Parathyroid Gland Disorders

a. Condition caused by hyposecretion of parathyroid hormone
by the parathyroid gland

b. Can occur following thyroidectomy because of removal of
parathyroid tissue

a. Hypocalcemia and hyperphosphatemia

b. Numbness and tingling in the face

c. Muscle cramps and cramps in the abdomen or in the
extremities

d. Positive Trousseau’s sign or Chvostek’s sign

e. Signs of overt tetany, such as bronchospasm,
laryngospasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias,
seizures

f. Hypotension

g. Anxiety, irritability, depression

a. Monitor vital signs.

b. Monitor for signs of hypocalcemia and tetany.

c. Initiate seizure precautions.

d. Place a tracheotomy set, oxygen, and suctioning at the
bedside.

e. Prepare to administer calcium gluconate intravenously for
hypocalcemia.

f. Provide a high-calcium, low-phosphorus diet.

g. Instruct the client in the administration of calcium
supplements as prescribed.

h. Instruct the client in the administration of vitamin D
supplements as prescribed; vitamin

D enhances the absorption of calcium from the
gastrointestinal tract.

i. Instruct the client in the administration of phosphate
binders as prescribed to promote the excretion of phosphate through the
gastrointestinal tract.

j. Instruct the client to wear a Medic-Alert bracelet.

1. Description: Condition caused by hypersecretion of
parathyroid hormone by the parathyroid gland

a. Hypercalcemia and hypophosphatemia

b. Fatigue and muscle weakness

c. Skeletal pain and tenderness

d. Bone deformities that result in pathological fractures

e. Anorexia, nausea, vomiting, epigastric pain

f. Weight loss

g. Constipation

h. Hypertension

i. Cardiac dysrhythmias

j. Renal stones

a. Monitor vital signs, particularly the blood pressure.

b. Monitor for cardiac dysrhythmias.

c. Monitor intake and output and for signs of renal stones.

d. Monitor for skeletal pain; move the client slowly and
carefully.

e. Encourage fluid intake.

f. Administer furosemide (Lasix) as prescribed to lower
calcium levels.

g. Administer normal saline intravenously as prescribed to
maintain hydration.

h. Administer phosphates as prescribed, which interfere with
calcium resorption.

i. Administer calcitonin (Calcimar) as prescribed to
decrease skeletal calcium release

and increase renal excretion of calcium.

j. Monitor calcium and phosphorus levels.

k. Prepare the client for parathyroidectomy as prescribed.
For the client with hyperparathyroidism, notify the physician immediately if a
precipitous drop in the calcium level occurs; assess for tingling and numbness
in the face and extremities and for other signs of hypocalcemia.

1. Description: Removal of one or more of the parathyroid
glands

2. Preoperative interventions

a. Monitor electrolytes, calcium, phosphate, and magnesium
levels.

b. Ensure that calcium levels are decreased to near-normal
values.

c. Inform the client that talking may be painful for the
first day or two after surgery.

a. Monitor for respiratory distress.

b. Place a tracheotomy set, oxygen, and suctioning at the
bedside.

c. Monitor vital signs.

d. Position the client in a semi-Fowler’s position.

e. Assess neck dressing for bleeding.

f. Monitor for hypocalcemic crisis, as evidenced by tingling
and twitching in the extremities and face.

g. Assess for positive Trousseau’s sign or Chvostek’s sign,
which signals the potential for tetany.

h. Monitor for changes in voice pattern and hoarseness.

i. Monitor for laryngeal nerve damage.

j. Instruct the client in the administration of calciumand
vitaminDsupplements as prescribed.