3. Parathyroid glands are
small endocrine glands in the neck of humans
and other tetrapods. Humans usually have
four parathyroid glands, located on the back
of the thyroid gland in variable locations. The
parathyroid gland produces and
secretes parathyroid hormone in response to a
low blood calcium, which plays a key role in
regulating the amount of calcium in the blood
and within the bones.
PARATHYROID GLAND
4. The parathyroid glands
contains two kinds of
epithelial cells. The
more numerous cells
called chief cells or
principal cells produces
parathyroid hormone or
parathormone . The
function of other kind
of cell called an
oxyphill cell is not
known in a parathyroid
glands.
5.
6. FUNCTIONS OF PARATHYROID
HORMONE
Maintenance of serum
calcium and its regulation.
Regulate phosphate and
bicarbonate excretion in
kidney tubules.
Regulates reabsorption of
calcium from glomerular
filtrate.
Regulates bone absorption
of calcium.
7. There are two disorders
which occur due to the
irregular production of
parathyroid hormone,
which as listed as follows:
HYPERPARATHYRODISM
HYPOPARATHYRODISM
DISORDERS
8. Hyperparathyroidism is
caused by the
overproduction of
parathyroid hormone by the
parathyroid glands ,is
characterized by bone
decalcification and
development of renal
calculi containing calcium.
HYPERPARATHYROIDISM
9. Types of hyperparathyroidism
PRIMARY
HYPERPARATHYRIODISM
: This occur at the age of 60
to 70 and most commonly
found in women. It may
result from genetic
disorders , multiple
endocrine benign neoplasm.
SECONDARY
HYPERPARATHYRIODISM
: This is similar to primary
but occur more in patients
with chronic renal failure
and so called renal rickets .
It may be caused by vitamin
D deficiency.
10. PRIMARY HYPERPARATHYROIDISM OCCUR BECAUSE OF:
A non cancerous growth on a gland which is a most
common cause i.e; adenoma
Enlargement of two or more parathyroid gland .
A cancerous tumor is a rare cause.
SECONDARY HYPERPARATHYROIDISM OCCUR BECAUSE OF:
Severe calcium deficiency.
Severe vitamin D deficiency.
Chronic kidney failure.
ETIOLOGY AND RISK
FACTORS
OF HYPERPARATHROIDISM
11. A woman who had gone through menopause.
Had prolonged, severe calcium or vitamin D
deficiency.
Have a rare, inherited disorder such as multiple
endocrine neoplasia , type 1 which usually affects
multiple glands.
Had radiations treatment for cancer that has
neck to radiations .
Have taken a lithium , a drug that most often
used to treat bipolar disease.
THERE IS AN INCREASED RISK OF
HYPERPARATHYROIDISMIF A PERSON
HAVE:
13. CALCIUM PHOSPHATE MAY
PRECIPATATE IN VARIOUS
ORGANS OF THE BODY AND
CAUSE TISSUE CALCIFICATIO N
CONDITION OF
HYPERPARATHYROIDISM
OCCUR
ONE OR MORE PARATHYROID
GLAND ENLARGE
14. HYPERPARATHYROIDISM IS
OFTEN DIAGNOSED BEFORE
SIGN AND SYMPTOMS OD
DISORDER ARE APPEARED.
SYMPTOMS MAY BE SO MILD
AND NON SPECIFIC THAY THEY
DON,T SEEM TO ALL REALTED
TO DISEASE.
CLINICAL MANIFESTATIONS
15. ACCORDING TO BODY SYSTEM
CNS: Psychological
manifestation may vary from
irritability and neurosis to
psychosis caused by the direct
effect of calcium on the brain
and nervous system.
Increased calcium level
decreases excitation potential
of nerves and muscle tissue .
16. Depression and forgetfulness.
GI : The incidence of peptic ulcers and
pancreatitis is increased and can lead to
symptoms like nausea , vomiting and abdominal
pain.
RENAL: The formation of stones in one or both
kidney, related to the increased urinary
excretion of calcium and phosphorous .
Renal damage result from the precipitation of
calcium, phosphate in the renal pelvis and
parenchyma resulting in renal calculi.
Renal failure
Pyelonephritis
17. MUSCOSKELETAL : Symptoms
accompanying it may result from
demineralization of bone or bone
tumor .
It can result into overgrowth of
osteoclasts.
Skeletal pain and tenderness
especially of back and joints.
Fracture and short body stature.
OTHERS : Tiring or weakness.
Depression
Frequent complaint of illness.
Loss of appetite.
Shortened QT interval on ECG
Hypertension
20. MEDICAL MANAGEMENT
HYDRATION THERAPY
MOBILITY
DIET AND MEDICATIONS
a. Calcimimetic
b. Hormone replacement therapy
c. Bisphosphates
21. The recommended treatment
of primary hyperparathyroidism
is the surgical removal of
abnormal parathyroid tissue
but in patients who have
slightly elevated level of serum
,surgery is delayed.
SURGICAL MANAGEMENT
22.
23. THE NURSING MANAGEMENT OF THE PATIENT
UNDERGOING PARATHYROIDECTOMY IS ESSENTIAL.
Health education to patient and his family about
the nutritional needs and medications of the
patient.
To check the serum calcium level in a scheduled
way.
Have a tracheostomy set and IV cannula
preparation readily available.
NURSING
MANAGEMENT
24. Assess mental and motor strength.
Monitor vitals, ECG, renal stones, calcium and
phosphate levels.
Monitor intake and output of fluid status (100ml if
Ca++ normal)
Administer diet low in calcium and high in
phosphate.
Monitor phosphate in renal patients.
Assess sigh oh haemorrhage.
27. Hypoparathyroidism is an uncommon condition in
which the body secretes abnormally low levels of
parathyroid hormone which is key to regulating and
maintaining a balance of our body’s level of two
minerals Ca++ and phosphorus.
It leads to low levels of calcium in the body and to an
increase of phosphorus in the body.
Supplements to normalize calcium and phosphorus
level treat this condition
Symptoms of hypoparathyroidism is caused by
deficiency of parathormone.
HYPOPARATHYROIDISM
28. POST- SURGICAL HYPOPARATHYROIDISM
AUTO –IMMUNE DISEASE
HEREDITARY HYPOPARATHYRODISM
EXTENSIVE CANCER RADIATION TREATMENT
OF FACE AND NECK
LOW LEVEL OF MAGNESIUM IN THE BODY
ETIOLOGY AND RISK FACTORS
29. FACTORS THAT CAN INCREASE THE RISK OF
DEVELOPING HYPOPARATHYROIDISMINCLUDES:
Recent neck surgery , particularly if the
thyroid was involved.
A family history of hypoparathyroidism.
Having certain autoimmune or
endocrine conditions such as Addison’s
disease which cause your adrenal glands
to produce too little of its hormone.
34. Tingling or burning in the
fingertips , toes , lips.
Brittle nails and anxiety.
Muscle ache or cramps in
the legs , feet , abdomen or
face.
Fatigue or weakness
Painful mensuration
Patchy hair loss
CLINICAL MANIFESTATIONS
35. Dry coarse skin.
POSITIVE CHVOSTEK’S SIGN: It is a clinical
sign of hypocalcemia which consists of
twitching of muscle enervated by facial
nerve. It refers to an abnormal reaction to
the stimulation of the facial nerve.
TROUSSEAU’S SIGN : It is positive when
carpopedal spasm is induced bu occulding
the blood flow of arm for three minutes with
a blood pressure cuff.
40. THE GOAL OF MEDICAL MANAGEMENT IS TO RAISE
THE SERUM CALCIUM LEVEL TO 9 TO 10 mg/dl AND
TO ELIMINATE THE SYMPTOMS OF
HYPOPARATHYROIDISM .
HIGH CALCIUM DIET
DOSAGE OF VITAMIN D
NO SURGICAL MANAGEMNENT
OF HYPOPARATHYROIDISM
MEDICAL MANAGEMENT
41. NURSING MANAGEMENT OF THE PATIENT WITH
POSSIBKE ACUTE HYPOPARATHYROIDISM ARE AS
FOLLOWS:
POST OPERATIVE CARE : Care of post operative
patients having thyroidectomy , parathyroidectomy
and radical neck dissection is towards detecting early
signs of hypocalcemia and anticipating sign of tetany,
seizures, and respiratory difficulty.
NURSING MANAGEMENT
42. ADMINISTRATION OF CALCIUM GLUCONATE :
Calcium and digoxin increase systolic
contraction and also potentiate each other, this
may produce potentially fatal dysrhythmia.
Consequently, the cardiac patient required
continuous cardiac monitoring and carefully
assessment.
MEDICATION AND DIET : Teaching about
medication and diet.
43. Ineffective breathing pattern related to depressed
breathing pattern.
Acute confusion related to depressed metabolism
and altered cardiovascular and respiratory status.
Constipation related to diminished peristalsis.
Fluid volume deficit related to vomiting.
Activity intolerance related to insufficient
physiology energy.
Deficient knowledge about the therapeutic
regimen.
NURSING DIAGNOSIS
45. IRREVERSIBLE COMPLICATIONS
ACCURATE DIAGNOSIS AND TREATMENT
MIGHT PRESENT THESE COMLPICATIONS
ASSOCIATED WITH
HYPOPARATHROIDISM
Stunted growth
Slow mental development
Cataract
Calcium deposition in brain
Seizures
46. DAILY ASSESSMENT
DIET
FOLLOW UP
EXERCISE
NO SMOKING AND
DRINK PLENTY OF
FLUIDS
HEALTH EDUCATION
