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Hypoparathyroidism

Definition: Hypoparathyroidism is decreased function of the parathyroid glands with under production of parathyroid hormone. This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary muscle contraction), and several other symptoms. The condition can be inherited, but it is also encountered after thyroid or parathyroid gland surgery, and it can be caused by immune system-related damage as well as a number of rarer causes. The diagnosis is made with blood tests, and other investigations such as genetic testing depending on the results. The treatment of hypoparathyroidism is limited by the fact that there is no artificial form of the hormone that can be administered as replacement; calcium replacement or vitamin D can ameliorate the symptoms but can increase the risk of kidney stones and chronic kidney disease.

Etiology and Pathophysiology: 1. The parathyroid glands may not secrete a sufficient amount of parathormone after thyroid surgery, parathyroid surgery, or radiation therapy of the neck; idiopathic hypoparathyroidism is rare. 2. As levels of parathormone drop, the serum calcium level also drops, causing signs of tetany; a concomitant rise in the serum phosphate level occurs.

Signs and Symptoms: Photophobia Diplopia Irritability Muscle cramps Dyspnea Trousseaus sign (carpopeddal spasm)

Chvosteks sign Decreased serum calcium level Elevated serum phosphate level Stridor, wheezing from laryngeal spasm Convulsions Cataracts, if the disease is chronic Cardiac dysrhythmias X-ray examination reveals increased bone density

Therapeutic interventions: 1. Calcium chloride of calcium gluconate given IV for emergency treatment 2. Calcium salts administered orally 3. Vitamin D, to increase the absorption of calcium from the GI tract 4. Parathormone injections 5. High calcium, low phosphate diet 6. Aluminum hydroxide to decrease the absorption of phosphorous from the GI tract

Assessment: History of muscle spasms, numbness or tingling of the extremities, visual disturbances or convulsions Presence of neuromuscular irritability Status of respiratory functions Heart rate and rhythm Serum calcium and phosphate levels

Nursing Diagnosis: Risk for injury Altered nutrition ( less than body requirements) Sensory / perceptual alteration

Interventions: Observe for respiratory distress and have emergency equipment available at bedside to perform immediate interventions Maintain seizure precautions Monitor the serum calcium and phosphate levels Check vital signs frequently if a history cardiac problems is present on a monitor Provide a calm environment, free from harsh stimuli Provide drug and dietary instructions, including the elimination of milk, cheese, and egg yolk because of their high phosphorous content Teach the client on the signs and symptoms of hypocalcemia and hypercalcemia, instruct the client to contact a physician immediately

Positive Outcomes: Adheres to a high-calcium, low potassium diet Remains free from neuromuscular irritability Maintains respiratory functioning within normal limits