BUKIDNON STATE UNIVERSITY COLLEGE OF NURSING S.Y.

2013-2014 Topic: HYPERPARATHYROIDISM Participants: 3rd 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 for the clients with the disease.
TIME ALLOTED TEACHING LEARNING ACTIVITIES

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

CONTENT

EVALUATION

REFERENCES

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

Hyperparathyroidism is a rare disorder of the parathyroid glands. It commonly occurs in clients older than 60 and affects women twice 2 mins as often as men. There are three types of HPT namely Primary, Secondary and Tertiary Hyperparathyroidism. Hyperparathyroidism is the overproduction of parathyroid 2 mins hormone. Etiologic factors may be due to adenoma (Primary HPT), 3 mins malfunction of another organ system (Secondary HPT) or by irrepressible (autonomous) HPT hormone production. Categorized 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. Care Plan for diseased patient while at the hospital. Home care plans for the diseased patient and for the family. 3 mins 3 mins 3 mins 2 mins 2 mins

Black, J., Hawks, J. (2008). Medical Surgical Nursing: Clinical Management for Positive Outcomes (8th ed). Pp 1032-1036. Singapore. Question and Answer Cooper, M. Primary Hyperparathyroidism Information Sheet. Mayo Clinic. 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 glands. It is characterized by bone decalcification and the development of renal 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 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 1. Radiation treatment that has exposed your neck to radiation 2. Lifestyle: smoking
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CLINICAL MANIFESTATIONS (bones, stones, moans, groans) BONES 1. Ostteitis fibrosa with a. 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, keratitis, conjunctivitis, hypertension, itching DIAGNOSTIC TESTS 1. BLOOD TESTS: Elevated PTH (Normal serum values for PTH are 10 - 55 picograms per milliliter (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 (Complete/Partial) 2. Autotransplantation of Parathyroid gland

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NURSING CARE PLAN

DATA Subjective: 1. Im feeling tired. 2. My muscles are weak. 3. My bones are hurting. 4. Nausea, 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 Activity 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. 3. Protect the patient from injury, monitor for possible complications, and provide patient education NURSING DX OBJECTIVES NURSING INTERVENTIONS Independent: 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 RATIONALE

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

5. Furosemide (Lasix) 2040 mg IV bidqid

DISCHARGE PLANS
Medication: Action, dosage, route, and side effects of all medications. Exercise: Suggest that the patient avoid bedrest; 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
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