-
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
-
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
-
manifestation of hyperparathy
moans- cns
- lethargy. fatige
- depression
- memory loss
- psychoses- parania
- personality chx, neuroses
- confusion, stupor coma
-
manife of hyperparathy
bones
- pathologic fractures0 compression fx
- pulls ca from bone
- skeletal pain, pain on WB
- radiological osteoporosis
- osteomalacia
- arthritis
-
manifes of hyperparathy
stones
- renal stomnes
- UTI, pyelonephritis- damage to kidney
- renal failure
-
manifestation of hyperparathy
groans
- abdominal groans
- constipation
- indigestion. N/V
- peptic ulcer
- pancreatitis
-
other manisf of hyperparathyr
- muscle atrophy
- HTN- vasocontriction
- dysrhythmias
- paresthesias
- corneal calcifications
-
hyperparathy
dx test
- Ca > 12 (norm 8-11)
- Po4 low
- PTH elea
- xray- bone demineralization
- us/mri
- look at big picture
-
hyperparathy
medical managment
- assess
- hydration with NS
- +/- lasix ** no thiazide diuretics (inc cal)
- antiresorption agents
- - phosphates, biphosonates, calcitonin, glucocorticoids
- tx underlying cause
-
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
-
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
-
surgical management
hyperparathyr
- usually only if disease is in gland
- outpt surgery
- good prognosis
- complication rare- similar to thyroidectemy
-
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
-
hypoparathy
patho
- decre PTH
- - dec bone reabsorp
- - dec renal absorption of ca
- - dec GI absorption of ca
- - low ca incre Po4
- low cal
-
hypopara manis
- tetany*** tremors, numbness, tingling
- irritability
- laryngospasm (tetany of airway)
- dysphagia
- arrhythmias, hypotension
- muscle of esophogus?
- chvostek sign
- trousseau's sign
-
hypopara dx
- decre ca < 6.5
- incre Po4
- decr PTH
- calcification seen on head CT or eye exam
-
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
-
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
-
hypopara nursing consideration
- assess resp/card/neuro status
- activity
- teach
- meds
- diet
- disease
- f/u care
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