Parathyroid Disorder.pptx for bachelor of nursing

useful for nurses

1. “ DISORDERS OF THE PARATHYROID GLANDS ” Mr Yogendra Mehta Lecturer, HOD(AHD) BRNC

2. INTRODUCTION Disorders of the parathyroid glands most commonly present with abnormalities of serum calcium. Patients with primary hyperparathyroidism, the most common cause of hypercalcemia in outpatients, are often asymptomatic or may have bone disease, nephrolithiasis, or neuromuscular symptoms. Hypoparathyroidism most often occurs after neck surgery; it can also be caused by autoimmune destruction of the glands.

3. Disorders of the Parathyroid Glands Definition When the parathyroid gland dysfunctions, hyperparathyroidism or hypoparathyroidism develops. Calcium and phosphorous levels are affected.

4. FUNCTION : secrete parathyroid hormone(PTH, parathormone). - regulates the blood calcium level. -PTH raises the blood calcium level by: Increased calcium absorption from the bones, kidney and intestine, which raises the serum calcium level. Increased serum calcium results in decreased parathormone secretion, creating a negative feedback system.

5. HYPERPARATHYROIDISM Definition: The presence of excess parathyroid hormone in the body resulting in disturbance of calcium metabolism with increase in serum calcium, characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium.

6. Classification: Hyperparathyroidism can be a P rimary S econdary Tertiary condition.  

7. PRIMARY HYPERTHYROIDISM - In primary hyperparathyroidism, excessive secretion of parathyroid hormones results in increased urinary excretion of phosphorus and loss of calcium from the bones. - The bones become demeneralized as the calcium leaves and enters the bloodstream.

8. Etiology An adenoma of one of the parathyroid glands Hyperplasia of Parathyroid

9. Secondary hyperparathyroidism - In secondary hyperparathyroidism, the parathyroid gland secrete an excessive amount of parathyroid hormone in response to hypocalcemia (low serum calcium level).

10. Etiology V itamin D deficiency, C hronic renal failure, large doses of thiazide diuretics Excessive use of laxatives and calcium supplements. Menopause lithium drug  

11. Tertiary hyperparathyroidism If the parathyroid glands continue to produce too much parathyroid hormone even though the calcium level is back to normal, the condition is called “tertiary hyperparathyroidism”. Secondary hyperparathyroidism causes tertiary hyperparathyroidism. Parathyroid glands become enlarged from working much more than they should. 

12. PATHOPHYSIOLOGY Parathyroid glands help to regulate calcium levels in the body if calcium levels are low Parathormone levels increase and vice versa Parathormone regulates calcium by influencing absorption in the GI tract, excretion in the urine and release from the bones

13. Calcium level in the blood increase Calcium from bones enter blood stream causing blood to have too much calcium Results in high blood pressure and kidney stones If too much parathormone is released, calcium regulation is disrupted

14. Clinical Features

15. Diagnosis Blood Test: CBC 24 hour urine test Parathyroid scan USG BMD Primary Hyperparathyroidism Sr. Calcium increased Sr. Vit . D Decreased Phosphate level Parathyroid Hormone Level Secondary Hyperparathyroidism Low level of Vitamin D Low or normal level of calcium High level of phosphate

16. DIAGNOSTIC FINDINGS X-ray subperiosteal bone resorption  · osteopenia · osteosclerosis

17. MANAGEMENT

18. GOAL The goal is to relieve symptoms and prevent complications caused by excess Parathyroid hormone.

19. 1. MANAGEMENT Parathyroidectomy Indications: Y ounger than 50  yrs Symptoms of hypercalcemia . High levels of calcium or creatinine in your blood or pee. Kidney stones. Calcium deposits in your kidneys. Osteoporosis.

20. 1. MANAGEMENT P rimary hyperparathyroidism management: If patient have mildly increased calcium levels due to primary hyperparathyroidism and no symptoms, just needs regular checkups with doctor. Calcimimetics ( Cenacalcet , Etelcacetide ): act like calcium in tissues and tell parathyroid glands to produce less PTH . Hormone replacement therapy- may help bones retain calcium Bisphosphonates : prevent calcium loss from bones and improve bone density.  Avoiding lithium & thiazides diuretics

21. 1. MANAGEMENT Secondary hyperparathyroidism management: - T reat the root cause Phosphate binders(Calcium carbonate Sucroferric oxyhydroxide Sevelamer Lanthanum carbonate Calcium acetate): remove excess phosphate from body. Ergocalciferol (vitamin D2 ) Calcimimetics Tertiary hyperparathyroidism Management: Surgery

22. Dietary management: a diet with restricted or excess calcium. limit intake of calcium (aim for less than 1,200 mg each day) and vitamin D (aim for less than 600 IU each day) protein feedings are necessary. Prune juice, stool softeners, increased fluid intake to prevent kidney stones.

23. Therapeutic management: Hydration therapy: A daily fluid intake of 2000 ml or more is encouraged to help prevent calculus formation. Mobility: The nurse encourages the patient to be mobile. Bones subjected to the normal stress of working give up less calcium. Bed rest increases calcium excretion and the risk of renal calculi.

24. SURGICAL MANAGEMENT: PRE-OPERATIVE CARE -Check doctor’s order. -Identify the patient. -Explain the procedure to the patient. -Prepare the patient for surgery.

25. POST-OPERATIVE CARE -A irway management -Monitor serum calcium -Assess symptoms- anxiety, hyperventilation, Chvostek’s and Trousseau’s signs, paresthesias . -Administer oral calcium carbonate 1 g per oral q6h, or IV calcium gluconate for severe hypocalcemia (<7.0) -Vitamin D supplementation -Watch out for bleeding and infection

26. NURSING MANAGEMENT: Intake and output Observe for signs of urinary calculi, flank pain and decreasing urine output Monitor serum potassium, calcium, phosphate and magnesium levels. Encourage a large volume of fluid. Encourage the patient to regular exercise. Assess the patient with walking, keep bed at its lowest position and raised side rails. Lift immobilized patient carefully to minimize bone stress. Provide rest periods and monitor fatigue

27. COMPLICATION: HYPERPARATHYROIDISM: Osteoporosis Kidney stones Cardiovascular disease

28. DEFINITION: Hypoparathyroidism occurs when either insufficient levels of parathyroid hormone are released by the parathyroid gland in the neck. It leads to low levels of calcium (hypocalcaemia) and high level of phosphorous in the blood ( hyperphosphatemia ).

29. ETIOLOGY: Abnormal parathyroid development Trauma to the glands Near total removal of the thyroid gland Destruction of parathyroid glands (surgical removal or auto immune response) and vitamin D deficiency.

30. RISK FACTORS Recent neck surgery, particularly if the thyroid was involved A family history of hypoparathyroidism Addison’s disease Drugs ( cimetidine , aluminium , doxorubicin) Metal (iron, magnesium, aluminium ) overload Magnesium deficiency due to alcoholism, malnutrition Cancer or infectious disease (e.g. HIV)

31. PATHOPHYSIOLOGY Due to cause-trauma to glands, surgery, or congenital absence of parathyroids Deficiency of parathormone Results in hypocalcemia Affects neuromuscular function Causes hyperexcitibility Results in spastic muscle contractions and paresthesias

32. CLINICAL MANIFESTATIONS Tingling, numbness or burning ( paresthesias ) in finger tips, toes and lips Muscle ache or cramp affecting legs, feet, abdomen or face Twitching or spasm of muscles, around mouth but also in hands, arms and throat Dry hair, brittle nails, dry course skin, loss of memory Severe muscle spasm (also called tetany ) and convulsion Anxiety, nervousness, depression, mood swings Cardiac dysarrhythmia , Carpopedal spasm(flexion of the elbows and wrists and extension of the carpophalangeal joints and dorsiflexion of the feet) Laryngeal spasm, hoarsenesss

33. DIAGNOSTIC FINDINGS: Taking medical history, and asking about symptoms. Conducting Physical examination. Radioimmunoassay for Parathyroid hormone shows diminished serum Parathyroid hormone concentration. Blood and Urine tests reveal decreased serum and urine calcium levels, increased serum phosphate levels(more than 5.4 mg/dl) X-rays indicate greater bone density and malformation. ECG changes disclose increased QT and ST intervals due to hypocalcemia

34. MANAGEMENT: GOALS: The goal of management for hypoparathyroidism is to restore the bodies calcium and phosphorous to normal level and reduce further complications.

35. 1.MEDICAL MANAGEMENT: PHARMACOLOGICAL MANAGEMENT: Oral calcium carbonate and vitamin D supplement are usually lifelong therapy Vitamin D supplement: vitamin D also help to regulate calcium level. Administration of IV calcium salt such as calcium glucoanate Bronchodilators are also used. Long term treatment after trauma to all in advertent removal of the parathyroids include administration of oral calcium and vitamin D.

36. DIETARY MANAGEMENT : A high calcium and vitamin D, low phosphorous diet is recommended High calcium diet includes dairy products, green leafy vegetables, broccoli, fortified orange juice and breakfast cereals. Instruct the patient to avoid carbonated soft drinks which contain phosphorous in the form of phosphoric acid Eggs and maize also tend to be high in phosphorous.

37. NURSING MANAGEMENT Detect early signs of hypocalcemia and anticipating signs of tetany , seizures and respiratory difficulties Calcium gluconate should be available for emergency, IV administration Be alert for signs of tetany . Assess for Chvostek’s and Trousseau’s signs Keep an emergency tracheostomy tray, mechanical ventilation equipment, artificial airway and endotracheal intubation equipment. Observe the client at frequent intervals for respiratory disease.

38. COMPLICATIONS Cataract: is a condition characterized by clouding of the lens of the eye Calcium deposit in the brain Stunted growth in children Slow mental development in children