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Lecture 6

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University of Calgary
NURS 287
Rick Nilson

Lecture 6  Hypoparathyroidism is rare, and results from inadequate circulating PTH.  It is characterized by hypocalcemia resulting from a lack of PTH to maintain serum calcium levels.  The most common cause is iatrogenic, due to accidental removal of parathyroid glands or damage to these glands during neck surgery.  Sudden decreases in serum calcium cause tetany, which is characterized by tingling of lips, fingertips, and increased muscle tension with paresthesias and stiffness.  Painful tonic spasms of smooth and skeletal muscles (extremities and face), and laryngospasms and a positive Chvostek sign and Trousseau sign are usually present.  Focus of patient care is to treat tetany, maintain normal serum calcium levels, and prevent long-term complications. Emergency treatment of tetany requires IV calcium.  Instruction about lifelong treatment and follow-up care includes monitoring of calcium levels.  Cushing syndrome is a spectrum of clinical abnormalities caused by excessive corticosteroids, particularly glucocorticoids.  The most common cause is iatrogenic administration of exogenous corticosteroids (e.g., prednisone).  Most cases of endogenous Cushing syndrome are due to adrenocorticotrophic hormone (ACTH) secreting pituitary tumor (Cushing’s disease).  Key signs include centripedal or generalized obesity, “moon facies” (fullness of face), purplish red striae below the skin surface, hirsutism in women, hypertension, and unexplained hypokalemia.  Treatment is dependent on the underlying cause, and includes surgery and drug therapy to normalize hormone levels.  Discharge instructions are based on patient’s lack of endogenous corticosteroids and resulting inability to react to stressors physiologically.  Lifetime replacement therapy is required by many patients.  In the patient with Addison’s disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced.  The etiology is mostly autoimmune where adrenal cortex is destroyed by autoantibodies.  Manifestations have a slow onset and include weakness, weight loss, and anorexia.  Skin hyperpigmentation is seen in sun-exposed areas of body, at pressure points, over joints, and in palmar creases.  The treatment is replacement therapy. Hydrocortisone, the most commonly used form of replacement therapy, has both glucocorticoid and mineralocorticoid properties. During times of stress, glucocorticoid dosage is increased to prevent addisonian crisis.  Mineralocorticoid replacement with fludrocortisone acetate (Florinef) is given daily with increased dietary salt. Patient teaching covers medications, techniques for stress management, and that patient must always wear an identification bracelet (Medic Alert). Addisonian Crisis  Patients with Addison’s disease are at ris
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