Week 11: Chp 43: Hyperparathyroidism

Question 1

What accounts for primary hyperparathyroidism?

Answer 1

parathyroid adenomas

Question 2

Secondary hyperparathyroidism occurs from what?

Answer 2

hyperplasia of the parathyroid glands

-most observed with patients with chronic renal failure or chronic malabsorption of calcium

Question 3

Hyperparathyroidism causes what?

Answer 3

causes hypercalcemia secondary to its actions on bone, kidneys, and the bowel
-the action of PTH on bone leads to osteoclastic (breakdown of bone) activity and bone demineralization, which causes pathological fractures and bone lesions

Question 4

The action of PTH on bone leads to what?

Answer 4

Osteoclastic (breakdown of bone) activity and bone demineralization, which causes pathological fractures and bone lesions
-osteoclastic activity increases release of calcium from the bone and leads to loss of bone density; increased renal absorption of calcium leads to elevated serum calcium levels

Question 5

What are osteoclasts?

Answer 5

large cells that secrete enzymes and acids to dissolve microscopic bits of bone, and then the minerals and amino acids are reabsorbed (resorption)

Question 6

What does osteoclastic activity do?

Answer 6

increases release of calcium from the bone and leads to loss of done density
-increased renal absorption of calcium leads to elevated serum calcium levels

Question 7

What does increased calcium levels in the urine filtrate cause?

Answer 7

hypercalciuria that increases the potential for calcium containing renal stones
-reabsorption of calcium in the bowel is also increased in hyperparathyroidism

Question 8

Patients with what condition may develop secondary hyperparathyroidism?

Answer 8

chronic renal failure
-decreased serum calcium and inactivated vitamin D develop early in renal failure, and PTH secretion increases the response to the hypocalcemia; over time, parathyroid gland hyperplasia develops because of low calcium levels; hyperparathyroidism can be differentiated from other causes of hypercalcemia, such as elevated calcium secondary to malignancy, through intact PTH assays

Question 9

Clinical Manifestations

Answer 9

some may be asymptomatic but can present with

• polyuria, anorexia, and constipation associated with elevated serum calcium levels that impact the kidneys and GI tract
• cardiac changes associated with elevated calcium levels include; a prolonged PR interval and a shortened QT interval due to the shortening of the ST segment
• may also develop abdominal pain because hypercalcemia leads to increased secretion of gastrin in the stomach and associated peptic ulcer disease
• other: lethargy, confusion, muscle weakness, fatigue, and generalized bone pain (secondary to bone demineralization caused by osteoclastic activity)

Question 10

Treatment goal for hyperparathyroidism

Answer 10

lowering serum calcium levels

Question 11

Treatment plan

Answer 11

• increase fluid intake is indicated to minimize potential renal injury secondary to elevated serum calcium, and in patients with mild disease, increased oral fluid intake may treat the disorder
• more severe cases of hypercalcemia require IV infusions of normal saline to protect against renal calculi
• patients taught to decrease consumption of calcium containing antacids and vitamin D
• Thiazide diuretics are to be avoided because thy increase reabsorption of calcium in the kidney

Question 12

The nurse prioritizes which nursing diagnosis in the patient after partial parathyroidectomy?

Answer 12

high risk for ineffective airway clearance linked to hypocalcemia

Question 13

Clinical Manifestations are linked to?

Answer 13

elevated serum calcium

• elevated ionized and serum calcium levels
• decreased serum phosphorus levels
• muscle weakness and atrophy
• low back pain
• increased incidence of pathological fractures
• prolonged PR interval
• shortened QT interval
• constipation, anorexia, and nausea and vomiting
• renal stones

Question 14

Nursing DIagnoses

Answer 14

• acute pain r/t pressure in renal tubules secondary to development of calcium-based renal calculi
• high risk for injury: falls r/t bone demineralization and calcium resorption

Question 15

Nursing Assessments

Answer 15

• serum calcium levels
• serum phosphorus levels
• cardiac monitoring
• acid-base status

Question 16

Assessments: Serum calcium levels

Answer 16

excessive PTH leads to release of calcium from the bone, increased renal absorption, and increased intestinal absorption, all leading to hypercalcemia

Question 17

Assessments: Serum Phosphorus levels

Answer 17

parathyroid hormone increases renal excretion of phosphorus

Question 18

Assessment: Cardiac Monitoring

Answer 18

elevated serum calcium may lead to shortening of the QT interval related to decreased depolarization and repolarization of the ventricle

Question 19

Assessment: Acid-base status

Answer 19

an acid pH decreases binding of calcium to protein and results in elevated ionized calcium

Question 20

Nursing Actions

Answer 20

-increase fluid intake to 3000 mL/day
-administer furosemide (Lasix) as ordered
-administer oral phosphates as ordered
-administer calcium chelators
-use a lift sheet in patients with chronic hyperparathyroidism to prevent bone injury
strain urine with suspected renal calculi

Question 21

Actions: Increase fluid intake to 3000 mL/day

Answer 21

increase fluid administration to decrease incidence of renal calculi
-normal saline is the fluid choice for IV administration

Question 22

Actions: Administer furosemide (Lasix) as ordered

Answer 22

this diuretic medication increases renal excretion of calcium
-Thiazide diuretics are to be avoided because they increase reabsorption of calcium into the kidneys

Question 23

Actions: administer oral phosphates as ordered

Answer 23

oral phosphates inhibit calcium loss from the bone and interfere with calcium absorption in the kidneys and bowel

Question 24

Action: administer calcium chelators

Answer 24

binding of calcium decreases the free, activated calcium and lowers serum levels

Question 25

Action: use a lift sheet in patients with chronic hypoparathyroidism to prevent bone injury

Answer 25

sustained hypoparathyroidism results in loss of calcium from the bone and increases the chances of bone trauma and pathological fractures

Question 26

Action: Strain urine with suspected renal calculi

Answer 26

confirmation of renal calculi composition is needed to implement corrective therapy

Question 27

Nursing Teaching

Answer 27

• signs of hypocalcemia and hypercalcemia
• low-calcium diet
• increase fluids and fiber to decrease complications of constipation