endocrine disorders parathyroid

  1. parathyroid gland
    • 4 small glands near the thyroid gland secretes PTH
    • - controls phosphate and ca metabolism- inverted rela
    • - for normal excitability of nerves and muscles
    • - controlled by feedback mech for calc
    • has an affect on Vit D
  2. hyperparathyroidism
    • hyperactivity. hypersecretion
    • - chracterized by bone decalcification and renal stones
    • Primary:
    • - incr secretion of PTH
    • - adenoma- tumor
    • Secondary
    • - compensatory response to hypocal
    • - renal failure
    • kidney makes vit d- can't activate so can't absorb cal
    • renal failure will incr phosphate so dec ca
  3. manifestation of hyperparathy
    moans- cns
    • lethargy. fatige
    • depression
    • memory loss
    • psychoses- parania
    • personality chx, neuroses
    • confusion, stupor coma
  4. manife of hyperparathy
    bones
    • pathologic fractures0 compression fx
    • pulls ca from bone
    • skeletal pain, pain on WB
    • radiological osteoporosis
    • osteomalacia
    • arthritis
  5. manifes of hyperparathy
    stones
    • renal stomnes
    • UTI, pyelonephritis- damage to kidney
    • renal failure
  6. manifestation of hyperparathy
    groans
    • abdominal groans
    • constipation
    • indigestion. N/V
    • peptic ulcer
    • pancreatitis
  7. other manisf of hyperparathyr
    • muscle atrophy
    • HTN- vasocontriction
    • dysrhythmias
    • paresthesias
    • corneal calcifications
  8. hyperparathy
    dx test
    • Ca > 12 (norm 8-11)
    • Po4 low
    • PTH elea
    • xray- bone demineralization
    • us/mri
    • look at big picture
  9. hyperparathy
    medical managment
    • assess
    • hydration with NS
    • +/- lasix ** no thiazide diuretics (inc cal)
    • antiresorption agents
    • - phosphates, biphosonates, calcitonin, glucocorticoids
    • tx underlying cause
  10. nursing interventions
    • safety precautions
    • ambulation activity
    • pain management
    • encourage fluids- 3-4L/Day
    • balance diet
    • stool softners or laxa PRN- can cause constipation
    • coping
    • teaching
  11. hypercal crisis
    • cause: malignancy
    • dx: serum cal > 13
    • s/s cardiac, muscle weakness, dehydration, lethargy,- stupor- coma
    • tx:
    • - ABC
    • - IV hydration
    • - calcitonin (allergy, anaphylactic) & glucocorticoids
    • - biphosphates- pulls ca in bone
  12. surgical management
    hyperparathyr
    • usually only if disease is in gland
    • outpt surgery
    • good prognosis
    • complication rare- similar to thyroidectemy
  13. hypoparathyr
    • insuffient PTH or failure of pth to ct at the tissue level
    • more common in women
    • - iatrogenic- more common due to surgery
    • - idiopathic- ? autoimmune
  14. hypoparathy
    patho
    • decre PTH
    • - dec bone reabsorp
    • - dec renal absorption of ca
    • - dec GI absorption of ca
    • - low ca incre Po4
    • low cal
  15. hypopara manis
    • tetany*** tremors, numbness, tingling
    • irritability
    • laryngospasm (tetany of airway)
    • dysphagia
    • arrhythmias, hypotension
    • muscle of esophogus?
    • chvostek sign
    • trousseau's sign
  16. hypopara dx
    • decre ca < 6.5
    • incre Po4
    • decr PTH
    • calcification seen on head CT or eye exam
  17. hypoparathyroidism
    management
    • goal: incre calcium and prevent/treat c/o
    • - prevent/treat seizure
    • - control larygeal spasms
    • - prevent/treat tetany
    • Airway
    • - breathing
    • IV Calcium gluconate
    • - IV slowly
    • - ECG monitoring
    • be careful of arrthymias
  18. hypopara
    calcium replacement
    • thiazide diuretics
    • po cal and vit d supplements
    • aluminum replacements (amphojel)- bind to phosphate
    • PTH replacement- expensive
    • high Ca, low phosphate diets
  19. hypopara nursing consideration
    • assess resp/card/neuro status
    • activity
    • teach
    • meds
    • diet
    • disease
    • f/u care
Author
Prittyrick
ID
319207
Card Set
endocrine disorders parathyroid
Description
thyroid
Updated