Angeles University Foundation

College of Nursing
A.Y. 2010-2011

Nursing Care Management 103

Parathyroid Disorders

Hyperparathyroidism – is a disorder caused by overactivity of one or more of the parathyroid glands leading to
hypersecretion of PTH.

1. Review of Health Promotion and Primary Disease Prevention

2. Secondary Disease Prevention

• Total Serum Calcium
o Venous blood is collected
o Increased – Hyperparathyroidism

• Qualitative Urinary Calcium (Sulkowitch Test)

o Collect urine specimen
o Fine white precipitate should form when Sulkowitch reagent is added to urine specimen
o Absent or decreased precipitate indicates low serum calcium and hypoparathyroidism

• Quantitative Urinary Calcium (Calcium Deprivation Test)

o Collect 24-hour urine specimen
o Increased- Hyper

• Serum Phosporus
o Collect venous blood specimen
o Decreased – Hyperparathyroidism

• Serum Alkaline Phosphatase

o Collect blood specimen
o Increased – Hyperparathyroidism

• PTH Radioimmunoassay
o Collect venous blood
o Increased – Hyperparathyroidism
o When elevated in conjunction with serum calcium levels, this is the most specific test for
hyperparathyroidism

3. Tertiary Disease Prevention

A. Medical Management

• Furosemide (Lasix) – used to promote calciuria

o Thiazide diuretics are not used since they cause calcium retention in the kidneys
Drugs that inhibit bone resorption
• Plicamycin (Mithracin) – chemotherapeutic drug that is effective in lowering serum calcium levels.
o The hypocalcemic effect occurs after 24 hours and lasts for about 1-2 weeks
• Gallium nitrate (Ganite)
• Phosphates
• Calcitonin (Calcimar) – decreases skeletal calcium release and increase renal clearance of calcium

Glucocorticoids – reduces hypercalcemia by decreasing the GI absorption of calcium

Etidronate (Didronel) – decreases release of calcium from the bones

Diet -
IVF – PNSS – it expands the volume and acts in the kidneys to inhibit resorption of calcium.

B. Surgical Management
Parathyroidectomy – Removal or one or more of the parathyroid glands

Indications
Primary hyperparathyroidism

Complications
• Similar with that of Thyroidectomy and rarely occur
• Hypocalcemia

Postoperative Care
 • Monitor for respiratory distress
• Have tracheostomy set, oxygen and suction at bedside
• Monitor vital signs
• Position to semi-fowler’s
• Monitor for bleeding
• Monitor for hypocalcemic crisis
• Administer calcium supplement and vitamin D as prescribed

C. Nursing Management
Impaired urinary elimination r/t renal involvement secondary to hypercalcemia and hyperphosphatemia
resulting in urolithiasis, painful urination, hematuria and spasms

• Encourage fluids – consume at least 3L of fluid each day. DHN is dangerous in clients with hyperparathyroidism
because it increases serum calcium level and promotes formation of renal stones
• Prevent Urolithiasis –
o Crannbery juice or prune juice may help to make urine more acidic. Acidification helps to prevent renal
stone formation because calcium is more soluble in acidic urine than in alkalinic urine
• Strain urine of stones – to detect gravel and stones. Save any specimens of abnormal urine for the physician to
examine and for lab analysis.
o Observe urine for blood and assess the client for renal colic

Risk for injury r/t preoperative drug sensitivities and postoperative complications

• Administer digitalis
• Monitor postoperative complications
• Assess for hemorrhage, airway obstruction, injury to recurrent laryngeal nerve

HYPOPARATHYROIDISM
hyposecretion of parathormone
Can occur following thyroidectomy because of removal of parathyroid tissue

1. Review of Health Promotion and Primary Disease Prevention

2. Secondary Disease Prevention

• Total Serum Calcium
o Decreased – Hypoparathyroidism

• Qualitative Urinary Calcium (Sulkowitch Test)

o Fine white precipitate should form when Sulkowitch reagent is added to urine specimen
o Absent or decreased precipitate indicates low serum calcium and hypoparathyroidism

• Quantitative Urinary Calcium (Calcium Deprivation Test)

o Decreased – Hypo

• Serum Phosporus
o Increased – hypoparathyroidism

• Serum Alkaline Phosphatase

o Decreased – Hypoparathoidism

• PTH Radioimmunoassay
o Increased – Hyperparathyroidism
o When elevated in conjunction with serum calcium levels, this is the most specific test for
hyperparathyroidism

3. Tertiary Disease Prevention

A. Medical Management
• Pure form of synthetic PTH
Elevate serum calcium levels

Acute Hyperparathyroidism
• 10% calcium gluconate solution IV infusion
• Breath in paper bag – to inhale carbon dioxide. CO2 causes mild metabolic acidosis, which elevates the
amount of ionized calcium in the blood

Chronic Hyperparathyroidism
-Keep the client asymptomatic with a serum calcium of 8.5-9.2 mg/dL
Oral calcium salts (If given with digoxin, increased risk for digoxin toxicity) (Reduce the absorption of tetracycline)
• Caclium carbonate
• Calcium gluconate
• Calcium lactate
• Calcium glubionate

Vitamin D supplements
• Calciferol (Calderol)
• Calcitrol (Calcijex, Rocatrol)
• Ergocalciferol
• Dihydrotachysterol (Hytakerol)

Phosphate binding agent

• Aluminum Hydroxide (Amphogel) – to lower phosphorus level and increase calcium

Calcium Regulators
(Not to be chewed; taken with water for atleast 30 minutes before breakfast and remain upright for 30 mins)
• Alendronate (Fosamax)
• Etidronate (Didronel)
• Pamidronate (aredia)

2. Nursing Management
Risk for Injury: Muscle tetany r/t decreased serum calcium levels

Nursing Interventions
Prevent respiratory arrest.
• Assess for laryngeal spasm and respiratory obstruction
• Prepare ET tube, laryngoscope and tracheostomy set available when caring for a client with acute tetany

Monitor and prevent tetany

• Keep an ampule of IV calcium carbonate at bedside
• Keep a patent heplock once IV tubing is removed to have a continuous IV access
• Encourage the client to ingest a ready source of calcium carbonate such as Tums.

Place client on seizure precaution

Monitor v/s. Notify the physician for hypotension.

Other related nursing interventions

• Explain that all forms of vitamin D, except dihydroxycholecalciferol, are slowly assimilated by the body.
Therefore it may take a week or longer before the manifestations improve.
• Teach the client about diet high in calcium but low in phosphorous.
• Remind the client to omit cheese and milk products, which have high phosphorous contents.
• Explain that calcium supplements may be obtained in either tablet or solution form
• Emphasize the importance of lifelong medical care for client with chronic hypoparathyroidism.
• Instruct the client to have serum calcium checked by a physician at least 3 times a year.