1. Endocrine - Parathyroid Part 1

2. Parathyroid - description • 4 Parathyroid glands • Behind thyroid (lobe)

3. Parathyroid - function • PTH  h blood Ca levels • PTH stimulated by hypocalcemia • PTH is inhibited by hypercalcemia

4. PTH - function • h the reabsorption of Ca & P from bone  blood • h absorption by sm. Intestine • h reabsorption by kidney • Increases blood Ca levels • Antagonist to Calcitonin • It is the most important regulator of serum Ca levels.

5. Calcium • Why do we need it? • Bones • Teeth • Blood coagulation • Transmission of nerve impulses • Muscle contraction & relaxation • Normal heartbeat

6. Hyperparathyroidism • Pathophysiology • h Parathyroid activity  • h PTH  • (What does PTH do?????) • h blood Ca levels  (out of control) • Hypercalcemia

7. Hyperparathyroidism • Where is the Ca coming from? • Movement of Ca out of the bones  blood

8. Hyperparathyroidism • Etiology • Hyperplasia/ tumor of parathyroid gland • Heredity

9. Hyperparathyroidism • S&S • d/t h serum Ca levels • Fatigue/ • Depression • Confusion • Polyuria • N/V  anorexia • Kidney stones • Renal calculi

10. S&S • Cardiac dysrhythmias • Peptic ulcers • Pathological fractures • Back pain • Bone tenderness • Coma • Cardiac arrest

11. Hyperparathyroidism • Diagnostic tests • h serum Ca levels • X-ray

12. Hyperparathyroidism • Medical management • Goal = i PTH • h fluids

13. Hyperparathyroidism • Pharmaceutical interventions • Lasix (Furosemide) • h renal secretion of Ca • Pamidronate (Aredia) • Calcitonin • Prevents Ca release from bones

14. Hyperparathyroidism • Surgical management • If sever  remove • Remove 3 ½ glands • Post OP • Bone pain gone in 3 days • Renal damage permanent

15. HYPOparathyroidism • Pathophysiology • i PTH  • i blood reabsorption of Ca from bone  • i serum Ca levels  • Hypocalcemia

16. Hypoparathyroidism • Etiology • Heredity • Thyroidectomy (accidental removal)

17. Hypoparathyroidism • S&S • Hypocalcemia causes neuromuscular irritability

18. Hypoparathyroidism • S&S: Acute • Tetany • Tingling of fingers • Muscle spasms • Twitching • + Chvostek’s sign • + Trousseau’s sign

19. Hypoparathyroidism • Chvostek’s sign • Tap facial nerve  • Facial spasm

20. Hypoparathyroidism • + Trousseau’s sign • Occlusion of brachial artery > 3 min. • Carpal spasm

21. Hypoparathyroidism • Chronic S&S • Lethargy • Muscle spasms • Calcification in eyes or brain • Convulsions • Laryngospasms •  obstruction of larynx •  deathmosis

22. Hypoparathyroidism • Diagnostic tests • Chvostek’s sign • Trousseau’s sign • i serum Ca levels • i PTH levels

23. Hypoparathyroidism • Medical management • IV Ca Glugonate • Breath into bag  • Acidosis • In Ca levels • In Ca diet • Oral Ca • Vitamin D • Thiazide diuretics

24. Hypoparathyroidism • Nursing Management • p For S&S tetany • p Stridor