Create a nursing concept map for the patient experiencing thyroid storm OR hyperparathyroidism.

Laboratory Test: Dx Procedures: Medications

↑serum calcium (in primary -Blood and urine test
-Furosemide with IV saline (mild)
hyperparathyroidism) -Xray, MRI, and CT scans -Calcimimetic or oral phosphates (severe)
↓ serum phosphorous -arteriography -IV phosphates (if needed to decrease calcium rapidly.)
↑serum magnesium -venous sampling of thyroid for blood -Calcitonin (↓ release of skeletal calcium and ↓calcium
↑serum PTH PTH levels excretion); must be given with glucocorticoids.
↑urine cAMP -ultrasonography

Causes:
-parathyroid tumor or Hyperparathyroidism
cancer
-congenital hyperplasia -Caused by increased levels of PTH.
-neck trauma or radiation -Causes: kidney ↑ reabsorption of calcium
-vitamin D deficiency
(hypercalcemia), ↑ phosphorus excretion
-chronic kidney disease Nursing Care:
(hypophosphatemia), ↓ bone density
with hypocalcemia
Assessment:
-PTH secreting carcinomas -Monitor cardiac function and I/O q 2
of lung, kidney, or GI tract. -weight loss hrs during hydration therapy.
-possible bone fractures, bone -Check ECG; look for t waves or QT
deformities (extremities or back), interval
Surgical Management: bone cysts, osteoporosis, or arthritis -Assess HR and rhythm
-waxy, pallor of skin (chronic) -Monitor serum calcium levels. Report
Parathyroidectomy -kidney stones and calcium deposits in sudden drops to MD
-Before surgery, pt. is stabilized, and calcium levels need kidney soft tissues -Prevent injury due to high risk of
-anorexia fractures.
to be ↓ to normal
-N/V -Encourage patient to take Vitamin D
-A hypocalcemic crisis can occur post-surgery. Calcium
-epigastric pain supplements or foods
levels need to be assessed frequently. Check for S/S of
hypocalcemia (tingling and twitching in extremities or Constipation
face) -elevated gastrin levels cause peptic
-Assess laryngeal nerve damage by assessing pts. changes ulcer disease
in voice patterns and hoarseness. -fatigue and lethargy
-if calcium level is > 12 mg/dL,
psychosis with confusion, followed by
coma and death.
Real life example:

I had one patient with a history of hyperparathyroidism. She mentioned that it took years before she found out that she had the disease because she
thought at first that her symptoms of fatigue, irritability and sleepiness was due to aging and stress. She eventually had partial parathyroidectomy.