Page 347 - Critical Care Nursing Demystified

332 CRITICAL CARE NURSING DeMYSTIFIED

3. Promotes increased excretion of phosphorous in the urine as PTH also
acts on the renal system. Phosphorous is measured as phosphate in the
urine. Normal serum phosphate values are the direct opposite of calcium
values: 2.8 to 4.5 mg/dL or 0.90 to 1.45 mmol/L.
4. Maintains neuromuscular activity.
5. Promotes blood-clotting functions.
6. Enhances cell membrane permeability.
The normal PTH value is 10 to 60 pg/mL. A feedback mechanism exists
between the PTH and calcium, in that PTH secretion will increase when serum
calcium levels are low and will decrease when calcium levels are high.

Conditions of the Parathyroid Gland
The parathyroid gland is sometimes damaged during thyroid surgery because
of its close proximity to the thyroid.

Hyperparathyroidism

This is a condition of excessive overproduction of PTH. The result is hypercal-
cemia or increased calcium levels. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

What Went Wrong?
Hyperparathyroidism is characterized by large amounts of bone decalcification
that could result in pathological fractures particularly of the spine. The devel-
opment of renal stones containing calcium could be another complication.

Hallmark Signs and Symptoms
Deep bone pain and possible fractures caused by bone demineralization lead to
additional symptoms such as flaccid muscles, anorexia, nausea, vomiting, leth-
argy, confusion, and headaches.

Prognosis
Surgical removal of the parathyroid gland may be necessary in more severe
cases. Mild cases have good outcomes with medication therapy.

Hypoparathyroidism

What Went Wrong?
Caused by deficient production of PTH manifested by hypocalcemic levels less
than 5 mg/dL.