PREPARED BY: Marcaida, Lestie Anne Martinez, Ly-Annie Mendol, Jessica A.

BSN- III NIGHTINGALE

DEFINITION
HYPERPARATHYROIDISM A condition in which the parathyroid glands, located in the neck, secrete too much parathyroid hormone (PTH). Usually due to a benign growth of 1:4 parathyroid glands. This result to high serum calcium levels and bone demineralization. PARATHYROID GLAND Tiny masses of grandular tissue most often found on the posterior surface of the thyroid gland. Produce parathormone (PTH) Regulates calcium and phosphorus balance. PARATHORMONE (PTH) A hypercalcemic hormone it acts to increase blood levels of calcium. A key modulator of calcium homeostasis. Regulated by negative feedback mechanism Activating Vitamin D which causes renal tubules to increase reabsorption of CA+ and promote excretion of phosphate Stimulates bone destruction cells ( osteoclasts ) to break down bone matrix and release calcium in blood. Stimulates the kidney to absorb calcium from the urine. Stimulates the kidney tubules to produce calcitriol(most active form of vitamin D) that stimulates the absorption of calcium from the GI tract. Elevates serum calcium levels by withdrawal of calcium from the bones. Elevates serum calcium level and inversely, lowers phosphorous levels. Relationship of PTH and Calcium is direct proportion. o Hypersecretion of PTH = Hypercalcemia o Hyposecretion of PTH = Hypocalcemia The relationship of PTH and phosphorus is inverse. o Hypersecretion of PTH = Hypophosphatemia. o Hyposecretion of PTH = Hyperphosphatemia. BONES Major PTH target. Act as storage system for calcium CALCIUM

Calcium is the only element that has its own control system. Acts as a catalyst in the transmission & conduction of nerve impulses The most important element for the nervous system, the muscular system, and the skeletal system. This is why parathyroid disease (over-production of PTH) causes symptoms of the brain, muscles, and bones. Calcium is used by nerve cells to transmit an impulse, and by muscle cells to contract. Humans want extremely regulated calcium levels because our brains (and entire nervous system) rely on calcium.

PHOSPHORUS Second most important mineral in the body after calcium. It helps your body use energy, maintain normal pH balance & carry oxygen to tissues. It also regulates absorption of calcium.

TYPES OF HYPERPARATHYROIDISM
PRIMARY Primary hyperparathyroidism results from a hyperfunction of the parathyroid glands. There is oversecretion of PTH due to adenoma, hyperplasia or rarely carcinoma of the parathyroid glands. SECONDARY Secondary hyperparathyroidism is the reaction of the parathyroid glands to a hypocalcemia caused by something other than a parathyroid pathology, (ex.chronic renal failure.,) TERTIARY Tertiary hyperparathyroidism result from hyperplasia of the parathyroid glands and a loss of response to serum calcium levels. This disorder is most often seen in patients with chronic renal failure.

CAUSES

Benign tumors in the parathyroid glands Parathyroid hyperplasia (excessive growth of normal parathyroid cells) Parathyroid cancer (rare)

Certain endocrine disorders, such as Type I and II multiple endocrine neoplasia (MEN) syndromes (rare)

vomiting center.

Kidney/renal stones

RISK FACTOR

Age: risk increases as you get older (but the disease can also affect children). Gender: twice as many women as men have the condition. Inherited endocrine problems (MEN syndromes). Radiation

R: due to continuous filtration of too much calcium and phosphorus in the kidney that can cause formation of stones. Constipation R: due to decrease Gastro Intestinal motility. Abdominal pain R: due to decrease Gastro Intestinal motility. Skeletal pain. R: due to increased decalcification in the bone. Heartburn R: high calcium in your blood will cause your stomach to make too much acid.

ASSESSMENT

COMPLICATIONS
Osteoporosis. Hyperparathyroidism poses a long-term threat to your bones, the more parathyroid hormone your parathyroid glands produce and release, the more calcium your bones lose. The result is weak, brittle bones that are prone to fractures. Kidney stones. Because your body tries to compensate for excess calcium by excreting more of the mineral in your urine, you're at increased risk of developing kidney stones, which could then lead to kidney damage. Peptic ulcers. High blood levels of calcium stimulate your stomach to produce more acid, making you more likely to develop peptic ulcers. Hypertension High calcium levels can put you at increased risk of high blood pressure (hypertension) and congestive heart failure. Pseudogout A joint disease that can cause attacks of arthritis. Like gout, the condition involves the formation of crystals in the joints. But in pseudogout, the crystals are formed from a salt instead of uric acid. Pseudogout is caused by the collection of salt called calcium pyrophosphate dihydrate (CPPD). The buildup of this salt forms crystals in the joints.

Health History Physical assessment Laboratory Test

SIGNS & SYMPTOMS

Feeling of weakness or fatigue Confusion, poor memory

R: because of overwork of muscle.

R: dec. level of calcium in the bone will slow the transmission of impulse in your brain. Thinning bones R: because of too much lose of calcium in the bones. High Blood Pressure R: due to calcification of the arterial wall that cause over contraction of the heart. Increased thirst and urination R: your kidney will sense a high concentration of calcium in the blood, as compensation your body will increase urination to excrete this too much calcium R: increase urination will decrease fluid volume, it will triggers thirst mechanism. Nausea, vomiting or loss of appetite R: due to increase gastric acid that will trigger the

INTERVENTION DIAGNOSITIC FINDINGS

Serum calcium Result increased due to: 1.Increased bone resorption, allowing flow of calcium from bone to blood 2.reduced renal clearance of calcium 3.increased intestinal calcium absorption Serum phosphorus may be decreased. Due to decreased renal tubular phosphate reabsorption. In secondary hyperpathyroidism, serum phosphorus is elevated because of renal disease. Qualitative Urinary Calcium (Sulkowith Test) (+) or Increase precipitate. o Fine white precipitate should form when sulkowith reagent is added to urine specimen. o Present or increased precipitate indicates high serum calcium and hyperparathyroidism. R: to determine how much calcium is being removed from the body. Parathormone Radioimmunoassay Increase, the most specific test for hyperparathyroidism. X-rays, CT, USshows bone demineralization, fractures, and renal calculi

Monitor VS (BP). Hypertension may occur. Monitor for urine output. Polyuria causes Dehydration Increased fluid intake. To prevent dehydration and renal stone formation. Administer normal saline IV as prescribed to maintain hydration. Sodium enhances excretion of calcium. Decreased Calcium & increased phosphorus in diet. Move client slowly and carefully. Client may experience skeletal pain and they are at risk for fracture. Monitor calcium and phosphorous level. Parathyroid crisis is a rare condition that sometimes occurs when people with hyperparathyroidism experience another illness, like vomiting or diarrhea, which causes excessive fluid loss or severely limits the amount of fluid they can consume. During parathyroid crisis, blood PTH and calcium levels rise sharply, causing severe symptoms of hypercalcemia. Most notably, there is a significant change in thinking and alertness, ranging from confusion to coma. Some people also experience severe abdominal pain, nausea, vomiting, stomach ulcers, and pancreatitis (inflammation of the pancreas). Parathyroid crisis must be treated quickly by replacing lost body fluids and removing the overactive parathyroid tissue.

PARATHYROID CRISIS

DIAGNOSIS
Anxiety r/t change in health status in associated changes in role function as manifested by confusion, increased urination and nausea. Fluid volume deficit r/t active fluid loss through increased dieresis as manifested by thirst. Risk for trauma r/t inc. risk of fracture. Impaired physical mobility r/t musculoskeletal impairments as manifested by limited range of motion.

PHARMACOLOGY
Administer Lasix (Furoximide) to lower serum calcium levels. Administer calcitonin. To decrease skeletal calcium release and increase renal clearance. Avoiding thiazide-type diuretics ("water pills) it reduces urinary calcium excretion.

PLANNING
To prevent other complications. Relief from abdominal discomfort. Maintain fluid & electrolyte balance.

CALCIMIMETICS A new type of drug for people with primary and secondary hyperparathyroidism on dialysis. It is recognised by the body as if it is calcium, in other words, it mimics the effect of calcium in your tissues. This tricks your body into thinking there is more calcium in the blood which reduces PTH release from parathyroid glands, leading to lower calcium and phosphorus levels in your blood. Calcimimetics control PTH release from parathyroid

glands without increasing calcium and phosphorus levels. The most common side effects of calcimimetics are mild or moderate nausea and vomiting.

SURGERY
PARATHYROIDECTOMY: o Removal of one or more of the parathyroid glands. o Monitor for hypocalcemic crisis!

EVALUATION
Skin turgor is good. Client states relief from abdominal discomfort. Maintained fluid and electrolyte balance& prevented dehydration.