Hyperparathyroidism and Hypoparathyroidism
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| Define primary hyperparathyroidism. | hyperplasia or tumor of one of the parathyroid glands, increasing the absorption of calcium from the GI tract
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| Define secondary hyperparathyroidism. | the parathyroid gland enlarges due to chronic hypocalcemia in the presence of elevated PTH
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| Define tertiary hyperparathyroidism. | The parathyroid glands are enlarged, do respond to changes in serum calcium levels, usually associated with chronic renal failure
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| Explain what happens to calcium, phosphate, bicarb, and potassium in hyperparathyroidism. | excess calcium is resorped from bones, the phosphorus it was bound to is excreted by the kidneys = hypercalcemia and hypophosphatemia; kidneys increase bicarbonate excretion and decrease acid excretion leading to metabolic acidosis and hypokalemia
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| What are the manifestations associated with serum electrolyte changes related to excess calcium? | bone decalcification, hypercalcemia causes calcium deposits in soft tissues, renal calculi, altered neurological function, muscle weakness and atrophy, altered GI function, constipation, abdominal pain, anorexia, altered cardiovascular system
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| What are the clinical manifestations of hyperparathyroidism? | Polyuria (early), renal calculi, anorexia, constipation, nausea, vomiting, abdominal pain (from peptic ulcer disease) generalized bone pain, pathologic fractures, muscle weakness/atrophy, depressed DTRs, pareshtesias, depression, psychosis
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| What lab results are consistent with hyperparathyroidism? | calcium levels up, PTH up, phosphate down, X-ray and CT may show decreased bone changes
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| What are the treatments for hyperparathyroidism? | decrease serum calcium by IV NS, Diuretics, and phosphate replacement; surgery to remove PTH glands; weight-bearing exercise to encourage delivery of calcium to bones and decrease renal calculi formation
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| What are the applicable nursing diagnoses for the client with hyperparathyroidism? | Risk for injury, pain, Impaired physical mobility, risk for altered urinary elimination, risk for constipation, deficient knowledge
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| How should we monitor for renal calculi? | Strain urine for calcium based stones
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| How can we help prevent renal calculi and constipation? | provide 2000 to 3000 mL of fluids daily as tolerated and a high-fiber diet
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| What risk may result from treatment of hypercalcemia and how do we monitor for it? | hypocalcemia – watch for numbness and tingling around mouth, fingertips, muscle twitching, change in voice, positive Chvostek and Trousseau sign
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| What medications might the patient with hyperparathyroidism receive? | analgesics for pain, diuretics and NS by IV infusion to excrete excess calcium, phosphate and calcitonin (Miacalcin) and biphosphonates like pamidronate (Aredia) and alendronate (Fosamax) may be used to inhibit bone resorption.
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| What does the client with hyperparathyroidism need to know about self care? | how to take their meds, about their condition, what symptoms to report including signs of hypocalcemia, activity intolerance, and infection
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| Define Hypoparathyroidism and the usual cause. | low PTH levels usually due to removal of all or part of the gland
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| What causes the clinical manifestations of hypoparathyroidism? | Hypocalcemia raises the threshold for nerve and muscle fiber excitability causing easy stimulation – could lead to life threatening tetany
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| What are the clinical manifestations of hypocalcemia? | GI-abdominal pain, nausea, vomiting, diarrhea, anorexia; hypocalcemia – anxiety, HA, paresthesias, neuromuscular irritability, tremors, muscle spasms; Laryngeal spasm, dry thin hair, patchy hair loss, ridged fingernails
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| What therapy is indicated for hypoparathyroidism? | supplemental calcium (oral or by IV) and vitamin D to promote absorption
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| Give 3 applicable nursing diagnoses for the client with hypoparathyroidism. | Risk for injury, anxiety, deficient knowledge
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| What should the client with hypoparathyroidism know about self care? | about the disorder, medic alert bracelet, how to take their medication, symptoms to report (signs of hypocalcemai), diet- high in calcium (cheese, milk, turnip/collard greens, almonds, beans, peanuts) and Vit D
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