Disturbances of the Parathyroid
Ann MacLeod, RN, BScN, MPH
Objectives
 Review anatomy and physiology of Parathyroid gland
 Understand Hyper and Hypoparathyroid
• assessment findings
• nursing diagnoses
• management
Physiology
Parathyroid Glands
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
Physiology
 Normal function of PTH is to control and increase bone resorption of calcium, therefor
maintain ca+ and phos. Ions within the bloodstream
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
Collaborative Treatment
 Primary: always treated surgically (1/2 of one gland is sufficient to sustain the body
 secondary: managed by correcting the cause
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
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
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:
Post-op Parathyroidectomy cont’d
 May need to increase calcium in the diet post. Op
 calcium gluconate injections
 Oral calcium preparations
Hypoparathyroidism
 Hyposecretion of PTH causes decreased blood calcium, and increased serum
phosphorus
 leads to pronounced neuromuscular irritability
Causes
 Accidental removal of parathyroid gland
 auto immune destruction
 congenital absence of the glands
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
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
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
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