1. Disturbances of the Parathyroid
Ann MacLeod, RN, BScN, MPH

2. Objectives Review anatomy and physiology of Parathyroid gland
Understand Hyper and Hypoparathyroid
assessment findings
nursing diagnoses
management

3. Physiology

4. Parathyroid Glands

5. Hyperparathyroidism Overactivity of one of the parathyroid gland
classified as primary or secondary
90% caused by adenoma
8% by hyperplasia or hypertrophy
2% by carcinoma

6. Physiology
Normal function of PTH is to control and increase bone resorption of calcium, therefor maintain ca+ and phos. Ions within the bloodstream

7. Assessment: excessive blood calcium causes: Hyperparathyroidism
Bone damage
muscles become hypotonic
fatigue, muscle weakness
cardiac muscle may be affected with arrhythmias
Back ache, joint pain
fractures, deformities
n/v, constipation
large amts. Of calcium passing through the kidneys may cause kidney stones

8. Collaborative Treatment
Primary: always treated surgically (1/2 of one gland is sufficient to sustain the body
secondary: managed by correcting the cause

9. Para-thyroidectomy
Pre-op: while ct. awaits surgery: push fluids to > 3000mls/day, cranberry and prune juice prevents stone formation and decreases infection
low Ca+ diet; no milk or milk products
prevent constipation; increase activity, stool softeners, laxatives

10. Parathyroidectomy Pre-op care cont’d
Strain all urine; observe for hematuria and renal colic
protect from injury d/t path. #s
Phosphate or Sodium Phytate(Rencal) this drug decreases absorption of calcium in the gut
calcitonin: decreases serum calcium

11. Post-operative Care:
Immed. Post.op observe for hemorrhage and airway obstruction
watch for serious decrease in blood calcium which will produce tetany
Tetany could be so severe and lead to muscle twitching and seizures Rx. IV calcium gluconate
Hungry Bone Syndrome:

12. Post-op Parathyroidectomy cont’d
May need to increase calcium in the diet post. Op
calcium gluconate injections
Oral calcium preparations

13. Hypoparathyroidism
Hyposecretion of PTH causes decreased blood calcium, and increased serum phosphorus
leads to pronounced neuromuscular irritability

14. Causes Accidental removal of parathyroid gland auto immune destruction
congenital absence of the glands

15. Assessment: caused by low serum calcium levels
Tetany
numbness and tingling of fingers
painful muscle spasms
chvostek’s sign: hyperirrritability of facial nerve
Trousseau’s sign: carpal spasm of fingers and hand after pressure cuff deflated
laryngeal spasm may also occur>>dyspnea
severe : can affect cardiac muscle>heart failure

16. Hypoparathyroidism - Assessment Cont’d
Chronic: lethargy, brittle nails, constipation, loss of tooth enamel, muscle pains
diagnosis is made based on the presence of Chvostek’s and Trousseau’s sign and also decreased calcium

17. Collaborative Management
Acute: can be life threatening;
goals: increase calcium rapidly, prevent and or treat possible convulsions, and control laryngeal spasms and possible resp. obstruction

18. Management 10% calcium gluconate by IV
Trach set and ET tube while emergency in progress
oral Calcium and Vit. D
Diet: Increase ca+, calcium supplements
Lifelong medication and follow-up
blood work
full recovery if diagnosed early