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NURS 3512 - Class 1-6 > Week 1 - Parathyroid Disorders > Flashcards

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
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2
Q

what is the most common cause of hyperparathyroidism

A
  • tumour in the PTH gland
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3
Q

how does hyperparathyroidism effect electrolytes (3)

A

causes:

  • hypercalcemia
  • hypophosphatemia
  • hypercalciuria
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4
Q

what can hypercalciuria lead to

A
  • calculi formation
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5
Q

what are the clinical manifestations of hyperparathyroidism associated w

A
  • hypercalcemia
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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
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7
Q

what are complications of hyperparathyroidism (6)

A
  • renal failure
  • pancreatitis
  • cardiac changes
  • fractures
  • osteoporosis
  • kidney stones
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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
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9
Q

what effect does hyperparathyroidism have on the cardio system (2)

A
  • hypotension

- dysrhythmias

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10
Q

what effect does hyperparathyroidism have on the GI tract (3)

A
  • anorexia
  • abdominal pain
  • constipation
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11
Q

what does calcium play a role in (3)

A
  • bone health
  • muscle contraction
  • nerve function
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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
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13
Q

what effect hyperparathyroidism have on the integumentary system (2)

A
  • moist skin

- skin necrosis

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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
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15
Q

what effect does hyperparathyroidism have on the neurological system (6)

A
  • personality changes
  • memory impairment
  • poor coordination
  • emotional irritability
  • confusion
  • parathesias
  • fatigue
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16
Q

what effect does hyperparathyroidism have on the renal system (4)

A
  • hypercalciuria
  • kidney stones
  • UTI
  • polyuria
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17
Q

what effect does hyperparathyroisim have on the eyes

A
  • corneal calcification
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18
Q

what is the goal of treatment for hyperparathyroidism (2)

A
  • relieve manifestations

- prevent complications caused by excess PTH

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19
Q

what are the 2 types of treatment for hyperPTH

A
  • surgical

- nonsurgical

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20
Q

what type of surgery is done for hyperPTH

A
  • parathyroidectomy
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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
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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
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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.
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24
Q

what are some potential postop complications after parathyroidectomy (3)

A
  • hemorrhage
  • fluid & electrolyte disturbances
  • tetany (due to sudden decrease in Ca)
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25
Q

when might tetany occur after parathyroidectomy?

A
  • usually apparent early in the postop period
26
Q

what is the treatment is tetany becomes severe post-parathyroidectomy

A
  • IV calcium
27
Q

what should the nurse monitor/encourage post parathyroidectomy (7)

A
  • Ca lvls
  • K
  • phosphate
  • magnesium
  • chvosteks sign
  • trousseas sign
  • encourage mobility to promote bone calcification
28
Q

what is chvosteks sign

A
  • twitching of facial muscles in response to tapping the cheek
29
Q

what is trousseaus sign

A
  • spasm of the hand & wrist in response to the pt wearing a BP cuff
30
Q

what is non surgical treatment for hyperparathyroidism (3)

A
  • continued ambulation & avoidance of immobility
  • phosphorus supplements
  • drugs to lower serum Ca and prevent boneresorption
31
Q

what is to be assessed in a pt with hyperparathyroidism who doesnt get surgery (3) ? how often?

A
  • annual exam w tests fo Ca and creatinine clearance

- eval of bone density every 1-2 years

32
Q

what drug can be used to normalize serum Ca lvls and prevent bone resorption

A
  • bisphosphonates (fosamax)
33
Q

list pt education for a pt with hyperparathyroidism who does not get surgery (3)

A
  • the importance of exercise
  • signs of hypo & hypercalcemia
  • assist w meal plan/refer dietician
34
Q

what are dietary measure for a pt with hyperparathyroidism (3)

A
  • high fluid intake
  • moderate calcium intake
  • phosphorus supplements
35
Q

what is hypoparathyroidism

A
  • condition associated w inadequate PTH lvls
36
Q

what effect does hypoparathyroidism have on electrolytes (2)

A
  • hyperphosphatemia

- hypocalcemia

37
Q

what is the most common cause of hypoparathyroidism

A
  • accidental damage or removal during thyroidectomy or other neck surgery
38
Q

what are most of the manifestations of hypoparathyroidism due to

A
  • the hypocalcemia
39
Q

what effect does hypoPTH have on the cardiac system (3)

A
  • dysrhythmias
  • decreased contractility of the heart
  • decreased CO
40
Q

what effect does hypoPTH have on the GI tract (3)

A
  • abdominal cramps
  • fecal incontinence in older adults
  • malabsorption
41
Q

what effect does hypoPTH have on the integ system (4)

A
  • dry, scaly skin
  • hair loss on scalp and body
  • brittle nails
  • changes in developing teeth
42
Q

what effect does hypoPTH have on the musculoskeletal system (6)

A
  • fatigue
  • weakness
  • painful muscle cramos
  • osteosclerosis
  • soft tissue calcification
  • difficulty walking
43
Q

what effect does hypoPTH have on neuro system (6)

A
  • personality changes
  • irritability
  • headache
  • seizures
  • tremor
  • hyperactive deep tendon reflexes
44
Q

what effect does hypoPTH have on the renal system (2)

A
  • urinary frequency

- urinary incontinence

45
Q

what effect does hypoPTH have on the eyes (3)

A

eye changes like:

  • lenticular opacites
  • cataracts
  • papilledema
46
Q

sudden decreases in calcium cause…

A
  • tetany
47
Q

what is tetany characterized by (7)

A
  • 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
Q

what can the spasms of smooth and skeletal muscle cause (2)? what is the concern w this?

A
  • dysphagia (constricted feeling in the throat)
  • laryngospasms

both can compromise breathing

49
Q

what can be used to diagnose hypoPTH (3)

A
  • decreased serum Ca
  • decreased PTH
  • increased phosphate
50
Q

what else can cause hypoPTH (3)

A
  • vitamin D deficiency
  • hypomagnesia
  • chronic renal failure
51
Q

what is the goal of treatment for hypoPTH (3)

A
  • treat acute complications like tetany
  • maintain normal serum Ca
  • prevent long-term complications
52
Q

emergency treatment of tetany required

A
  • IV calcium
53
Q

how should IV calcium be administered? why?

A
  • infuse slowly

- high Ca could cause hypotension, dysrhythmias, cardiac arrest

54
Q

what should be monitored when a pt is taking IV calcium

A
  • ECG monitoring

- monitor for extravasation

55
Q

why is it important to monitor for exttravasation with IV calcium

A
  • IV calcium can cause venous irritation & inflammation
56
Q

what kind of diet should a pt with hypoPTH be on

A
  • high calcium –> at least 1.5-3g/day
57
Q

what are good sources of calcium (3)

A
  • dark green veggies
  • soybeans
  • tofu
58
Q

when is vitamin D used as a treatment for hypoPTH

A
  • if the pt has chronic and resistant hypocalcemia
59
Q

what is the treatment for mild hypoPTH (2)

A
  • oral calcium

- vitamin D

60
Q

what foods should pts with hypoPTH avoid (5)

A 
foods w oxalic acid
- spinach 
- rhubarb 
foods w phytic acid
- bran
- whole grains
and phosphorus
  • all reduce calcium absorption
61
Q

what should you teach pts with hypoPTH (3)

A
  • need for lifelong treatment and follow up care
  • monitoring of Ca 3-4/year
  • diet needs
62
Q

why is PTH replacement therapy not a recommended drug therapy for hypoPTH (2)

A
  • expensive

- need for parental admin

NURS 3512 - Class 1-6 (47 decks)

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