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bones to increased parathyroid hormone (PTH), thereby increasing bone calcium

Prednisone

20-50 mg PO bid

Glucocorticoids

Manages secondary hyper-parathyroidism in the management of some cancers that lead to hypercalcemia

Furosemide (Lasix)

20-40 mg IV bid-qid

Loop diuretic

Used with normal saline to cause diuresis and to reduce calcium levels

Independent

Generally, increase the patient's mobility, protect the patient from injury, monitor for possible complications, and provide patient education. Provide comfort measures for bone and joint pain. Increased activity limits further bone demineralization. Moderate weight-bearing activities are more beneficial to the patient than either range-of-motion exercises in bed or chair rest. Patients with hyperparathyroidism may be weak and at risk for falls and trauma. If the patient is hospitalized, maintain safety measures.

If the patient is recovering from a parathyroidectomy, the most life-threatening complication is airway compromise, either from swelling or from acute hypocalcemia. Keep emergency intubation and tracheostomy equipment in a readily available location. Notify the surgeon immediately if the patient develops respiratory distress, stridor, neck swelling, or hoarseness because of laryngeal nerve damage. Maintain the patient in a semi-Fowler position to decrease postoperative edema. If the patient develops tingling in the hands and around the mouth, notify the surgeon and obtain serum calcium levels if prescribed to determine if tetany is beginning.

As with many endocrine disorders, the patient may be frustrated with the clinical manifestations of the disease and require frequent reassurance. Reassure the patient that most of the symptoms will reverse with the return of normal calcium levels. Assist the patient in identifying stressors and methods of coping with the stressors.

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