Care of Patient with Hypo- parathyroidism

1. Care of Patient with Hypo-parathyroidism Presented by Aisha Parveen

2. Objectives By the end of the class students will be able to • Review anatomy and physiology of parathyroid gland and related system • Define Hypoparathyroidism • Discuss pathophysiology • Identify signs and symptoms of Hypoparathyroidism • Discuss treatment modalities of disorders.

3. Objectives Conti…. • Utilize nursing process in the provision of care for patients with disorder • Design comprehensive discharge teaching to patient with disorder

6. Parathyroid Function • Produce ,store, and secrete Parathormone in response to serum level of ionized calcium • Parathormone, the protein hormone from the parathyroid glands, regulates calcium and phosphorus metabolism

7. PTH Caliterol Ca Ca Ca Extracellular Ca

8. Regulated within narrow range Elevated extracellular levels prevent membrane depolarization Decreased levels lead to spontaneous action potential generation PTH increases Ca2+ extracellular levels and decreases extracellular phosphate levels Vitamin D stimulates Ca2+ uptake in intestines Calcitonin decreases extracellular Ca2+ levels Regulation of Calcium Ions

10. Hypoparathyroidism

11. Hypoparathyroidism • Hypoparathyroidism results from a deficiency of parathyroid hormone OR Is disorder in which the parathyroid glands do not produce enough parathyroid hormone (PTH).

12. Pathophysiology • In the absence of parathormone, there is decreased intestinal absorption of dietary calcium • Decreased resorption of calcium from bone and through the renal tubules. • Decreased renal excretion of phosphate and reabsorption of calcium

14. Causes of Hypoparathyroidism • Idiopathic • Autoimmune • Accidental removal during thyroidectomy Or radical neck dissection. • Interruption of the blood supply

15. Clinical Manifestations • Hypocalcemia • Tetany (numbness, tingling, and cramps in the extremities) • Stiffness of hands and feets • Hypotension • Bronchospasm • Laryngeal spasm • Carpopedal spasm

16. Clinical Manifestations cont,.. • Dysphagia • Seizures. • Neurological symptoms • anxiety, irritability, • ECG changes • Prolonged QT interval

17. Carpopedal spasm / Trousseau’s sign

18. Diagnostic • Serum calcium • 8.6–10.3 mg/Dl • Serum parathyroidhormone level • 10–65 pg/mL • A positive Chvostek’s sign/ A positive Trousseau’s sign • ECG: prolonged QT interval

19. Chvostek’s sign • Chvostek’s sign is positive • when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye

22. Hypoparathyroidism: Treatment • The goal of therapy is to raise the serum calcium level to 9 to10 mg/dL (2.2 to 2.5 mmol/L) • Diet • Rich in calcium and low in phophorus

23. Calcium supplements • Parenteral parathormone can be administered to treat acute hypoparathyroidism with tetany • Vitamin-D • ECG monitoring: block and arrhythmias • CNS monitoring: seizure activity • Respiratory monitoring: bronchospasm, laryngospasm

24. Nursing Management • Assess neuromuscular status in patients at risk for hypocalcaemia • Check for positive Trousseau and Chvostek ’s signs • Monitor serum calcium and phosphorus level • Fall prevention

25. Nursing Management cont,.. • Tell the patient to notify you immediately if he or she has difficulty swallowing or has tightness in the throat. • Keep the intubation tray ready • Oral calcium gluconate, calcium lactate, or calcium chloride.

26. Nursing Management cont,.. • Emergency supplementation: • Calcium gluconate 2 g IV over 10 min followed by an infusion of 6 g in 500 mL D5W over 4–6 hr • Vitamin D • Calciferol • 50,000–100,000 U/day PO/IM

27. Nursing Management cont,.. • Identify early signs of hypocalcemia ,signs of tetany, seizures, and respiratory difficulties in postoperative patients (thyroidectomy,parathyroidectomy,and radical neck dissection) • Calcium gluconate is kept at the bedside, with equipment necessary for intravenous administration. • Teaching about medications and diet therapy

28. The Patient With Hypoparathyroidism Home care teaching objectives: • State present and potential effects of hypoparathyroidism on the body • State precipitating factors and interventions for complications (seizure, cardiac dysrhythmias, cardiac arrest) • State necessary actions for seizure activity

29. Cont,… • State purpose, dose, route, schedule, side effects, and precautions of prescribed medications (calcium, phosphate ) • Identify foods high in calcium and vitamin D, low in phosphorus

30. Reference • Brunner and Suddarth's Textbook of Medical-Surgical Nursing