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Patient-Centered Collaborative CareAssessmentManifestations are related to excessive PTH or effects of hypercalcemia (excessive calcium)High levels of PTH cause renal calculi and deposits of calcium in the soft tissue of the kidneyBone lesions are due to an increased rate of bone destruction, resulting in pathologic fractures,bone cysts, and osteoporosisAnorexia, n/v, epigastric pain, constipation, weight loss are commonSerum PTH, calcium, and phosphate levels and urine cyclic adenosine monophophate (cAMP) most common lab tests to detect hyperparathyroidismX-rays show kidney stones, calcium deposits, and bone lesionsArteriography, lCT scans, venous sampling of thyroid for blood PTH levels, & ultrasonography (US).Hyperparathyroidism: Nonsurgical Management Diuretic and hydration therapies – used for reducing serum calcium levelsMonitoring cardiac function and I&O every 2 to 4 hours during hydration therapy.
Monitor ECG tracings, for changes in T waves, QT interval & rate and rhythm.Monitor for hypocalcemia Preventing injury – high risk for pathological fracturesDrug therapy – used when hydration & furosemide cannot reduce hypercalcemiaHyperparathyroidism: Surgical ManagementParathyroidectomy, looking at respiratory distress, emergency trecestomyPostoperative care includes:Observe for respiratory distress.Keep emergency equipment at bedside.Hypocalcemic crisis can occur.Recurrent laryngeal nerve damage can occurHypoparathyroidismDecreased function of parathyroid glandIatrogenic – caused by removal of all parathyroid tissue during total thyroidectomy or deliberatesurgical removalIdiopathic – can occur spontaneously, cause is unknownHypomagnesemia – may cause hypoparathyroidismInterventions—correcting hypocalcemia, vitamin D deficiency, hypomagnesemiaChapter # 67 Care of Patients with Diabetes MellitusInsulin PhysiologyNormal Insulin SecretionTypes of DiabetesType 1 Type 2 Gestational (GDM)Other specific conditions resulting in hyperglycemiaAbsence of InsulinHyperglycemia
PolyuriaPolydipsiaPolyphagiaKetone bodiesHemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxiaAcidosis, Kussmaul respirationHypokalemia, hyperkalemia, or normal serum potassium levelsAcute Complications of DiabetesDiabetic ketoacidosis Hyperglycemic-hyperosmolar state (HHS)Hypoglycemia from too much insulin or too little glucoseChronic Complications of Diabetes Macrovascular/microvascular diseaseRetinopathy (vision problems)Nephropathy (kidney dysfunction)Neuropathy (nerve dysfunction)Macrovascular ComplicationsCardiovascular diseaseCerebrovascular diseaseMicrovascular ComplicationsEye and vision complicationsDiabetic neuropathyDiabetic nephropathyMale erectile dysfunctionMetabolic SyndromeAlso called syndrome X