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Module 4 > UNIT 4- PARATHYROID DISORDERS > Flashcards

UNIT 4- PARATHYROID DISORDERS Flashcards

1
Q

What does the parathormone (PTH) regulate?

A

Calcium balance

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2
Q

Increased PTH levels means ___ phosphorus?

A

Decreased

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3
Q

If serum calcium is decreased what happens to the PTH level?

(normal functioning parathyroid)

A

Parathyroid increases PTH level and calcium is drawn from the bone and increases the serum calcium level

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4
Q

If serum calcium is increased what happens to the PTH level?

(Normal functioning)

A

Thyroid increases calcitonin which decreases serum calcium

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5
Q

What are the 3 types of hyperparathyroidism?

A
  1. Primary
  2. Secondary
  3. Tertiary
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6
Q

What is happening in primary hyperparathyroidism?

A
  1. Enlargement of parathyroid glands
    • increased PTH = Increased blood calcium
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7
Q

What is happening in secondary hyperparathyroidism?

A
  1. Excess PTH 2nd due to low CA level
  2. Possible causes:
    • vit. D deficiency
    • Ca not absorbed from intestines
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8
Q

What is happening in tertiary hyperparathyroidism?

A
  1. Renal failure
    • Decreased ability to excrete phosphate
    • decreased ability to activate vit. D into usable dihydroxyvitamin D
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9
Q

What labs would you expect to see in a patient with hyperparathyroidism?

A
  1. Increased CA & PTH
  2. Decreased Phosphorus
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10
Q

What might you find on your assessment of a hyperparathyroid patient? ( CV, MS, GI, Renal, CNS, Psychological)

A

CV: increased BP, dysrhythmia
MS: Bone pain/ fracture, muscle weakness
GI: Anorexia
Renal: polyuria, or renal calculi
CNS: decreased DTR, paresthesia
Psychological: Depression, psychosis, cognitive dysfunction

Hypercalcemic crisis

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11
Q

Hyperparathyroidism uses the acronym WEAK… what does that stand for?

A

W- Weakness
E- EKG
A- Absent Reflex
K- Kidney stone

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12
Q

Increased calcium puts patients at risk for what?

A

Kidney stones

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13
Q

How do we manage mild hyperparathyroidism?

A
  1. increased fluids & wt. bearing exercise
  2. Avoid Ca supplements, large doses vit. A & D
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14
Q

How do we manage acute hyperparathyroidism?

A
  1. Ns gtt, loop diuretics, phosphates, calcitonin
  2. Dialysis
    • if level is greater than 15
  3. Surgery
    • won’t happen unless patient is stabilized.
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15
Q

What nursing problems should the nurse be watching for with a patient with hyperparathyroidism?

A
  1. Pain
    • Bone pain
  2. Knowledge deficit
  3. Risk
    • injury, mobility, cardiac, neurological, urinary or bowel elimination, fluid & electrolyte
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16
Q

What is the treatment for hyperparathyroidism?

A
  1. Monitor- if not symptomatic
    • Ca intake 1000mg/day
    • Vit D. 400-600 IU/day
    • Bisphosphonates- ibandronate
      & risedronate
    • Calcitonin
  2. Surgery
17
Q

What is the MOA ibandronate & risedronate for treatment of hyperparathyroidism?

A
  1. Osteoporosis 2nd to hyperparathyroidism
18
Q

What are adverse effects of ibandronate & risedronate for tx of hyperparathyroidism?

A
  1. GI upset
  2. Musculoskeletal pain
19
Q

Caution using ibandronate & risedronate with what patients?

A
  1. Pt with upper GI disorders, pt who cannot sit/stand upright for 30 mins
20
Q

What should we teach a patient taking ibandronate & risedronate for hyperparathyroidism?

A
  1. Take in the AM
  2. Remain upright for 30mins
  3. Do not take with ca supplements, antacids, caffeine or OJ
    • can interfere with absorption
  4. Call if difficulty swallowing or develop heartburn
21
Q

As the nurse we should monitor what labs for hyperparathyroidism?

A
  1. Monitor serum ca, phos, PTH, & bone density
22
Q

Why would use with calcitonin?

A
  1. Hypercalcemia
23
Q

What is the MOA of calcitonin for hyperparathyroidism tx?

A
  1. Increases deposition of CA & Phos in bone; lowers CA levels in blood,
24
Q

What are the adverse effects of calcitonin for hyperparathyroidism tx?

A
  1. nausea, nasal dryness
25
Caution using calcitonin for hyperparathyroidism tx in patients with....
1. Allergy to fish protein 2. Renal disease
26
What are the different route of calcitonin which is used for hyperparathyroidism tx?
1. Nasal spray 2. IM 3. SC
27
What should we teach patients taking calcitonin?
1. Nasal spray- alternate nostrils 2. Rotate sites inj. sites 3. Monitor- serum Ca, bone density 4. Diet- high Ca & Vit. D
28
What pre-op things should a nurse consider prior to a parathyroidectomy?
1. Monitor electorlytes-- Ca, Phos, Mg 2. see thyroidectomy notes
29
What post-operative things do we need to know regarding parathyroidectomy?
1. See thyroidectomy notes 2. Monitor electrolytes 3. Monitor for tingling in extremities or face 4. Monitor voice pattern and quality - whisper? call if you cant get cleared up w/ little h2o & ice chip
30
What is hypoparathyroidism?
Deficiency of PTH leading to decreased calcium
31
What causes hypOparathyroidism?
1. Acquired- damage/removal 2. Hereditary- not present or poor function 3. Radiation- external or RAI 4. Autoimmune- not hashimotos
32
Upon assessment of CV, RESP, GI, CNS, MS, LAB of a hypoparathyroidism patient what might you expect to see?
CV: decreased bp, dysrhythmias RESP: bronchospasms, laryngeal spasm, hoarseness GI: N/V/D, abd. pain, diff. swallowing CNS: Paresthesia, anxious, irritable MS: Muscle cramps, seizure, + trousseau/Chvostek's LAB: Decreased PTH & Serum CA, Increased phos
33
S/S of hypoparathyroidism uses the acronym CRAMPS what does that mean?
C: Confusion R: Reflexes hyperactive A: Arrythmias M: Muscle spasms P: + Trousseau S: Signs of Chvostek
34
How is hypoparathyroidism managed?
GOAL: Increased serum ca to 9-10mg/dL 1. immediate treatment: Calcium gluconate IV then CA carbonate 2. Vitamin D - cheese, margarine, butter, fermented milk, healthy cereals, fatty fish
35
What are nursing problems of hypoparathyroidism to be aware of?
1. imbalance- electrolyte, nutrition 2. Knowledge deficit 3. Anxiety 4. Risk - airway clearance, breathing patten, dysrhythmia, injury
36
What should we teach hypoparathyroidism patients?
1. Monitor serum ca & phos 2. Prevent constipation 3. Nutrition- high Ca & low Phos. 4. IV calcium- telemetry monitoring

Module 4 (29 decks)

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