01.10 Hypoparathyroidism

Overview

  1. Hypoparathyroidism
    1. Underactive parathyroid glands
    2. Low PTH levels

Nursing Points

General

  1. Parathyroid gland releases parathyroid hormone (PTH)
  2. Hypoparathyroidism = less PTH
  3. Purpose of PTH
    1. Bones release calcium into blood
    2. Intestines absorb calcium
    3. Kidneys retain calcium
    4. Kidneys excrete phosphorus out in urine
  4. Not enough PTH
    1. Decreased calcium levels –>increased nerve excitability –>tetany (muscle spasms)
      1. Seizures
      2. Arrhythmias
    2. Increased phosphorus levels
  5. Causes of hypoparathyroidism
    1. Surgery
    2. Autoimmune disease
    3. Genetics
    4. Radiation

Assessment

  1. Presentation
    1. Muscle spasms
      1. Bronchospasms –> difficulty breathing
    2. Tingling/numbness
      1. Around mouth
      2. Fingers
    3. Muscle aches
    4. Fatigue
    5. Seizures
    6. Irregular heart rhythm
  2. Doctor orders
    1. Calcium level
    2. PTH level
    3. Phosphorus level

Therapeutic Management

  1. Calcium supplements
  2. Vitamin D supplements
  3. Cardiac monitoring –>watch rhythm
  4. Anti-epileptic medications

Nursing Concepts

  1. Hormone Regulation –> low parathyroid hormone levels (PTH)
  2. Nutrition
    1. Low calcium –> need food high in
    2. High Phosphorus –> need food low in
  3. Patient Education –> choose foods carefully

Patient Education

  1. Eat foods rich in calcium
    1. Dairy
    2. Green leafy veggies
    3. Orange juice
  2. Limit phosphorus rich food
    1. Meat
    2. Whole grains
    3. Carbonated beverages
  3. Follow up blood tests twice per year

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Video Transcript

Hey guys! In this lesson we’ll explore what hypoparathyroidism is and what happens in the body. 

So with hypoparathyroidism, the parathyroid glands are underactive, meaning they aren’t making enough of the parathyroid hormones or PTH. Let’s explore what PTH does normally for our body. 

So PTH has many functions. It makes the bones release calcium into the blood. It makes the intestines absorb calcium and the kidneys retain calcium. PTH also tells the kidneys to excrete phosphorus out in urine. So in hypoparathyroidism, there is less PTH, so let’s explore what happens in the body with less PTH. 

Less PTH results in less calcium in the body, which in turn increases nerve excitability. This means there are increased impulses sent through the nervous system, which affects the nerves and muscle movement. For example, the patient with hypoparathyroidism may have tetany, or muscle spasms. The increased impulses could cause seizures or heart arrhythmias. Without enough PTH to tell the kidneys to excrete phosphorus, the phosphorus levels in the body will increase. Next let’s talk about the causes of hypoparathyroidism. 

Hypoparathyroidism may be caused by the surgery, like if the patient had hyperparathyroidism and had to have the parathyroid glands removed. Autoimmune diseases can cause antibodies to attack to glands causing injury and decreased PTH production. Those with family histories of the disease are more likely to get it. Radiation to treat cancer can also injure the glands. Next we will talk about what the patient looks like. 

So the patient will likely have muscle spasms from that increased nerve excitability. This includes spasms in the lungs known as bronchospasms. This can make it hard to breath. Tingling and numbness can occur around the mouth and in the fingers. The patient may feel tired and experience seizure or heart palpitations. 

So if the patient is having those symptoms, the doctor may order a lab draw to test the calcium, PTH, and phosphorus levels to help diagnose the disease. If the patient is then diagnosed, we will begin management of hypoparathyroidism. 

So to help manage the disease, we will administer calcium and vitamin D supplements. Remember that vitamin D is needed for the body to absorb calcium. Cardiac monitoring may be ordered to watch the rhythm of the heart. Anti-epileptic medications may be ordered to prevent or stop seizures. 

The patient with hypoparathyroidism will need education on what they can and cannot eat. We should encourage foods high in calcium like dairy, green leafy veggies, and orange juice. The patient should limit food that is high in phosphorus like meat, whole grains, and carbonated beverages. It’s important that they follow up with blood tests twice a year to keep an eye on the PTH levels. 

Our priority nursing concepts for the patient with hypoparathyroidism include hormone regulation, nutrition, and patient education. 

Okay, now let’s review the key points from this lesson. Hypoparathyroidism involves underactive parathyroid glands which results in low PTH. Less PTH means less calcium in the blood, resulting in increased nerve excitability. This can cause seizures, tetany or muscle spasms, and heart arrhythmias. The doctor may order labs to help diagnose the disease like PTH, calcium, and phosphorus levels. Hypoparathyroidism is managed with Calcium and vitamin D supplements, anti-seizure medications, and PTH lab work as ordered by the doctor. We should encourage our patients to eat foods high in calcium like dairy and green leafy veggies, and eat foods low in phosphorus like meat. 

That’s it for the lesson on hypoparathyroidism! No go out and be your best self today, and as always, happy nursing!

 



Read more

  • Question 1 of 5

A nurse is caring for a client with hypoparathyroidism. The nurse knows that which of the following supplements might be administered to a client for treatment of hypoparathyroidism?

  • Question 2 of 5

The nurse is giving discharge instructions to a client with hypoparathyroidism. Which of the following should be included in education about items to avoid consuming?

  • Question 3 of 5

A client is admitted with complications due to hypoparathyroidism. The nurse is aware that which of the following treatments should be implemented? Select all that apply.

  • Question 4 of 5

A nurse is assigned a client with the diagnosis of hypoparathyroidism. The nurse knows that which of the following would be expected in the client’s test results?

  • Question 5 of 5

A client that is admitted after surgery to remove the parathyroid glands due to cancer. The nurse is assessing and knows to look for which of the following side effects? Select all that apply.