Parathyroid Disorders

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1 Parathyroid Disorders Hyperparathyroidism (Hypercalcemia) Overactivity of the parathyroid hormone, with increased production of parathormone. Caused by adenomas,pyelonephritis, or glomerulonephritis. Affects adults between 30 to 70 years of age, twice as often in women. HYPERCALCEMIA: Calcium moves from bones to blood Skeletal l pain on weight bearing pathologic fractures Kidney stones 1

2 Clinical manifestations Bone Demineralization ASSESSMENT Severity of skeletal pain Effectiveness of pain medication Degree of muscle weakness Apathy, nausea, vomiting, anorexia Constipation,personality changes. Renal calculi. 2

3 ASSESSMENT Presence of hematuria and kidney stones. Hypertension and Dysrhythmias. Bradycardia Stupor of coma Diagnostic Tests X-rays Increased PTH levels Alkaline phosphate p levels Calcium level is elevated Phosphorus is decreased Bone density measurements MRI or CT to detect adenoma Medical Management Fluids and LASIX (Acute) Removal of adenoma Removal of parathyroid gland 3

4 Encourage fluid intake Carefully monitor IV therapy Monitor intake and output Strain urine Check calcium levels daily Encourage cranberry juice. NO MILK No antacids Give pain medication as ordered Post surgery care the same as thyroidectomy. Check for Hypocalcemia post-surgery Check for overhydration post-op. 4

5 DISCHARGE Teach good body mechanics Teach patient pain will decrease Encourage mild exercise Teach how to strain urine Hypoparathyroidism (Hypocalcemia) Hypoparathyroidism Decreased activity of parathyroid hormone. Decreased level of serum calcium levels. Most common cause is the inadvertent removal of glands post thyroidectomy. 5

6 Clinical manifestations Neuromuscular hyperexcitability Muscle spasm Hypocalcemic tetany Laryngeal spasm (severe) Stridor, cyanosis and possible asphyxia Clinical manifestations Positive Trousseau s sign Positive Chvostek s sign Decrease cardiac output, Dysrhythmias Diagnostics Tests Decreased calcium levels Increased urinary calcium Increased serum phosphorus level Decrease urinary phosphorus level 6

7 Medical Management Calcium Gluconate IV Give calcium slowly (rapid administration is painful and can cause cardiac arrest) Oral Vitamin D and calcium Check for s/s of hypercalcemia when receiving calcium Assess for respiratory distress Assess renal involvement Diet high in calcium: milk,green vegetables, soybeans, canned fish with bones Check calcium level daily if hospitalized Disorders of the Disorders of the Adrenal Gland 7

8 Cushing syndrome (Adrenal Hyperfunction) Excess Corticosteroids (glucocorticoids) Failure in the negative feedback Cause by : Overstimulation from ACTH hyperplasia of adrenal tissue Tumor of adrenal gland Prolonged administration of steroids. Cushing syndrome Clinical Manifestations Moonface Buffalo hump Thin arms and legs Hypokalemia 8

9 Cushing syndrome Cushing syndrome Clinical Manifestations Hyperglycemia Urine protein, increased calcium in urine infection 9

10 Assessment Assess for ability to concentrate Depression Loss of libido Observe for ecchymoses, petechiaed Clinical Manifestations Thin and fragile skin Delayed wound healing Assess for abdominal enlargement striae Diagnostic tests Clinical appearance Plasma Cortisol levels are elevated Increased level of steroids in 24 hours collection urine. Blood sugar levels Abdominal CT scan and ultrasound 10

11 Medical Management Treat cause Mitotane (Lysodren) therapy Diet low in sodium, low calories and carbohydrates, high in potassium If related to use of steroids: decreased dose, taper down dose or alternate-day regimen. Nursing interventions Gentle care of skin Check for infection Reposition patient to avoid decubitus Promote ambulation Encourage verbalization of feelings Teach mitotane therapy administration Teach the patient to wear an alert bracelet Teach to avoid stress and infections Post adrenalectomy: proper wound care Check for s/s of Addison's disease 11

12 Addison s Disease Adrenal Hypofunction Occurs : post adrenalectomy Pituitary Hypofunction Long-standing steroid therapy Autoimmune disease (most common) Clinical Manifestations Disturbances of the metabolism of fat, carbohydrates, and proteins Electrolytes imbalances, water loss and hypovolemia. Postural hypotension Labile emotional status Muscle weakness, tires easily Clinical Manifestations Darkly pigmented skin: sun-exposed areas, pressure points, joints, and palmar creases 12

13 Clinical Manifestations Clinical Manifestations Weigh loss Nausea/ vomiting Low or high temperature Hyponatremia and Hyperkalemia Diagnostic Tests Decreased sodium Increased potassium Decreased serum glucose Decreased level of urine steroids Low fasting plasma cortisol and aldosterone levels 13

14 Medical Management Steroids replacement:fludocortisone and Hydrocortisone Diet: high in sodium and low in potassium Fluid replacement Check patient s circulatory status Keep I & O records Weigh patient daily Monitor VS and including T Keep patient s room warm Check for s/s adrenal crisis Sudden drop in BP N/V High T Cyanosis 14

15 Teach patient to carry an emergency kit at all time: Hydrocortisone Injection 100 mg to be given IM. STAT Teach family how to give IM meds PHEOCHROMOCYTOMA PHEOCHROMOCYTOMA TUMOR OF THE ADRENAL MEDULLA TUMOR OF THE ADRENAL MEDULLA THAT CAUSES INCREASED EPINEPHRINE AND NOREPINEPHRINE LEVELS 15

16 CLINICAL MANIFESTATIONS HYPERTENSION CRISIS 300/175 ASSESSMENT Assess for severe HA and palpitations Nervousness Take BP and RR Check pupil for dilation Diagnostic Tests High Plasma catecholamines 24 hours Urine Collection for Increased metanephrines values in 90% of patients VMA in 24 hour urine collection is high 16

17 Diagnostic Tests CT scan and MRI of adrenal gland Oral intake is restricted for 8 hours before IVP. Give laxative the night before the test Medical Management Surgical removal of tumor Control hypertension with alphaadrenergic medications Metyrosine to block catecholamines for long-term basis if no surgery Closely monitor BP after surgery Teach patient to avoid stress and take BP. Allow time to rest Record I and O Diet: free of coffee, tea or soft drinks 17

18 THE END 18

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