NCLEX - Hypoparathyroidism & Calcium Imbalances

Here are key facts for NCLEX-RN & NCLEX-PN from the Parathyroid Hormone & Calcium Homeostasis tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

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1. Typical reference blood calcium range is 2.2-2.6 mmol/L (8.6-10.3 mg/dL). 2. Low parathyroid hormone leads to low levels of calcium and high levels of phosphate. 3. Two key signs of tetany in hypoparathyroidism: Chvostek sign and Trousseau's sign. 4. Chvostek sign: tapping the facial nerve (in the parotid gland/masseter muscle area) produces facial muscle spasms. 5. Trousseau's sign: carpopedal spasm seen after a few minutes of wearing an inflated blood pressure cuff (20 mmHg above systolic pressure). In the spasm, the patient will have flexed wrist, thumb, and metacarpophalangeal but hyperextended fingers. 1. Neuromuscular effects: Muscle weakness, Paresthesia (tingling or burning, especially in the feet, hands, and around the mouth), Cramping, Tetany. 2. Laryngospasms, bronchospasms, and stridor are also associated with hypoparathyroidism. 3. Psychiatric effects: Irritability and confusion. 4. Cardiovascular effects: Include prolonged QT interval or heart failure. 5. Ocular: Cataracts 1. Treatments: Activated Vitamin D and calcium supplements, possibly magnesium supplements. 2. Dietary recommendations: high in calcium (green leafy vegetables, legumes, fortified cereals) and low in phosphorous (less meat, soft drinks, and dairy products, which are high in phosphorus).

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1. Most often the result of surgical removal or damage to the parathyroid glands. 2. Other causes include autoimmune destruction (i.e., Autoimmune polyglandular syndrome type 1), congenital lack of functioning parathyroid glands, and very low magnesium levels. 1. Muscle weakness 2. Paresthesia (tingling or burning, especially in the feet, hands, and around the mouth) 3. Cramping 4. Tetany 5. Laryngospasms, bronchospasms, and stridor 1. Psychiatric effects: Irritability and confusion. 1. Include prolonged QT interval or heart failure. 1. Chvostek sign: tapping the facial nerve (in the parotid gland/masseter muscle area) produces facial muscle spasms. 2. Trousseau's sign: carpopedal spasm seen after a few minutes of wearing an inflated blood pressure cuff (20 mmHg above systolic pressure). In the spasm, the patient will have flexed wrist, thumb, and metacarpophalangeal but hyperextended fingers. 1. Disorders that cause excessive bone resorption: Cancers, Paget disease, hyperthyroidism, Familial hypocalciuric hypercalcemia, Vitamin D toxicity. 2. Disorders that cause excessive gastrointestinal calcium absorption: Sarcoidosis, other granulomatous diseases. 3. Drugs that increase extracellular calcium, including lithium and thiazide diuretics. 1. Vitamin D deficiency or resistance (including antiseizure drugs that alter vitamin D metabolism) 2. Pancreatitis 3. Magnesium imbalances 1. Administration of activated Vitamin D and calcium supplements, possibly magnesium supplements. 2. Dietary teaching: high in calcium (green leafy vegetables, legumes, fortified cereals) and low in phosphorous (less meat, soft drinks, and dairy products). 3. Teaching about condition: Prolonged exposure to parathyroid hormone promotes resorption of old bone, releasing calcium and phosphate into extracellular fluid.

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Below is information not explicitly contained within the tutorial but important for NCLEX. 1. Assessment: Monitoring vital signs and cardiac rhythm in calcium disorders, recognizing early signs of tetany. 2. Nursing Diagnosis: Risk for injury related to neuromuscular effects; Ineffective breathing pattern related to laryngospasm. 3. Planning: Safety precautions for patients with hypocalcemia, cardiac monitoring for patients with electrolyte imbalances. 4. Implementation: Safe administration of calcium supplements, emergency response to tetany, airway management. 5. Evaluation: Monitoring serum calcium levels, assessing for resolution of symptoms. 1. Teaching about medication administration: timing, food interactions, side effects. 2. Dietary guidance for long-term calcium management. 3. Recognizing and reporting symptoms of calcium imbalances. 4. Safety precautions to prevent injury related to neuromuscular symptoms. 1. Managing airway in laryngospasm due to hypocalcemia. 2. Immediate interventions for tetany. 3. Cardiac monitoring for patients with calcium imbalances. 4. Post-thyroidectomy care and monitoring for hypocalcemia.