Exam 13: Parathyroid Disorders
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| Trousseau's sign | inflate BP cuff on the upper arm, above the systolic reading and hold.
Wait 3 minutes and observe client for carpopedal spasm (spasm of the hand flexing
inward).
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| Laryngospasms | constriction of the airway causing dyspnea with long, crowing respirations as the air tries to get past the constriction. Cyanosis may be present, and the patient may be in danger of asphyxia and cardiac dysrhythmias.
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| Chvostek's sign | patient's mouth twitches and jaw tightens when facial nerve (immediately
in front of ear) is tapped.
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| Parathyroid Glands (Location) | Four glands located on the posterior surface of the thyroid gland.
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| Parathyroid Glands: Function | Secrete parathormone.
↑ concentration of Ca and regulates the amount of Phosporus in the blood.
Release ↑ reabsorption of calcium and magnesium from kidney tubules and increases elimination of phosphorous by kidneys.
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| Hypoparathyroidism | ↑ parathyroid hormone release, resulting in ↓ levels of serum Ca.
Idiopathic form is rare.
Inadvertent removal or destruction of one or more of the tiny parathyroid
glands during thyroidectomy is the most common cause.
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| Calcium | Primary element which makes muscles contract & gives bones rigidity.
Normal conductions of electrical currents along nerves.
Essential element of the clotting process.
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| Too much Calcium | Kidney stones.
Depressed neural function.
Calcium deposits in soft tissue.
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| Too little Calcium | Muscle tetany.
Osteoprosis.
Retarded growth in children.
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| Phosphorus | Inverse proportion of Calcium.
Important for energy storage and transfer.
Component of bones and teeth.
↓ levels lead to poor growth.
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| Hypoparathyroidism: Clinical Manifestations (Hypocalcemia, hyperphosphatemia) | Neuromuscular hyperexcitability.
Involuntary and uncontrollable muscle spasms.
Hypocalcemic tetany.
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| Hypoparathyroidism: Clinical Manifestations (Severe hypocalcemia) | Laryngeal spasm, stridor, cyanosis with increased risk of asphyxia.
Calcification of the basal ganglia in the brain.
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| Hypoparathyroidism: Subjective Assessment | Complaint of dysphagia.
Complaint of numbness and tingling.
Anxiety, irritability, depression.
Headaches, nausea.
Kidney stone formation due to increased renal excretion.
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| Hypoparathyroidism: Objective Data (1) | Positive Chvostek's sign.
Positive Trousseau's sign.
Laryngeal spasm/stridor.
Decreased cardiac output.
Spasms of the extremities.
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| Hypoparathyroidism: Objective Data (2) | Cardiac dysrhythmias.
Muscle cramping may be present.
Generalized convulsions.
Nausea, vomiting, and abdominal cramps.
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| Hypoparathyroidism: Diagnosis (Serum) | Hypocalcemia
Hyperphosphatemia
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| Hypoparathyroidism: Diagnosis (Urine) | Increased urinary calcium.
Decreased urinary phosphorous.
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| Thyroidectomy | Recognition of hypoparathyroid tetany as may be seen after a
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| Hypoparathyroidism: Medical Management | Calcium gluconate.
Calcium chloride.
Vitamin D.
Bronchodilators.
Endotracheal intubation.
Mechanical ventilation.
A diet high in calcium.
Low in phosphorus recommended.
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| Hypoparathyroidism: Nursing Interventions | Monitor for signs/symptoms of hypocalcemia.
Keep at bedside:
Emergency tracheostomy tray.
Airways .
Mechanical ventilation.
Endotracheal intubation equipment.
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| Hyperparathyroidism | Over production of parathormone causes:
*Increased renal excretion of PO4
*Loss of Ca from bones
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| Hyperparathyroidism: Can result in | BONES BECOME WEAK RENAL DISEASE
Stones, Pyelonephritis, Uremia
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| Hyperparathyroidism: Causes | Hypertrophy/Hyperplasia
of gland tissue.
Adenoma-(87-93%)
(tumor in glandular tissue).
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| Hyperparathyroidism: Pathophysiology | Affects women twice as often as men
Usually occurs between 30 and 70 years of age
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| Hyperparathyroidism: Clinical Manifestations | Hypercalcemia.
Skeletal pain.
Pain on weight bearing.
Pathological fractures.
Kidney stone formation.
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| Hyperparathyroidism: Subjective Data | Assessment of severity of pain.
Degree of muscle weakness.
Complaints:
-fatigue, drowsiness. apathy
-nausea, constipation.
Personality changes.
Disorientation.
Paranoia.
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| Hyperparathyroidism: Objective Data | Skeletal deformity.
Abnormal bone movement.
Monitor urine (Quanity, Hematuria, Stones).
Vomiting.
Weight loss.
Hypertension.
Cardiac dysrhythmias.
Bradycardia.
Decreased level of consciousness.
Stupor.
Coma.
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| Hyperparathyroidism: Diagnosis | Hypercalcemia and hypophosphatemia.
↑ blood parathyroid hormone levels (PTH) and alkaline phosphatase.
Urine shows ↑ urine calcium levels.
X-rays may reveal skeletal decalcification (loss of calcium from bones).
MRI or CT identify parathyroid adenoma.
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| Hyperparathyroidism: Medical Management | Removal of hypertrophied gland tissue or of an individual tumor.
Observe for signs and symptoms of hypoparathyroidism.
Post-op management similar to that of patient with thyroidectomy.
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| Hyperparathyroidism: Prognosis | With proper medical or surgical treatment –fairly normal life style
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| Parathyroid carcinoma: Prognosis | very grave prognosis.
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| WHAT IS THE SOLE PURPOSE OF THE PARATHYROID GLAND?? | TO REGULATE CALCIUM
LEVELS
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| What is the name of the hormone secreted by the parathyroid gland? | PARATHORMONE
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| OVER PRODUCTION OF PARATHORMONE RESULTS IN INCREASED LEVELS OF WHAT ELECTROLYTE IN THE BLOOD? | CALCIUM
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| WHAT ARE POSSIBLE COMPLICATIONS OF HYPERCALCEMIA? | PATHOLOGIC FRACTURE
CARDIAC ARRHYTHMIAS
RENAL DISEASE
NAUSEA/VOMITING
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| WHAT IS THE MOST COMMON CAUSE OF HYPOPARATHYROIDISM? | TRAUMA
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| WHAT IS TETANY? | *NUMBNESS, TINGLING
IN FINGERS TOES
*MUSCULAR HYPERTONIA
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| WHAT IS THE MEDICAL CARE FOR A PATIENT WITH HYPOPARATHYROIDISM? | CALCIUM GLUCONATE
ET
BRONCHODILATORS
VIT D
HIGH CA, LOW PO4 DIET
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