01.09 Hyperparathyroidism

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Overview

  1. Hyperparathyroidism
    1. Overactive parathyroid glands –> Increased PTH
    2. Excessive calcium in blood

Nursing Points

General

  1. Parathyroid hormone (PTH)
    1. Makes bone release calcium into blood
    2. Intestines absorb calcium
    3. Kidneys retain calcium
  2. Too much PTH (caused by cancer/tumor)
    1. Increased calcium levels in blood
      1. Decreased nerve excitability
      2. Calicum deposits
        1. Hardening of arteries
        2. High blood pressure
        3. Coronary artery disease
        4. Kidney stones
    2. Bone thinning
    3. Impaired kidney function
    4. Impaired heart function
    5. Low phosphorus levels
      1. PTH stimulates kidneys to excrete phosphorus out in urine

Assessment

  1. Presentation
    1. Muscle weakness
    2. Tired
    3. Depressed
    4. Pain in bones
    5. High blood pressure

Therapeutic Management

  1. Calcitonin
    1. Medication to decrease calcium levels
    2. Inhibits bone breakdown
  2. Phosphorus supplements
  3. Surgery –> removal of parathyroid glands

Nursing Concepts

  1. Hormone Regulation –> increased parathyroid hormone (PTH)
  2. Elimination –> kidney stones from calcium buildup, increased release of phosphorus in urine
  3. Lab Values –> elevated calcium in blood, decreased phosphorus

Patient Education

  1. Drink a lot of water (decrease risk of kidney stones)
  2. Stay active
  3. Intake moderate amount of calcium (about 1000 mg) and vitamin D (10 mcg)

Reference Links

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Video Transcript

Hey guys! In this lesson we will explore hyperparathyroidism and what happens to the body.

So hyperparathyroidism is where the parathyroid gland is overactive, creating too much parathyroid hormone, or PTH. Let’s explore what PTH does. 

The parathyroid hormones or PTH have the normal function of  making the bones release calcium into the bloodstream. Too much PTH will weaken the bones over time leading to osteoarthritis. PTH makes the intestines absorb more calcium into the body, and the kidneys retain calcium. So too much PTH results in a lot of calcium in the body! PTH makes the kidneys excrete phosphorus out in the urine, so more PTH means less phosphorus in the body. Let’s look at what happens when we have too much parathyroid hormone in the body.

So the increased calcium as a result of too much PTH results in decreased nerve excitability or decreased impulses sent through the nervous system, which affects the nerves and muscle movement. So for example, with decreased nerve excitability the patient could have decreased muscle tone in the face where the face looks kind of droopy. The extra calcium in the blood creates calcium deposits that can collect in the damaged vessels causing hardened arteries and high blood pressure, resulting in coronary artery disease. Check out the lesson on coronary artery disease for details on how this works. The calcium deposits also create kidney stones which can make it difficult and painful to urinate. Let’s talk about what this patient will look like. 

The patient with hyperparathyroidism is going to feel weak, tired, and depressed from the decreased nerve excitability. They may have pain in the bones since they are lacking calcium in the bones from the PTH. Their blood pressure might be high because of the increased calcium deposit build up in the vessels. Remember, they may also have problems or pain with urinating if those calcium deposits built up in the kidneys causing kidney stones. Next let’s discuss what treatment will look like for this patient. 

Hyperparathyroidism can be managed by administering calcitonin to decrease the calcium levels by inhibiting bone breakdown. Phosphorus supplements will help to battle the extra excretion in the urine. Surgery may be necessary to remove the parathyroid glands. 

Our patient with hyperparathyroidism should be educated to drink lots of water to help decrease the risk of developing kidney stones from the calcium deposit buildup. They should stay active to battle fatigue and depression. Calcium and vitamin D should be consumed in moderation, as calcium levels will already be high in the body and vitamin D helps the body absorb more calcium. 

The nursing concepts for hyperparathyroidism are hormone regulation, elimination, an lab values.

Now let’s review the key points. Hyperparathyroidism involves the overactive parathyroid glands creating too much PTH. PTH makes the intestines absorb calcium, bones release calcium, and make the kidneys reabsorb calcium and excrete phosphorus. Too much PTH in the boy causes increased calcium levels, calcium deposits in the vessels and the kidneys, and decreased nerve excitability. The patient will present with weakness, fatigue, and depression form the decreased nerve excitability. They will probably have high blood pressure from the calcium deposit buildup in the vessels. They may complain of bone pain which occurs because of the bones release of calcium into the bloodstream. We manage hyperparathyroidism with calcitonin to inhibit bone breakdown, decreasing calcium levels in the blood. Phosphorus supplements help to counteract the extra excretion of phosphorus in the urine. Calcium and vitamin D should be consumed in moderations to avoid bringing the calcium levels up more. Surgery to remove the parathyroid glands may be necessary in some cases where the patient has a tumor or cancer. 

Thanks for listening about hyperparathyroidism! Now go out and be your best self today, and as always, happy nursing

Read more

  • Question 1 of 7

The nurse is preparing to receive a postoperative client following parathyroidectomy surgery. The nurse is aware that which of the following are potential occurrences with this type of surgery? Select all that apply.

  • Question 2 of 7

The nurse is caring for a client that was diagnosed with primary hyperparathyroidism. Her vital signs are the following: blood pressure 172/94 heart rate 82 temperature 98.9F Respirations 16 Which of the following orders should the nurse implement first?

  • Question 3 of 7

The healthcare provider notifies the nurse that they are testing for hyperparathyroidism. Which of the following tests should the nurse expect to see in the client’s orders?

  • Question 4 of 7

The nurse is caring for a client with hyperparathyroidism. The nurse knows that the client is at risk for other comorbidities. The nurse is aware that which of the following is a high risk for this client?

  • Question 5 of 7

A nurse is reviewing discharge education with a client. Which of the following should the nurse provide to the client diagnosed with hyperparathyroidism?

  • Question 6 of 7

The nurse is preparing a client for a parathyroidectomy. Which of the following is an appropriate teaching point?

  • Question 7 of 7

A client with hyperparathyroidism from a tumor is told that the healthcare provider wants to remove the parathyroid glands. The client asks the nurse what will happen if the parathyroid glands are removed. Which of the following is an appropriate answer by the nurse?