Hypoparathyroidism NCLEX review notes for students who are prepping to take the NCLEX exam. The endocrine system is made-up of many disorders, such as hypoparathyroidism and hyperparathyroidism. As a student prepping for NCLEX, it is very important you know the differences between these two conditions.
As the nurse taking care of the patient with hypoparathyroidism it is important you understand the signs and symptoms, pathophysiology, causes, nursing interventions, and medical treatments.
Don’t forget to take the quiz on hypoparathyroidism vs hyperparathyroidism.
In this NCLEX review, you will learn the following:
- Pathophysiology of the parathyroid gland
- Negative feedback loop of the parathyroid gland
- Signs and symptoms of hypoparathyroidism
- Causes of hypoparathyroidism
- Nursing Interventions
- Medications for hypoparathyroidism
Lecture on Hypoparathyroidism
NCLEX Review for Hypoparathyroidism
Definition: low production of parathyroid hormone (PTH) by the parathyroid gland
Parathyroid Gland: located in the neck, behind the thyroid gland. There is a total of 4 parathyroid glands and they secrete parathyroid hormone.
Parathyroid hormone (PTH): regulates calcium and phosphate blood levels. It regulates calcium levels by acting on the bones (stimulates osteoclasts which break down the bones and this causes bone resorption which releases calcium into the blood), kidneys (reabsorb calcium and activates vitamin D), and GI system (vitamin d activated by the kidneys cause the small intestine to reabsorb calcium from food intake), and it regulates phosphate by inhibiting the kidneys from reabsorbing phosphate, and is therefore excreted into the urine.
Kidneys: reabsorb Ca+ and excrete phosphate, and activate vitamin D
Bones: causes osteoclasts in the bones to break down bone and release calcium through bone resorption
Small Intestines: the activation of vitamin D by the kidneys causes the gut to absorb calcium from the food
PTH Negative feedback Loop: Low levels of calcium detected in the blood causes the parathyroid gland to release PTH which stimulates the bones and kidneys to increase calcium levels.
In HYPOparathyroidism, there isn’t enough PTH being released by the parathyroid gland to cause the kidneys and bones to release or absorb calcium so calcium levels fall. The patient will experience: HYPOcalcemia and HYPERphosphatemia (this is because the kidneys start to conserve phosphate).
Hypocalcemia: low calcium levels (calcium plays a role in muscle and nerve conduction, bone health and needs vitamin D to help the body absorb calcium)
Hyperphosphatemia: high phosphate levels (phosphate plays a role in bone health, muscle and nerve function….the kidneys regulate the amount of phosphate in the body)
Causes of Hypoparathyroidism
- Destruction or manipulation of the parathyroid glands (most common): Thyroidectomy or treatment of cancer of the neck/throat…due to the close proximity and sharing of blood supply of the thyroid gland and parathyroid.
- Hypomagnesemia: low levels of magnesium can cause the parathyroid gland to not work properly
- Autoimmune: body produces antibodies that attack the gland
- Body is resistant to PTH: parathyroid works great but the bones and kidneys do not respond to it being released.
Signs and Symptoms of Hypoparathyroidism
Signs and symptoms are mainly due to the low calcium level
Remember “PTH” for parathyroid hormone to help you remember S & S
- Paresthesia (tingling sensation on the mouth, face, and finger/toes), Positive Trousseau’s sign or Chvostek’s sign (due to hypocalcemia)
- KNOW how to elicit a positive Trousseau’s Sign. You do this by using a blood pressure cuff and place it around the upper arm and inflate it to a pressure greater than the systolic blood pressure and hold it in place for 3 minutes. If it is positive the hand of the arm where the blood pressure is being taken will start to contract involuntarily.
- KNOW how to elicit a positive Chvostek’s Sign (nerve hyperexcitability of the facial nerves). To elicit this response, you would tap at the angle of the jaw via the masseter muscle and the facial muscles on the same side of the face will contract momentarily (the lips or nose will twitch) if positive.
- Tetany (severe) due to low calcium and high phosphate level which is involuntary muscle cramping and contraction: bronchospasm and laryngospasms, hand/feet spasms, seizures, EKG changes
- Hypocalcemia and Hyperphosphatemia
Nursing Interventions for Hypoparathyroidism
- Monitor calcium (normal 8.6 to 10.0 mg/dL) and phosphate levels (normal 2.7 to 4.5 mg/dL)
- Monitor airway due to tetany and seizures (bronchospasm/laryngospasms)…prepare for the worst…have a trach kit, oxygen, suction at bedside)
- Ensure patient eats a diet high in calcium (dairy, green leafy vegetables) and low in phosphate (organ meats, soft drinks, eggs)
Administering Medications per physician’s order:
Goal of medications are to increase calcium levels and decrease phosphate levels.
- IV Calcium (if very low): (ex: calcium gluconate)….give slowly as ordered (be on cardiac monitor and watch for cardiac dysrhythmias). Assess for infiltration or phlebitis because it can cause tissue sloughing (best to give via a central line). Also, watch if patient is on Digoxin because this can cause Digoxin toxicity.
- Oral calcium with Vitamin D: Calcium Carbonate “Os-cal with vitamin D” (patient education: GI upset, constipation…renal calculi…flank pain)
- ***Calcium supplements interfere with the absorption of iron and thyroid hormone so give at separate times
- Phosphate-binders may be ordered to increase excretion of phosphate by GI system into the stool: Aluminum carbonate (Gelusil Amphojel) ADMINISTER after meals
- Parathyroid Hormone Replacement: Natpara
- Monitor calcium levels: can increase calcium levels too high, GI issues nausea vomiting, paresthesia
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