Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag,ofVigan City
College Nursing
2700
Website: www.unp.edu.ph OfficialIlocos Sur unpnursingvc@yahoo.com
eMail Address:

Official mobile number: 09177148749, 09175785986

YADAO, Calvin Keith M. BSN 3-F

For every disease, search for its definition, signs and symptoms, diagnostics, management and nursing
interventions. Hyper/hypoparathyroidism, Cushing's and Addison's disease.

Hyper/hypoparathyroidism

HYPOPARATHYROIDISM
- results when insufficient amount of parathyroid hormone are secreted or when the hormone fails
to act at the tissue level.

Signs and Symptoms

The symptoms of hypoparathyroidism can include:

1. a tingling sensation (paraesthesia) in your fingertips, toes and lips

2. twitching facial muscles
3. muscle pains or cramps, particularly in your legs, feet or tummy
4. tiredness
5. mood changes, such as feeling irritable, anxious or depressed
6. dry, rough skin
7. coarse hair that breaks easily and can fall out
8. fingernails that break easily

Diagnostic Test
1. (+) Chvostek’s sign – twitching of mouth, nose and eye when facial nerve is tap
2. (+) Trousseau’s sign – carpopedal spasm
3. Low serum calcium level
4. X-ray – shows calcification para-spinal basal ganglia of the brain

Management
 1. Post parathyroidectomy, thyroidectomy, and radical neck dissection, monitor for signs of
hypocalcemia e.g. tetany, seizure and respiratory difficulty.
2. Calcium gluconate should be always at bedside
3. High calcium, low phosphate diet
4. Institute seizure precautions
5. Place a tracheostomy set, O2 and suction machine at bedside
6. Give vitamin D to enhance calcium absorption at the GIT

Nursing Intervention

1. Monitor VS, airway, labs, educate diet (high calcium, low phosphate)
2. Administer Medications: Goal of medications are to increase calcium levels and decrease
phosphate levels
- IV calcium (if severe) Calcium Gluconate
- Oral calcium supplements with vitamin D (side effects: GI upset, constipation, increase risk of
renal stones)
- Phosphate-binders: Aluminum carbonate to remove phosphate into stool (take after meal)
- Parathyroid replacement: Natpara (injection)…watch calcium levels, GI upset, or parathesia
 HYPERPARATHYROIDISM
- Results from over production of parathormone

Signs and symptoms

 Fatigue
 Apathy
 Nausea and vomiting
 Muscle weakness due to increase calcium level
 Cardiac dysrhythmias
 Hypertension
 Increased excretion of calcium and phosphorus in urine
 Constipation
 Irritability – effect of increased calcium in CNS
 Neurosis to psychosis
 Skeletal pain
 Bone tenderness
 Pain on weight bearing result from demineralization of bone
 Pathologic fracture
 Deformities

Diagnostic Test
1. Elevated serum calcium level
2. Elevated level of parathormone
3. Bone scan – to detect bone changes

Management
1. Hydration to prevent renal calculi formation. Increase fluid intake 2000 ml and up.
Cranberry juice lowers the urinary pH.
 2. Activity at tolerable level is encouraged because bone subjected to normal stress least
likely to give up calcium.
3. Restriction of diet rich in calcium.
4. Move patient slowly and carefully.
5. Prepare for parathyroidectomy.

Nursing Interventions

1. Monitor VS, urine for kidney stones, encourage fluids to prevent dehydration and stone
formation, monitor labs, educate on diet (low calcium, high phosphate…but watch phosphate in
renal patients)
2. Prep for Parathyroidectomy: treatment in primary hyperparathyroidism
3. Administered Medications: goal decrease calcium levels and keep hydrated
- IV solutions: normal saline for hydration
- Calcimimetics: “Senispar” decreases PTH, calcium, and phosphate levels (treatment for
secondary hyperparathyroidism for patients with chronic kidney disease)
- Calcitonin: lowers calcium levels and protects bones
- Lasix: loop diuretics decrease calcium levels by inhibiting calcium resorption in the renal tubules
(watch potassium levels because Lasix wastes potassium)
- Bisphosphonates: Pamidronate (Aredia) or Alendronate (Fosamax) helps protect bones from
losing calcium by slowing down osteoclasts (which break down bones) and allow osteoblasts to
work (to help build bones)
 CUSHING’S DISEASE
 A medical condition characterized by the overproduction and secretion of the adrenal
cortex hormones- glucocorticoids, mineralocorticoids and androgens.

Signs and Symptoms

1. Growth arrest
2. Thin extremities/skin (lipolysis)
3. Increased risk of infection
4. Hyperglycemia
5. Psychiatric manifestations
a. Depression
b. Mania
c. Lability
6. Moon-faced appearance ( fat redistribution or fluid retention)
7. Truncal or central obesity
8. Buffalo hump
9. Muscle wasting (protein catabolism)
10. Osteoporosis (Ca+ depletion)
11. Hyperglycemia or overt DM

Diagnostic Test

o Overnight dexamethasone suppression test

o Basic metabolic panel
 Serum electrolytes
 Increased Na+, decreased K+ and Ca+
 Elevated blood sugar
 Serum cortisol determination
o Complete blood count with differential panel
 Decreased eosinophils
  Leukopenia
o 24-hour urine cortisol determination
o CT-scan or other imaging techniques to detect any tumors in the hypothalamus, pituitary
glands or adrenals

Management

 For Cushing’s due to tumors in the pituitary or the hypothalamus

o Radiation therapy of the pituitary or hypothalamus
o Transsphenoidal hypophysectomy and/or resection of the hypothalamus
 The removal of the pituitary gland and/or the hypothalamus
 Lifelong replacement of hormones
 Ocreotide (Sandostatin)- suppresses ACTH secretion
 For Cushing’s due to adrenal hypertrophy
o Single or bilateral adrenalectomy
 Single adrenalectomy
 Little or no need for replacement therapy of adrenal hormones
 Bilateral adrenalectomy
 Life-long use of hormone replacement medications.
o For ectopic sources of ACTH
 Adrenal enzymes inhibitors
 Metyrapone
 Aminogluthemide
 Mitotane
 Ketoconazole
 Ocreatide
 Removal of ACTH-producing tumors
 Radiation therapy or chemotherapy
o For iatrogenic cause of Cushing’s
 Reduction or tapering down of steroid dosages

Nursing Intervention
1. Provide a quiet environment
2. Decrease sodium intake, increase K+, Ca++ and proteins
3. Prevent infection and possible exposure from infection
4. Provide adequate res period in between activities
5. Ensure safety
6. Increase intake of nutrients needed in immune function such as vitamin B-complex and
vitamin C
7. May limit oral fluid intake
8. Monitor weight daily
9. Assist patient to use effective coping strategies and encourage client to discuss feeling
about physical appearance.
 ADDISON’S DISEASE
 Also known as adrenal insufficiency.
 Characterized by insufficient levels of adrenal cortex hormones to meet the body’s
demand.

Signs And Symptoms:

o Extreme fatigue
o Gastrointestinal symptoms:
 Nausea, vomiting and diarrhea
o Emaciation
o Anorexia and weight loss
o CV symptoms:
 Hypotension
 Tachycardia
 Dysrhythmias
o Neurologic symptoms:
 Confusion
 Depression
 Emotional lability
 Lethargy
 Coma
o Hematologic:
 Low sodium
 High potassium
 Low blood sugar
 Possible hemoconcentration
o Fluid volume depletion
o Hyperpigmentation and vitiligo
Diagnostics Test:

o Early morning serum cortisol and ACTH level

o Serum electrolytes:
 Hyponatremia
 Hyperkalemia
o Blood sugar monitoring
o Urine 17-hydroxycorticosteroids
o PPD and CXR to rule out TB infection
o CBC
 Leukocytosis

Management

1. Replacement of adrenal cortex hormones:

a. Corticosteroids such as prednisolone
b. Fludrocortisone (a synthetic mineralocorticoids)

Nursing Intervention

1. Maintain fluid and electrolyte balance.

a. Encourage intake of fluids of up to 3000ml a day
b. Increase Na+, decrease K+
c. Monitor I and O, daily weight
d. Monitor blood glucose levels
2. Promote safety
a. Providing assistive devices for walking
b. Adequate lighting
3. Administer adrenal cortex hormone replacement medications