTH replacement therapy not a recommended drug therapy for hypoPTH (2)
- expensive
| - need for parental admin
