Hyperpara and Hypoparathyroidism .pdf

Disorders of the parathyroid gland 1 Hyperparathyroidism ⩥ caused by overproduction of parathormone by the parathyroid glands and is characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium Clinical manifestations Apathy fatigue, muscle weakness n...

Disorders of the parathyroid gland 1 Hyperparathyroidism ⩥ caused by overproduction of parathormone by the parathyroid glands and is characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium Clinical manifestations Apathy fatigue, muscle weakness nausea, vomiting, constipation hypertension, cardiac dysrhythmias Psychological effects may vary from irritability and neurosis to psychoses ⩥ nephrolithiasis ⩥ ⩥ ⩥ ⩥ ⩥ 3 Assessment and diagnostic findings ⩥ persistent elevation of serum calcium levels and an ⩥ ⩥ ⩥ ⩥ ⩥ ⩥ elevated concentration of parathormone Radioimmunoassays double-antibody parathyroid hormone test Ultrasound MRI thallium scan fine-needle biopsy 4 Surgical management ⩥ Parathyroidectomy ⩥ Surgery is recommended for asymptomatic patients who meet one or more of the following criteria: ⊳ (1) younger than 50 years, ⊳ (2) any patient unable or unlikely to participate in follow up care, ⊳ (3) serum calcium elevations of 1-1.6 mg/dl (0.25-0.4 mmol/liter) above the accepted normal range, ⊳ (4) GFR < 60 mL/min ⊳ (5) urinary calcium level greater than 400 mg/day (10 mmol/day) ⊳ (6) bone density at hip, lumbar spine, or distal radius with T score < -2.5 or previous fracture fragility at any site ⊳ (7) nephrolethiasis or nephrocalcinosis 5 Hydration Therapy ⩥ daily fluid intake of 2,000 mL or more ⩥ Instruct the patient to report other manifestations of renal calculi, such as abdominal pain and hematuria 6 Pharmacologic management ⩥ Lasix- to promote calciuria after rehydration has occurred ⩥ IV saline solutions- expand blood volume and acts in the kidneys to inhibit the reabsorption of the calcium ⩥ Oral or IV phosphate ⊳ Calcitonin ⊳ Mithracin ⊳ Gallium Nitrate 7 Nursing management ⩥ Closely monitor the patient for signs and symptoms of tetany. ⩥ Prevent injury ⩥ Encourage weight bearing 30 mins/day ⩥ Low calcium diet ⩥ Encourage patient to avoid dairy products 8 hypoparathyroidism ⩥ Deficiency of PTH due to hyposecretion of parathyroid gland ⩥ Serum calcium levels are abnormally low, serum phosphate levels are abnormally high and pronounced neuromuscular irritability (tetany) may develop. 9 causes ⩥ Iatrogenic ⊳ Surgery (thyroidectomy) ⊳ Infarction of the parathyroid glands because of inadequate blood supply during surgery ⩥ Idiopathic/autoimmune disorder 10 Physical assessment ⩥ Acute hypoparathyroidism ⊳ Positive Chvostek’s Sign and Trousseau Sign ⊳ Hyperactive Deep tendon reflexes ⊳ Paresthesia: numbness and tingling of fingers 11 Physical assessment ⩥ Chronic hypoparathyroidism ⊳ Lethargy, weakness, fatigue ⊳ Thin, patchy hair ⊳ Brittle nails ⊳ Dry scaly skin ⊳ Cataract ⊳ Permanent brain damage 12 Diagnostic findings ⩥ ⩥ ⩥ ⩥ ⩥ ⩥ Decreased serum calcium levels (1.75 mEq/L) Low PTH levels Decreased urine calcium Ophthalmic exam: calsification of lens Radiograph- increased bone density of skull 13 Medical management ⩥ Active form of vitamin D ⊳ Rocatrol ⊳ Hytakerol (Dihydortachysterol) ⩥ IV Calcium ⊳ 10% Calcium Chloride and Calcium gluconate ⩥ Supplemental calcium (oral, dietary) ⩥ Parathyroid hormone replacement 14 Nursing management ⩥ Teach the patient to consume high calcium, low phosphate diet ⩥ Avoid milk and cheese (high in phosphorus) ⩥ Assess for signs of tetany ⩥ Implement seizure precautions ⩥ Maintain patent airway, keep trachea set at bedside ⩥ Keep ampule of IV calcium at bedside 15