Page 348 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 333

Hallmark Signs and Symptoms
This condition presents with neurological disturbances such as tetany or mus-
cular hypertonia, tremors, and spasmodic movements that develop when cal-
cium levels are very low. Additional complaints include numbness, tingling, and
cramps in the extremities.
Tetany can be identified by evaluating the patient for
1. Trousseau’s sign – Carpopedal spasm occurs after occluding blood flow to
the arm for 3 minutes with the use of an inflated blood pressure cuff. The
resulting tonic spasm of the hand is a positive sign of hypoparathyroidism.

2. Chvostek’s sign – Twitching of the eye or mouth is a positive sign of hy-
poparathyroidism as the nurse taps over the facial nerve in front of the
parotid gland to elicit such a response.

Interpreting Test Results
Diagnostic studies such as plain x-rays, bone scans, MRI, and ultrasound can be
used to examine the parathyroid gland and to evaluate bone changes that may
have resulted from this condition. Laboratory analysis will provide continuous
data regarding PTH, serum calcium, and serum phosphate 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.

4 Prognosis
Restoring calcium, phosphorous and PTH levels to within normal limits and
preventing complications provides a positive outlook to recovery.
Care and management consists of restoring calcium, phosphorous, and
PTH levels to within normal limits and to prevent further development of
complications.

5 Nursing Diagnosis for Hypoparathyroidism Expected Outcomes
Altered comfort level related to excessive Calcium levels will return to
facial and hand tremors and decreased within normal parameters
blood calcium levels Episodes of facial and hand
tremors will be resolved

Nursing Interventions

Assess daily calcium levels to determine return to normal ranges of 9.0 to
11.0 mg/dL.
Assess for continued signs of tetany by provoking Trosseau’s or Chvostek’s
signs through facial tapping or blood pressure cuff inflation.
Administer prescribed calcium-containing medications.