Hyperparathyroidism

  1. General information
    1. Increased secretion of PTH that results in an altered state of calcium, phosphate, and bone metabolism
    2. Most commonly affects women between ages 35-65
    3. Primary hyperparathyroidism: caused by tumor or hyperplasia of parathyroid glands
    4. Secondary hyperparathyroidism: caused by compensatory oversecretion of PTH in response to hypocalcemia from chronic renal disease, rickets, malabsorption syndrome, osteomalacia
  2. Assessment findings
    1. Bone pain (especially at back), bone demineralization, pathologic fractures
    2. Renal colic, kidney stones, polyuria, polydipsia
    3. Anorexia, nausea, vomiting, gastric ulcers, constipation
    4. Muscle weakness, fatigue
    5. Irritability, personality changes, depression
    6. Cardiac arrhythmias, hypertension
    7. Diagnostic tests
      1. Serum calcium levels elevated
      2. Serum phosphate levels decreased
      3. Skeletal x-rays reveal bone demineralization
  3. Nursing interventions
    1. Administer IV infusions of normal saline solution and give diuretics as ordered; monitor I&O and observe for fluid overload and electrolyte imbalances.
    2. Assist client with self-care: provide careful handling, moving, and ambulation to prevent pathologic fractures.
    3. Monitor vital signs; report irregularities.
    4. Force fluids; provide acid-ash juices, e.g., cranberry juice.
    5. Strain urine for stones.
    6. Provide low-calcium, high-phosphorus diet.
    7. Provide care for the client undergoing parathyroidectomy (see Thyroidectomy).
    8. Provide client teaching and discharge planning concerning
      1. Need to engage in progressive ambulatory activities
      2. Increased intake of fluids
      3. Use of calcium preparations and importance of high-calcium diet following a parathyroidectomy

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