Research Paper On Parathyroidism
Hyperparathyroidism occurs as a result of too much parathyroid hormone being produced by the parathyroid glands. The parathyroid hormone acts to balance the calcium level in the blood and in tissues that need calcium to function properly. When the calcium level increases, it will cause symptoms that point to hyperparathyroidism. The extra calcium in the blood comes from the bones so fractures can occur. Blood work as well as bone density scanning will be used to diagnose hyperparathyroidism. Treatment at first will try to correct the high calcium level by dilution with IV fluids and Lasix. If the condition is severe, the parathyroid gland that is malfunctioning will be surgically removed. Keeping the person free from injury, usually becomes the top priority (Williams, L. S., & Hopper, P. D., 2015).
Pathophysiology
Our bodies have four parathyroid glands that are responsible for the production of parathyroid hormone (PTH). This hormone is responsible for keeping the calcium level in the bloodstream balanced. When one or more of the parathyroid glands produce too much PTH, the body pulls calcium from the bones into the bloodstream to compensate for the high level of PTH
(Williams, L. S., & Hopper, P. D., 2015). There is …show more content…
primary hyperparathyroidism where one or more of the parathyroid glands are overproducing and there is secondary hyperparathyroidism where it is a result of another disease or condition. If a disease causes low calcium levels that linger, it will cause the body to start producing more PTH (Poskurica, M., Poskurica, M., & Petrović, D. 2016).
Etiology & Causes Hyperparathyroidism can be hereditary, or it can be caused by an enlargement of the parathyroid glands from hyperplasia or from a benign tumor. Hyperplasia is usually seen in beginning stages of cancer, but in the parathyroid glands, cancer is rare. A patient with kidney failure is more likely to have parathyroidism due to the kidneys not activating vitamin D which is required for calcium to absorb into the body (Williams, L. S., & Hopper, P. D. 2015). Primary hyperparathyroidism occurs when there is a problem of the parathyroid glands and is usually random. Secondary hyperparathyroidism occurs from deficiencies in calcium and vitamin D or from kidney disease. When calcium and phosphorus levels are not balanced, it can cause the muscle signals to be interrupted and can cause muscle pain and weakness (Hyperparathyroidism, 2016). Risk Factors Women who have gone through menopause are at a much higher risk of having hyperparathyroidism due to the decrease of estrogen and progesterone production which also affects the calcium absorption in the body. Having radiation on your neck will also make you more likely to suffer from problems with your parathyroid glands. The radiation not only kills the bad cells, but also some of the good parts. When the parathyroid glands become damaged, they no longer can operate the way they were made to. If you are taking lithium, you will have your blood serum levels for calcium, phosphorus, and vitamin D checked regularly to make sure they have not been affected by the lithium. If they blood levels do not stay within normal limits, the provider will have to find another way to treat you to avoid the possibility of developing hyperparathyroidism (Hyperparathyroidism, 2016).
Signs and Symptoms Most patients with hyperparathyroidism are asymptomatic.
If symptoms do occur, it is usually as a result from the high blood serum calcium levels. Fatigue is one of the first signs seen, but can be mistaken for many other diseases or conditions. The person can become confused or depressed. They can have increased urination or the formation of kidney stones from the urine not excreting sufficiently. Nausea and vomiting may occur which can lead to anorexia. If cardiac dysrhythmias are present, it should be checked out immediately (Williams, L. S., & Hopper, P. D. 2015). . Pain in the bones and joints is common from the loss of calcium in the bones. This can also lead to fractures in bones with no apparent trauma (Hyperparathyroidism,
2016).
Complications
When the body is deficient of calcium for an extended period of time or if there is too much calcium in the bloodstream, there will be negative effects that start to happen. The bones will become soft and brittle causing fractures to happen easily and causing osteoporsis. If the calcium level is too high, it can cause formation of kidney stones which are extremely painful and can cause damage to the kidneys and ureters. If a patient is pregnant and has hyperparathyroidism that is not taken care of, the baby can be born with low calcium levels. The exact relationship between heart disease and high calcium level is not clear, but it does cause hypertension which may be what caused the heart to have to work harder (Hyperparathyroidism, 2016).
Diagnostic Tests Diagnosis of hyperparathyroidism is done with blood serum tests. Levels that must be evaluated are calcium, phosphorus, and PTH. If these tests show levels that are too high or low, they will then do a 24 hour urine collection to determine how these are being excreted by the kidneys. A bone density scan may also be ordered to determine if the calcium level has affected the density of the bones (Williams, L. S., & Hopper, P. D. 2015). Images of your parathyroid glands may also be taken by x-ray or CT or with a Sestamibi parathyroid scan. This scan will use a radioactive compound to assess the function of the parathyroid glands (Hyperparathyroidism, 2016).
Treatments
Treatments will start by trying to correct the calcium level by giving IV fluids or by giving Lasix to cause the kidneys to excrete more calcium in the urine. Medication may be given to keep the calcium in the bones. Surgery may be necessary to remove the parathyroid gland that is causing the problems if the patient has a high risk of bone or kidney problems ( Williams, L. S., & Hopper, P. D. 2015). The surgeon will only remove the gland that is malfunctioning. If all four parathyroid glands are affected, only three will be removed and part of the fourth, to allow some tissue to remain so PTH production is not completely lost. Most of the time, surgery will correct the problem (Hyperparathyroidism, 2016). When the hyperparathyroidism is a result of secondary condition, treatment will focus on delaying or treating the condition causing the hyperparathyroidism (Poskurica, M., Poskurica, M., & Petrović, D. 2016).
Nursing Interventions Nursing interventions will focus on monitoring the serum blood levels as ordered to prevent serious problems from occuring. Making sure the patient remains free of injury usually becomes the priority intervention (Williams, L. S., & Hopper, P. D. 2015). Nursing diagnosis: Activity Intolerance r/t weakness and fatigue. Goal: Patient will be able to function at their previous level. Interventions: Monitor ability to participate in normal activities, provide active or passive range-of-motion exercises every 8 hours to improve strength, refer to PT and OT for evaluation, and teach exercises to do while sitting or laying. Nursing diagnosis: Deficient Knowledge r/t lack of exposure. Goal: Patient will be able to state causes and symptoms of hyperparathyroidism. Interventions: Assess what knowledge patient has about the disease, provide written and verbal information to teach patient about the disease, teach patient the causes and symptoms to be aware of and when to report to the provider, have patient teach back to evaluate the effectiveness of the teaching. Nursing diagnosis: Risk for injury r/t biochemical dysfunction. Goal: Patient will remain free of injury until blood levels are corrected. Interventions: Monitor serum blood levels to prevent imbalances from occurring, provide oral fluids, assess environment for safety concerns and correct possible issues, provide information on how to quit smoking if patient is a smoker, teach signs and symptoms to report to provider, and teach about medication regimen for long term use. In conclusion, if calcium levels in the body become too high or too low due to a dysfunctioning parathyroid gland, it can have many negative effects. If a patient is taught the causes, signs, and symptoms of hyperparathyroidism, serious complications can be avoided. When providing care for a patient with hyperparathyroidism, you must be aware of the possibility they have of becoming injured due to their bones losing calcium into the blood and causing the bones to become brittle and fractures to happen easily. Careful monitoring is necessary and keeping the calcium level within normal limits is the desired result. Knowing that fatigue can be a sign for many different diseases, can keep a patient from seeking care in the early stages. Always consult a doctor if your activity tolerance changes.
Pathophysiology
Our bodies have four parathyroid glands that are responsible for the production of parathyroid hormone (PTH). This hormone is responsible for keeping the calcium level in the bloodstream balanced. When one or more of the parathyroid glands produce too much PTH, the body pulls calcium from the bones into the bloodstream to compensate for the high level of PTH
(Williams, L. S., & Hopper, P. D., 2015). There is …show more content…
primary hyperparathyroidism where one or more of the parathyroid glands are overproducing and there is secondary hyperparathyroidism where it is a result of another disease or condition. If a disease causes low calcium levels that linger, it will cause the body to start producing more PTH (Poskurica, M., Poskurica, M., & Petrović, D. 2016).
Etiology & Causes Hyperparathyroidism can be hereditary, or it can be caused by an enlargement of the parathyroid glands from hyperplasia or from a benign tumor. Hyperplasia is usually seen in beginning stages of cancer, but in the parathyroid glands, cancer is rare. A patient with kidney failure is more likely to have parathyroidism due to the kidneys not activating vitamin D which is required for calcium to absorb into the body (Williams, L. S., & Hopper, P. D. 2015). Primary hyperparathyroidism occurs when there is a problem of the parathyroid glands and is usually random. Secondary hyperparathyroidism occurs from deficiencies in calcium and vitamin D or from kidney disease. When calcium and phosphorus levels are not balanced, it can cause the muscle signals to be interrupted and can cause muscle pain and weakness (Hyperparathyroidism, 2016). Risk Factors Women who have gone through menopause are at a much higher risk of having hyperparathyroidism due to the decrease of estrogen and progesterone production which also affects the calcium absorption in the body. Having radiation on your neck will also make you more likely to suffer from problems with your parathyroid glands. The radiation not only kills the bad cells, but also some of the good parts. When the parathyroid glands become damaged, they no longer can operate the way they were made to. If you are taking lithium, you will have your blood serum levels for calcium, phosphorus, and vitamin D checked regularly to make sure they have not been affected by the lithium. If they blood levels do not stay within normal limits, the provider will have to find another way to treat you to avoid the possibility of developing hyperparathyroidism (Hyperparathyroidism, 2016).
Signs and Symptoms Most patients with hyperparathyroidism are asymptomatic.
If symptoms do occur, it is usually as a result from the high blood serum calcium levels. Fatigue is one of the first signs seen, but can be mistaken for many other diseases or conditions. The person can become confused or depressed. They can have increased urination or the formation of kidney stones from the urine not excreting sufficiently. Nausea and vomiting may occur which can lead to anorexia. If cardiac dysrhythmias are present, it should be checked out immediately (Williams, L. S., & Hopper, P. D. 2015). . Pain in the bones and joints is common from the loss of calcium in the bones. This can also lead to fractures in bones with no apparent trauma (Hyperparathyroidism,
2016).
Complications
When the body is deficient of calcium for an extended period of time or if there is too much calcium in the bloodstream, there will be negative effects that start to happen. The bones will become soft and brittle causing fractures to happen easily and causing osteoporsis. If the calcium level is too high, it can cause formation of kidney stones which are extremely painful and can cause damage to the kidneys and ureters. If a patient is pregnant and has hyperparathyroidism that is not taken care of, the baby can be born with low calcium levels. The exact relationship between heart disease and high calcium level is not clear, but it does cause hypertension which may be what caused the heart to have to work harder (Hyperparathyroidism, 2016).
Diagnostic Tests Diagnosis of hyperparathyroidism is done with blood serum tests. Levels that must be evaluated are calcium, phosphorus, and PTH. If these tests show levels that are too high or low, they will then do a 24 hour urine collection to determine how these are being excreted by the kidneys. A bone density scan may also be ordered to determine if the calcium level has affected the density of the bones (Williams, L. S., & Hopper, P. D. 2015). Images of your parathyroid glands may also be taken by x-ray or CT or with a Sestamibi parathyroid scan. This scan will use a radioactive compound to assess the function of the parathyroid glands (Hyperparathyroidism, 2016).
Treatments
Treatments will start by trying to correct the calcium level by giving IV fluids or by giving Lasix to cause the kidneys to excrete more calcium in the urine. Medication may be given to keep the calcium in the bones. Surgery may be necessary to remove the parathyroid gland that is causing the problems if the patient has a high risk of bone or kidney problems ( Williams, L. S., & Hopper, P. D. 2015). The surgeon will only remove the gland that is malfunctioning. If all four parathyroid glands are affected, only three will be removed and part of the fourth, to allow some tissue to remain so PTH production is not completely lost. Most of the time, surgery will correct the problem (Hyperparathyroidism, 2016). When the hyperparathyroidism is a result of secondary condition, treatment will focus on delaying or treating the condition causing the hyperparathyroidism (Poskurica, M., Poskurica, M., & Petrović, D. 2016).
Nursing Interventions Nursing interventions will focus on monitoring the serum blood levels as ordered to prevent serious problems from occuring. Making sure the patient remains free of injury usually becomes the priority intervention (Williams, L. S., & Hopper, P. D. 2015). Nursing diagnosis: Activity Intolerance r/t weakness and fatigue. Goal: Patient will be able to function at their previous level. Interventions: Monitor ability to participate in normal activities, provide active or passive range-of-motion exercises every 8 hours to improve strength, refer to PT and OT for evaluation, and teach exercises to do while sitting or laying. Nursing diagnosis: Deficient Knowledge r/t lack of exposure. Goal: Patient will be able to state causes and symptoms of hyperparathyroidism. Interventions: Assess what knowledge patient has about the disease, provide written and verbal information to teach patient about the disease, teach patient the causes and symptoms to be aware of and when to report to the provider, have patient teach back to evaluate the effectiveness of the teaching. Nursing diagnosis: Risk for injury r/t biochemical dysfunction. Goal: Patient will remain free of injury until blood levels are corrected. Interventions: Monitor serum blood levels to prevent imbalances from occurring, provide oral fluids, assess environment for safety concerns and correct possible issues, provide information on how to quit smoking if patient is a smoker, teach signs and symptoms to report to provider, and teach about medication regimen for long term use. In conclusion, if calcium levels in the body become too high or too low due to a dysfunctioning parathyroid gland, it can have many negative effects. If a patient is taught the causes, signs, and symptoms of hyperparathyroidism, serious complications can be avoided. When providing care for a patient with hyperparathyroidism, you must be aware of the possibility they have of becoming injured due to their bones losing calcium into the blood and causing the bones to become brittle and fractures to happen easily. Careful monitoring is necessary and keeping the calcium level within normal limits is the desired result. Knowing that fatigue can be a sign for many different diseases, can keep a patient from seeking care in the early stages. Always consult a doctor if your activity tolerance changes.