Hyperparathyroidism

BUKIDNON STATE UNIVERSITY COLLEGE OF NURSING S.Y. 2013-2014 Topic: HYPERPARATHYRO HYPERPARATHYROIDISM IDISM Participants: 3 rd Year Level Students, NCM 103 Venue: Anatomy and Physiology Room

Date: July 2013 Facilitator: Lyra Dain O. Lorca

General Objectives: At the end of the 20 minute discussion, the students will be able to define and describe Hyperparathyroidism. Participants will also be able to explain the disease process, identify diagnostic tests and the clinical manifestations, and lastly be able to list and recall medical, surgical and nursing management management for the clients with the disease.

SPECIFIC OBJECTIVES  After 20 minutes, minutes,  students will will be able to discuss the  following: Introduction

Definition Etiology And Risk  Factors Manifestations Manifestat ions Diagnostic Exams Medical/Surgical Management  Nursing Care Plan Plan Discharge Plan

CONTENT

Hyperparathyroidism Hyperparathyroidism is a rare disorder of the parathyroid glands. It commonly occurs in clients older than 60 and affects women twice as often as men. There are three types of HPT namely Primary, Secondary and Tertiary Hyperparathyroidism. Hyperparathyroidism. Hyperparathyroidism Hyperparathyroidism is the overproduction overproduction of parathyroid hormone. Etiologic factors may be due to adenoma (Primary HPT), malfunction of another organ system (Secondary HPT) or by irrepressible (autonomous) HPT hormone production.

TIME ALLOTED

TEACHING LEARNING ACTIVITIES

2 mins

Categorized Categori zed into bones, stones, moans, groan. Blood tests, Bone mineral density test (bone densitometry), Urine tests, Imaging tests of kidneys ie X-ray, ultrasound, Sestamibi scan Parathyroidectomy. Parathyr oidectomy.

3 mins 3 mins

Care Plan for diseased diseased patient patient while at the the hospital. Home care plans for the diseased patient and for the family.

2 mins 2 mins

3 mins

REFERENCES

Black, J., Hawks, J. (2008).  Medical Surgical Nursing: Clinical Management for   Positive Outcomes (8th ed). Pp 1032-1036. Singapore.

2 mins 3 mins

EVALUATION

Question and   Answer 

Cooper, M. M. Primary  Hyperparathyroidism  Hyperparathyroidism  Information  Information Sheet. Mayo Clinic.  Hyperparathyroidism.  Hyperparathyroidism. http://www.mayoclinic.co m/health/hyperparathyroidi sm/DS00396/DSECTION= causes

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HYPERPARATHYROIDISM hyper = too much. parathyroid = parathyroid gland. ism = a disease or condition DEFINITION : Hyperparathyroidism, caused by overproduction of parathormone by the  parathyroid  parathyroid glands. It is characterized characterized by bone decalcification decalcification and and the development development of renal calculi calculi (kidney stones) containing calcium. ETIOLOGY PRIMARY HYPERPARATHYROIDISM: occurs when one or  more of your parathyroid glands become enlarged and overactive. The gland, or glands, releases too much parathyroid hormone.

1. A noncancerous/cancerous growth (adenoma/malignant) on a gland. 2. Enlargement (hyperplasia) of two or more parathyroid SECONDARY HYPERPARATHYROIDISM: caused by other diseases or deficiencies that is affecting the body. These other conditions cause a chronic low level of calcium in your blood. This means that your parathyroid glands are permanently being stimulated to try to raise your   blood calcium level. As a result, your parathyroid glands enlarge and their output of parathyroid parathyroid hormone increases.

1. Vitamin D deficiency, mal-absorption, chronic renal failure, hypophosphatemia TERTIARY HYPERPARATHYROIDISM: occurs as a result of prolonged secondary hyperparathyroidism. In tertiary hyperparathyroidism, the condition causing your low blood calcium has been treated (or your blood calcium level has been corrected). However, your parathyroid glands continue to produce large amounts of parathyroid hormone. This is because they start to act by themselves (autonomously) and are no longer sensitive to your blood calcium level. They are not 'switched off' when your blood calcium level rises. RISK FACTORS

 Predisposing Factors 1. Age: Female, >60 yo (menopause) 2. Genetic disorder: Multiple endocrine neoplasia

Precipitating Factors Factors 1. Radiation treatment that has exposed your neck to radiation 2. Lifestyle: smoking 2|P a g e

CLINICAL MANIFESTATIONS ( bones, stones, stones, moans, moans, groans) BONES 1. Ostteitis fibrosa with a. Subperiosteal Subperiosteal resorption  b. Osteoclastomas c. Bone Cyst 2. Osteomalacia/ rickets 3. Arthritis STONES 1. Renal stones 2. Polyuria 3. Polydipsia 4. Uremia

ABDOMINAL GROANS 1. Constipation 2. Indigestion, nausea, vomiting 3. Peptic ulcer  PSYCHIC MOANS 1. Lethargy, fatigue 2. Depression 3. Memory Loss 4. Confusion, stupor, coma OTHERS: proximal muscle weakness, weakness, keratitis, conjunctivitis, conjunctivitis, hypertension, hypertension, itching

DIAGNOSTIC TESTS

1.

BLOOD TESTS:  Elevated PTH (Normal serum values for PTH are 10 - 55 picograms  per milliliter (pg/mL) (pg/mL)  Elevated serum calcium >10mg/dl  Lowered phosphorus <10mg/dl

Figure 1 Signs and Symptoms of client with Hyperparathyroidism

2. BONE MINERAL DENSITY TEST (BONE DENSITOMETRY). The most common test to measure bone mineral density is dual energy X-ray absorptiometry, or a DXA scan. This test uses special X-ray devices to measure how many grams of calcium and other bone minerals are packed into a segment of bone.  Identify osteoporosis

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3. URINE TESTS. A 24-hour collection of urine can provide information on how well your kidneys function and how much calcium is excreted in your urine. This test may help in judging the severity of hyperparathyroidism or diagnosing a kidney disorder causing hyperparathyroidism.  Elevated urine calcium 4. ULTRASOUND. A small device held against your skin (transducer) emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures. A computer converts the echoes into images on a monitor.  Ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue. 5. SESTAMIBI SCAN. Sestamibi is a specially designed radioactive compound that is absorbed by overactive parathyroid glands and can be detected on computerized tomography (CT) scans. A small dose of the compound is injected into your bloodstream before the imaging test is done.

MEDICAL MANAGEMENT/ SURGICAL MANAGEMENT

MEDICAL MANAGEMENT Goal: 1. To lower excessive elevation of calcium levels 2. To increase bone reabsorption of calcium Management: 1. Hydration 2. Calciuria 3.  Normal saline fluid 4. Furosimide 5. Diet that is low in calcium and vitamin D 6. Plycamycin 7. Gallium Nitrate 8. Glucocorticoids

SURGICAL MANAGEMENT Goal: To remove defective gland that causes hyperparathyroidism

Management: 1. Parathyroidectomy Parathyroidectomy (Complete/Partial) (Complete/Partial) 2. Autotransplantation of Parathyroid gland

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NURSING CARE PLAN DATA

NURSING DX

OBJECTIVES

Subjective: 1. I’m feeling tired. 2. My muscles are weak. 3. My bones are hurting. 4.  Nausea, vomiting vomiting Objective: 1. Parathyroid hormone (PTH) is 60 picograms per  milliliter  2. 15 mg/dL level of  serum calcium 3. X-ray shows enlargement of   parathyroid gland

NURSING INTERVENTIONS

RATIONALE

Independent:  Activity intolerance intolerance related to fatigue, muscle weakness, and  bone pain

1. To conserve energy 2. To be knowledgeable of disease process, diet, medication, and  prescribed activity. activity. 3. Protect the patient from injury, monitor for   possible complications, complications, and provide patient education

1. Adjust activities and reduce intensity level 2. Provide positive atmosphere, while acknowledging the difficulty of  situation for the client. 3. Assist patients with activities/ monitor clients use of assistive device such as walker 

1. To prevent overexcertion 2. Helps minimize frustration, rechanneling of energy 3. To protect client from injury

Dependent: 4. Parathyroidectomy

5. Furosemide (Lasix) (Lasix) 20 – 40 40 mg IV  bid – qid qid

4. To remove cause of  hyper secretion of   parathormones  parathormones 5. Loop diuretic used with normal saline to cause diuresis and to reduce calcium levels

DISCHARGE PLANS Medication: Action, dosage, route, and side effects of all medications. Exercise: Suggest that the patient avoid bedrest; encourage encourage the patient to space activity throughout the day and use the energy levels as a guide to activity. Remind the patient to avoid contact sports or other activities that place her or him at risk for falls or fractures. Outpatient diet: Low in calcium with limitation and avoidance of milk products 5|P a g e