N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide gland enlargement caused by chronic hypocalcemia in presence of elevated PTH. Increased calcium reabsorption and increased phosphate excretion lead to hypercalcemia and hypophosphatemia; kidneys increase bicarbonate excretion and decrease acid excretion, leading to metabolic acidosis and hypokalemia. Bones increase the rate of calcium and phosphorous release, leading to bone decalcification. Hypercalcemia results in calcium deposits in soft tissues, renal calculi, altered neurological function with muscle weakness and atrophy, altered GI function with constipation, abdominal pain, and anorexia. Signs and symptoms include polyuria (early sign) renal colic, renal calculi, arrhythmias, constipation, osteoporosis, muscle weakness, deep bone pain, and pathologic fractures. EKG will show a shortened QT interval. Peptic ulcer disease from hypercalcemia is also a sign. CNS signs include depressed deep tendon reflexes, paresthesias (altered sensations), depression, and psychosis. Possible bone changes will appear on skeletal x-rays and CTscan. Treatment: decrease serum calcium levels with IV normal saline infusions, diuretics, and phosphate replacement; possible surgery to remove involved parathyroid gland; promote comfort and safety; strain all urine to detect calcium based urinary stones; provide 2000 to 3000ml of fluids daily, as tolerated, and a high fiber diet; encourage progressive activity as tolerated; use pacing activities with rest periods; promote nutrition, fluid, and electrolyte balance; check weight daily; monitor for hypocalcemia to prevent tetany caused by surgery or aggressive excretion of calcium; watch for numbness and tingling around mouth and fingertips, and muscle twitching of extremities; monitor for change in voice; check for positive Chvostek’s sign (spasm of facial muscles when cheek is touched; check for positive Trousseau sign (spasm of hand when BP cuff inflated); medications include analgesics to control pain and diuretics and NS by IV infusion to excrete excess calcium; phosphate and calcitonin (Miacalcin) may be used to inhibit bone reabsorption Surgical Interventions • Adrenalectomy: An adrenalectomy is the surgical removal of one or both adrenal glands. Adrenalectomy disturbs mineralocorticoid and glucocorticoid secretion, resulting in altered fluid and electrolyte balance. Keep the patient in a semi-fowler’s position and maintain a quiet environment. The patient will require lifelong medication replacement. • Hypophysectomy: A hypophysectomy is the surgical removal of part or all of the pituitary gland. Post-operatively assess cardiac, respiratory, and neurologic status and fluid balance. Inspect the surgical dressing or nasal drip pad and change as needed. Keep the patient in a semi-fowler’s position. Observe the patient for signs of increased intracranial pressure and check for rhinorrhea. Tell the patient to avoid coughing, blowing nose, lifting, or straining while defecating and sneezing. The patient will require lifelong hormone replacement. 3.2 Deficient Production of Hormones Disorders Growth Hormone Deficiency (GHD) is a disorder caused by deficiency of growth hormone (GH) production or release from the anterior pituitary gland. It may be inherited or caused by an infection in the pituitary gland (such as sickle cell disease), a tumor in brain, cranial irradiation, chemotherapy, brain trauma, or psychosocial deprivation. ©2017 Achieve Test Prep Page 75 of 140