GLAND PARATHYROI D GLAND

HORMONE Parathormon e

FUNTION Parathormone , the protein hormone produced by the parathyroid glands, regulates calcium and phosphorus metabolism.

DYSFUNCTION HYPERPARATHYRO IDISM -overproduction of parathormone by the parathyroid glands causes increased calcium absorption from the kidney, intestines and bones which raises the blood calcium level. Also causes increased presence of vitamin D. It also tends to lower phosphate levels.

ETIOLOGY --overproduction of parathormone by the parathyroid glands -secondary hyperparathyroid ism occurs in patients who have chronic renal failure and so-called renal rickets as a result of phosphorus retention, increased stimulation of the parathyroid glands and increased parathormone excretion.

SIGNS AND SYMPTOMS -characterized by bone decalcification and development of renal calculi (kidney stones) containing calcium -may be asymptomatic manifesting affectation of other body systems Increased Ca concentration: -Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension and cardiac dysrhythmias. -irritability, neuroses, psychoses -increase in calcium produces a decrease in the excitation potential of nerve and muscle tissue. -formation of stones in one or both kidneys r/t

DIAGNOSTIC TEST -Primary hyperparathyroidism : persistent elevation of serum calcium levels and an elevated concentration of parathormone. -Radioimmuno assays -bone changes detected in x-rays or bone scans -double anti-body parathyroid hormone test -ultrasound, MRI, thallium scan and fine needle biopsy

NURSING MANAGEMENT -Provide the patient and the family an awareness of the course of the disorder. -Patient undergoing parathyroidectomy has same management in patients undergoing thyroidectomy. Precautions about airway patency, dehydration, immobility, and diet are important in postparathyroidectomy . -Monitor calciumphosphorus balance. Closely monitor the patient and detect signs of tetany.

MEDICAL MANAGEMENT

parathyroidectom y -hydration therapy: (daily fluid intake of more than 2000ml) to help prevent calculus formation. Cranberry juice is suggested to acidify urine. Avoid dehydration. -mobility: walking or use of a rocking chair so that bone wont give up more calcium. -Oral phosphates lower serum level of calcium -Diet and Medication: avoid diet with excess or restricted calcium. If pt. has peptic ulcer prescribe -Nurse reminds the antacids and patient and the protein feedings. family about the Prune juice, stool importance of softeners, follow up to ensure hydration and return of serum activity help offset

increased urinary excretion of calcium and phosphorus. -renal damage from precipitation of calcium phosphate -musculoskeletal symptoms caused by demineralization of the bones or by bone tumor. This includes skeletal pain and tenderness, especially of the back and joints; pain on weight bearing; pathologic fractures; deformities and shortening of body stature. -peptic ulcer and pancreatitis

calcium levels to normal.

constipation w/c is common post operatively

GLAND Parathyroid Gland

HORMONE Parathormone

FUNTION Parathormone, the protein hormone produced by the parathyroid glands, regulates calcium and phosphorus metabolism.

DYSFUNCTION HYPOPARATHYROI DISM -deficiency of parathormone results in increased blood phosphate (hyperphosphate mia) and decreased blood calcium (hypocalcemia) levels. -in the absence of parathyroid hormone, there is decreased intestinal absorption of dietary calcium and decreased resorption of calcium from bone and through the renal tubules. -decreased renal excretion of phosphate causes hypophosphaturia and low serum calcium levels result in hypocalciuria.

ETIOLOGY -inadequate secretion of parathormone after interruption of the blood supply or surgical removal of the parathyroid gland tissue durinf thyroidectomy, parathyroidecto my or radical neck dissection. Atrophy of the parathyroid glands of unknown cause is a less common cause of hypoparathyroi dism.

SIGNS AND SYMPTOMS -irritability of the neuromuscular system and contributes to the chief symptom of hypoparathyroidis m-tetany. -symptoms of latent tenany are numbness, tingling and cramps in the extremities. -Patient complains of stiffness in the hands and feet. -Overt tetany: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias and seizures. -Other symptoms include anxiety, irritability, depression and even delirium. -ECG changes and hypotension. -positive Trousseaus and Chovsteks sign.

DIAGNOSTIC TEST -physical assessment: positive Trousseaus and Chovsteks sign. -tetany develops at serum calcium levels of 5-6 mg/dL (1.2 to 1.5mmol/L) or lower. -Serum phosphate levels are increased and x-rays of bone shows increased density. -calcification is detected on x-rays of the subcutaneous or paraspinal basal ganglia of the brain.

NURSING MANAGEMENT -Provide an environment that is free from noise, drafts, bright lights or sudden movement. -monitor early signs of hypocalcemia and anticipating signs of tetany, seizures and respiratory difficulties especially in postop thyroidectomy, parathyroidectom y or radical neck dissection. -Calcium glucoante is kept at bedside woth equipment necessary for emergency IV administration. If the patient has a cardiac disorder administer calcium gluconate is administered slowly. - Calcium and digitalis increase systolic contraction and

MEDICAL MANAGEMENT -GOAL: serum calcium level of 9 to 10mg/dL (2.2 to 2.5mmol/L and to eliminate signs and symptoms of hypoparathyroidi sm and hypocalcemia. -administration od IV calcium gluconate as an immediate treatment of hypocalcemia and tetany after thyroidectomy. -Sedatives like phenobarbital may be administered. -Parenteral parathormone can be administered to treat acute hypoparathyroidi sm with tetany. -Tracheostomy or mechanical ventilation may be necessary along bronchodilating medications if

also potentiate each other; this may produce potentially fatal dysrhythmias. Consequently, the cardiac patient requires Continuous cardiac monitoring and careful assessment. -provide health teachings about medications and diet therapy. Emphasize the reason for high calcium and low phosphate intake and the symptoms of hypocalcemia and hypercalcemia.

patient developed respiratory distress. -Diet high in calcium and low in phosphorus is prescribed. -milk, milk products and egg yolk are restricted because they are also high in phosphorus. Spinach is also avoided. -oral tablets or calcium salts such as calcium gluconate may be used to supplement diet. -Aluminum hydroxide gel or aluminum carbonate -Vitamin D preparationdihydrocholester ol, ergocalciferol, cholecalcoferolto enhance calcium absorption in the GIT.

GLAND Thyroid

HORMONE Thyroid hormone: T4 and T3 Calcitonin

FUNTION -control cellular metabolic activity. -T4 maintains body metabolism in a steady state. -T3 about five times potent as T4 and has a rapid metabolic action. -These hormones accelerate metabolic processes by increasing the level of specific enzymes that contribute oxygen consumption and altering the responsiveness of tissues to other hormones. -influence cell replication and are important in brain development. -necessary for normal growth -Calcitonin: secreted in response to high

DYSFUNCTION THYROID CANCER: Types: Papillary adenocarcinoma, Follicular adenocarcinoma, Medullary, Anaplastic, Thyroid carcinoma. -In adults, hypothyroidism manifests as lethargy, slow mentation, and generalized slowing of body functions. -Oversecretion of thyroid hormones (hyperthyroidism) is manifested by a greatly increased metabolic rate. -increased response to circulating catecholamines (epinephrine and norepinephrine).

ETIOLOGY -External radiation of the head, neck, or chest in infancy and childhood increases the risk of thyroid carcinoma.

SIGNS AND SYMPTOMS - Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy

DIAGNOSTIC TEST Physical Assessment: -Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy -Thyroid function tests -Needle biopsy of the thyroid gland -second type of aspiration or biopsy uses a large bore needle rather than the fine needle used in standard biopsy -ultrasound, MRI, CT scans, thyroid scans, radioactive iodine uptake studies, and thyroid suppression tests.

NURSING MANAGEMENT - external sources of radiation therapy is at risk for mucositis, dryness of the mouth, dysphagia, redness of the skin, anorexia, and fatigue - Care must be taken to avoid iodinecontaining foods and contrast agents - preoperative goals are to gain the patients confidence and reduce anxiety -protect the patient from such tension and stress to avoid precipitating thyroid storm -PREOPERATIVE: instructs the patient about the importance of eating a diet high in carbohydrates

MEDICAL MANAGEMENT - Total or neartotal thyroidectomy - Modified neck dissection or more extensive radical neck dissection - After surgery, ablation procedures are carried out with radioactive iodine to eradicate residual thyroid tissue if the tumor is radiosensitive. - After surgery, thyroid hormone is administered in suppressive doses to lower the levels of TSH to a euthyroid state -thyroxine may be required permanently - oral administration of radioactive iodine and external

plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.

and proteins - Supplementary vitamins, particularly thiamine and ascorbic acid, may be prescribed - reminded to avoid tea, coffee, cola, and other stimulants. - informs the patient about the purpose of preoperative tests, if they are to be performed, and explains what preoperative preparations to expect. - demonstrating to the patient how to support the neck with the hands after surgery to prevent stress on the incision POST OP CARE: - assesses the surgical dressings and reinforces them when necessary -Monitor for signs of bleeding and

administration of radiation therapy - Postoperatively, the patient is instructed to take exogenous thyroid hormone to prevent hypothyroidism. - Total body scans are performed 2 to 4 months after surgery to detect residual thyroid tissue or metastatic disease - FT4, TSH, serum calcium, and phosphorus levels are monitored

shock -Monitor for respiratory distress. tracheostomy set is kept at the bedside at all times. - intensity of pain is assessed and analgesic agents are administered as prescribed - nurse carefully supports the head and avoids tension on the sutures - most comfortable position is the semi-Fowlers position, with the head elevated and supported by pillows - Intravenous fluids are administered during the immediate postoperative period. - Water may be given by mouth as soon as nausea subsides.

- initially, cold fluids and ice may be taken better than other fluids. Often, patients prefer a soft diet to a liquid diet in the immediate postoperative period - advised to talk as little as possible to reduce edema to the vocal cords - patient is usually permitted out of bed as soon as possible and is encouraged to eat foods that are easily eaten. A well-balanced, high-calorie diet may be prescribed to promote weight gain. Sutures or skin clips are usually removed on the second day. -Monitor for complications like hemorrhage, hematoma formation, edema

of the glottis and injury to the recurrent laryngeal nerve, disturbance in calcium metabolism. -educate the patient and the family on what signs and symptoms to report.

GLAND THYROID GLAND

HORMONE Thyroid hormone: T4 and T3 Calcitonin

FUNTION -control cellular metabolic activity. -T4 maintains body metabolism in a steady state. -T3 about five times potent as T4 and has a rapid metabolic action. -These hormones accelerate metabolic processes by increasing the level of specific enzymes that

DYSFUNCTION NODULAR GOITER: -In adults, hypothyroidism manifests as lethargy, slow mentation, and generalized slowing of body functions. -Oversecretion of thyroid hormones (hyperthyroidism) is manifested by a greatly increased metabolic rate. -increased response

ETIOLOGY Some thyroid glands are nodular because of areas of hyperplasia (overgrowth).

SIGNS AND SYMPTOMS -No symptoms may arise as a result of this condition, but not uncommonly these nodules slowly increase in size, with some descending into the thorax, where they cause local pressure symptoms.

DIAGNOSTIC TEST Physical assessment: -visible swelling in the neck

NURSING MANAGEMENT -Provide wellbalanced meals of small size. -High-calorie and High-protein foods are encouraged. Highly-seasoned foods and stimulants like coffee, tea, cola, and alcohol are discouraged. -Provide an environment that reduces stress. -Convey an understanding of

MEDICAL MANAGEMENT -patient with many thyroid nodules may eventually require surgery.

contribute oxygen consumption and altering the responsiveness of tissues to other hormones. -influence cell replication and are important in brain development. -necessary for normal growth -Calcitonin: secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.

to circulating catecholamines (epinephrine and norepinephrine).

the patients concern about these problems and promotes use of the patients concern about these problems and promotes use of effective coping strategies. -Monitor and manage potential complications.