Primary Nursing Diagnosis

Activity intolerance related to fatigue, muscle weakness, and bone pain

OUTCOMES. Energy conservation; Knowledge: Disease process, Diet, Medication, and Prescribed activity; Nutritional status: Energy; Pain level; Symptom severity

INTERVENTIONS. Electrolyte management: Hypercalcemia; Fluid management; Medication management; Exercise promotion; Fall prevention; Surveillance

H PLANNING AND IMPLEMENTATION Collaborative

Surgical removal of the parathyroid glands is the only definitive treatment and is the treatment of choice for primary hyperparathyroidism. Indications for surgery include symptoms resulting from hypercalcemia, nephrolithiasis, reduced bone mass, serum calcium level in excess of 12 mg/dL, age younger than 50 years, and infeasibility of long-term follow-up. If hyperplasia (proliferation of normal cells) of the glands is excessive, all but one-half of one gland is removed because only a small amount of glandular tissue is necessary to maintain appropriate levels of PTH. The individual who has had all four glands removed will quickly become hypoparathyroid and must be treated accordingly. To prevent postoperative deficits of calcium, magnesium, and phosphorus, the patient may need either IV or oral supplements. Bone pain may subside as soon as 3 days after surgery, but renal dysfunction may be irreversible.

Nonsurgical management includes medications to assist in the excretion of calcium by the kidneys. Medical therapy, however, has not been shown to affect the clinical outcome of primary hyperparathyroidism. Postmenopausal women with primary hyperparathyroidism may receive estrogen replacement therapy. The patient may be placed on a low-vitamin D diet that is high in calories, but calcium restrictions are generally not beneficial. To increase calcium excretion, the patient needs a large fluid intake, at least 2 to 3 L per day, and 8 to 10 g of salt per day. Foods high in fiber will assist the patient to have normal bowel function.

Secondary hyperparathyroidism is managed by treating the underlying cause; either vitamin D therapy, prednisone, or aluminum hydroxide may be used, depending on the underlying cause of the disorder.

Pharmacologic Highlights

Medication or

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