hey everyone it's Sarah with register nurse rn.com and in this video I'm going to be going over hyperthyroidism in the previous video I went over hypoparathyroidism so be sure to check that video out so you can compare these two conditions so what I'm going to do in this video is I'm going to go over the causes the patho the signs and symptoms and the nursing interventions and cover the things specifically you need to know for inlex and your nursing lecture exams and after you watch this video be sure to go to website register nurse rn.com and take the free quiz that will test your knowledge on hypoparathyroidism versus Hyper parathyroidism and a card should be popping up so you can access that video so let's get started first let's start out talking about what is the definition of hyper parathyroidism what is this condition it is an excessive secretion of pth parathyroid hormone by the parathyroid gland and whenever this happens the patient will present clinically with hypercalcemia and hypophosphatemia so why are they presenting with a high calcium and a low false level why is pth causing this well let's look at the negative feedback loop of how um the parathyroid Works to regulate your calcium levels along with your FAL levels now your parathyroid gland is found in your neck behind the thyroid gland and this pink area is your thyroid gland and these little green areas are your parathyroids you have four of them and what happens is that it is stimulated whenever your body has a low calcium level in the blood a normal calcium level is 8.6 to 10 milligram per deciliter so whenever it drops below 8.6 the parathyroid gland says hey we need to release some pth parathyroid hormone so we can increase our calcium levels now pth is released and it acts on the kidneys and the bones so let's talk about how pth affects the kidneys whenever the kidneys sense pth is being released by the parathyroid gland it causes the kidneys to reabsorb calcium and that increases calcium levels but it also causes the kidneys to excrete phosphate so if you have a lot of parathyroid hormone being secreted you're going to have a lot of calcium being absorbed by the kidneys and you're going to be excreting lots of phosphate which is why you're getting hypercalcemia and hyperphosphatemia now another thing the kidneys also whenever it senses the pth it activates vitamin D what does vitamin D do in order to absorb calcium in the body you have to have vitamin D so you're having a lot of vitamin D being activated and this causes your small intestine to start absorbing lots of calcium from the food that you've been taking in so you're increasing your calcium levels even more now how does pth affect affect the bones okay you have osteoclast in your bones and what pth does is it stimulates those osteoclast what do osteoclasts do they break down bones which causes bone Resort resorption and whenever that happens your bones are breaking down it's releasing calcium into the blood BL so when you have lots of pth your bones are just majorly depleting themselves of calcium so you're going to start seeing some bone problems which we'll see here in a second on our signs and symptoms now let's look at the causes what causes this condition okay there's two different little subsets of causes you have primary and secondary okay primary problems let's talk about this a primary problem is a problem with the parathyroid gland itself so the issue is with the gland and things that can cause this non-cancerous adenomas which is the most common so you get an adenoma on one of these glands it can cause the gland to mess up and over secrete parathyroid hormone another thing is hyperplasia of the gland this is one of those par parathyroid glands are enlarged so when they're enlarged they're over secreting pth it's working over actively or a cancerous growth on the parathyroid now let's look at secondary causes this is a disease that is causing the parathyroid gland to mess up so really the parathyroid gland is working but this disease is causing it to malfunction so what can do that one of the most common um diseases is chronic renal failure and what happens with with this is that your parathyroid becomes overworked because think back to people who have renal issues they're going to have issues with reabsorbing the calcium excreting the phosphate and things like that and that's really according to this me this negative feedback loop that's going to mess up your um parathyroid because it's going to be sensing these low calcium levels because it's stimulated by low calcium levels so your parathyroid is going to become overworked and you're going to enter into this condition another thing is just having hypocalcemia just that over a long period of time keep having those long low calcium levels and this is going to overwork the parathyroid again or the vitamin D deficiency and remember vitamin D helps us take in calcium and if we don't have enough vitamin D we're not going to be taking in calcium so then that's going to overwork the parathyroid so how is this patient going to look to you what are those big classic signs and symptoms that you need to know for exams and inlex Okay the reason the patient is presenting with signs and symptoms of hyper parathyroidism is because of that high calcium level that is what's causing our issues so remember what does calcium do calcium plays a ro a role in our bone health and it plays a role in our muscle and nerve function so bone health is not going to be good um because remember we talked about how the bones the Osteo class activity is really stimulated it's going to be breaking down bones which is going to be causing calcium to be leaking out of your bones into your blood so you're going to be seeing a lot of bone issues like osteoporosis bone fractures and um it plays a role in your muscle and nerve function which will slow it down so you're going to be seeing some GI issues things like that so let's see what we're going to have okay bone fractures again pth causes that that excessive breaking down of Bones which causes calcium to leak into the blood and you're going to have fragile bones so you'll see patients with bone fractures a calculi this is renal Stone formation why that well you have the increased calcium level and the kidneys are absorbing the calcium plus these patients are becoming dehydrate because they're going to have excessive urination so they're definitely at risk of forming those stones another thing is constipation remember calcium excessive calcium level slows down muscle contraction and in the GI system you have smooth muscles so you're going to slow down that muscle contraction um stool food is going to stay in those intestines longer it's going to get hard and patients are going to become constipated GI problems like nauseum vomiting and this is usually due to the epigastric payment they having because calcium increases your gastrin acid levels which will cause epigastric pain and make the patient feel nauseous and may have some vomiting also frequent urination excessive urination um this is because the increased calcium levels causing the kidneys to work harder then you're going to get in dehydration because they're peeing all the time and then that's going to concentrate your urine and that's going to probably lead to um renal Stone formation so it all goes hand in hand and also there can be EKG changes that calcium level gets low enough and um you can get a Short QT interval that's one of the Hallmark things you need to watch out for with a high calcium level Short QT interval so let's look at the nursing interventions what do you need to do for this patient as the nurse what do exams like to hit on things you need to know okay so first of course you want to monitor their Vital sign their EKG strain their urine watch their urine closely for any kidney stones they're having any flank pain things like that the typical signs and symptoms of that watch their calcium and phosphate levels watch their intake and output and encourage fluids as tolerated to keep their urine nice and um diluted instead of concentrated because they're going to have that frequent urination also encourage a diet low in calcium because they have high calcium levels and high in false however if this is a renal patient you want to watch their phosphate levels they are a little bit different because they tend to keep phosphate so they may actually have hyperphosphatemia with this so you don't want to encourage a high phosphate diet in them treatments and medications as ordered by The Physician what can you expect as a nurse what are things you have to watch out what are your role okay a typical treatment for especially um the primary cause of hyper parathyroidism is a parathyroid ectomy and this is where they go and remove either the enlarg or the glands with the tumors on them to help correct the parathyroid so it can start to work better with this however remember this stuff you need to monitor the respiratory status why because of the nature of the surgical site and where they went in so watch for any respiratory distress um you're going to place them in semif position why um this position helps um alleviate any strain they may put on the surgical side and with drainage and excess of swelling also as an emergency you want to have a trait kit at the bedside along with suction oxygen just in case the patient does go in respiratory failure you need to watch calcium levels because um they've messed with the parathyroid gland there is um chances that the patient could go into hypocalcemia um so watch for low calcium levels which would present with tingling numbness excessive twitching a positive true so sign or chat STI sign and we talked about that in the hyper parathyroidism video Next Big Thing remember this because of the close proximity of the surgery with lenel nerve watch for lenel nerve damage and this would present with the patient having difficulty speaking like their voice sounds horse or they have problems swallowing or talking and you would want to notify the physician immediately of that okay typical medications that you're going to give this patient that's going to be ordered by The Physician okay goals of our medications is to decrease the parathyroid hormone decrease the calcium level because we have excessive amounts of that going on and keep the patient hydrated so what are we going to do um one thing that Physicians like to order especially for patients with a secondary cause of hyper parathyroidism with chronic kidney disease um is calcium mics also one drug is called cipar that's a popular one and this works by mimicking the role of calcium and deceiving the parathyroid gland that there's enough calcium in the body so the parathyroid gland is going to think that there's enough calcium in the body so it's going to quit releasing so much parathyroid hormone and remember this mimics and part of the word calcium minic is m m e TI C and remember that with the function in case your ask that okay so what does it do once this patient takes it it will decrease the pth it will also decrease their calcium levels and decrease their phosphate levels because remember like I said earlier patients with renal issues have issues with high phosphate levels so this medication will help all three of those and help keep their calcium nice and regular um you would want to give this medication with food okay another type of medication that's usually prescribed is calcitonin this is given by either injection or nasally it's um calcitonin is actually naturally produced by your thyroid gland and how this is going to work is it's going to lower your calcium levels and suppress that osteoclast activity so it's going to prevent those bones from breaking down and it'll cause your kidneys to excrete back calcium so you're going to lower those calcium levels and protect those bones and help build them back up another thing prescribed is Loop Diuretics like Lasix how this works is it helps decrease calcium levels by inhibiting calcium resorption in the renal renal tuul however you want to watch their potassium levels with this other thing that can be prescribed are by phosphates um some popular ones um Aria like pamidronate or famax also called alendronate and how these work is that they like to protect the Bones from losing calcium by slowing down that Osteo class activity which breakes Bones down and increasing the osteoblast activity which actually builds the bones up however there's something you want to remember about Fosamax I would totally remember this very important um take have the patient take falx on an empty stomach by itself with no other medications with a full glass of water and have them set up for at least 30 minutes after taking it and the whole reasoning behind this is because Fosamax is hard on the stomach and the esophagus and it can cause severe ulcers so that is the reasoning for that and have them wait at least 30 minutes before taking vitamins or anti acids so that is about hyper par thyroidism now go take that free quiz on my website register nar.com and be sure to check out this other endocrine series for inlex reviews and thank you so much for watching and please consider subscribing to this YouTube channel