Patient centered collaborative care assessment

Patient-Centered Collaborative Care
Assessment
 Manifestations 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 kidney
 Bone lesions are due to an increased rate of bone destruction, resulting in pathologic
fractures, bone cysts, and osteoporosis
 Anorexia, n/v, epigastric pain, constipation, weight loss are common
 Serum PTH, calcium, and phosphate levels and urine cyclic adenosine monophophate
(cAMP) most common lab tests to detect hyperparathyroidism
 X-rays show kidney stones, calcium deposits, and bone lesions
 Arteriography, lCT scans, venous sampling of thyroid for blood PTH levels , & ultrasonography
(US).
Hyperparathyroidism: Nonsurgical Management
 Diuretic and hydration therapies – used for reducing serum calcium levels
 Monitoring 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 fractures
 Drug therapy – used when hydration & furosemide cannot reduce hypercalcemia
Hyperparathyroidism: Surgical Management
 Parathyroidectomy, looking at respiratory distress, emergency trecestomy
 Postoperative care includes:
 Observe for respiratory distress.
 Keep emergency equipment at bedside.
 Hypocalcemic crisis can occur.
 Recurrent laryngeal nerve damage can occur
Hypoparathyroidism
 Decreased function of parathyroid gland
 Iatrogenic – caused by removal of all parathyroid tissue during total thyroidectomy or
deliberate surgical removal
 Idiopathic – can occur spontaneously, cause is unknown
 Hypomagnesemia – may cause hypoparathyroidism
 Interventions—correcting hypocalcemia, vitamin D deficiency, hypomagnesemia
Chapter # 67 Care of Patients with Diabetes Mellitus
Insulin Physiology
Normal Insulin Secretion
Types of Diabetes
 Type 1
 Type 2
 Gestational (GDM)
 Other specific conditions resulting in hyperglycemia
Absence of Insulin
 Hyperglycemia

 Polyuria
 Polydipsia
 Polyphagia
 Ketone bodies
 Hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxia
 Acidosis, Kussmaul respiration
 Hypokalemia, hyperkalemia, or normal serum potassium levels
Acute Complications of Diabetes
 Diabetic ketoacidosis
 Hyperglycemic-hyperosmolar state (HHS)
 Hypoglycemia from too much insulin or too little
glucose
Chronic Complications of Diabetes
 Macrovascular/microvascular disease
 Retinopathy (vision problems)
 Nephropathy (kidney dysfunction)
 Neuropathy (nerve dysfunction)
Macrovascular Complications
 Cardiovascular disease
 Cerebrovascular disease
Microvascular Complications
 Eye and vision complications
 Diabetic neuropathy
 Diabetic nephropathy
 Male erectile dysfunction
Metabolic Syndrome
 Also called syndrome X
