How to care for patients undergoing surgery for primary hyperparathyroidism.

Primary hyperparathyroidism is the third most common endocrine condition. Initial symptoms can be vague, leading to problems in other body systems before diagnosis; if it remains undiagnosed, it can lead to a life threatening parathyroid crisis. This in itself provides challenges to nurses working in surgical and endocrine specialties, and a thorough understanding of physiology is essential to ensure safe practice and promote good patient outcomes. This article discusses the pathophysiology of primary hyperparathyroidism and the care of patients with the condition.

Long-term lithium therapy leading to hyperparathyroidism: a case report.

PURPOSE: This paper reviews the effect of chronic lithium therapy on serum calcium level and parathyroid glands, its pathogenesis, and treatment options. We examined the case of a lithium-treated patient who had recurrent hypercalcemia to better understand the disease process. CONCLUSION: Primary hyperparathyroidism is a rare but potentially life-threatening side effect of long-term lithium therapy. Careful patient selection and long-term follow-up can reduce morbidity. PRACTICAL IMPLICATIONS: As much as 15% of lithium-treated patients become hypercalcemic. By routinely monitoring serum calcium levels, healthcare providers can improve the quality of life of this patient group.

Outpatient parathyroidectomy: a new paradigm from a nursing perspective.

PURPOSE OF REVIEW: Nursing assessment and management regarding the care of patients with primary hyperparathyroidism (1 degrees HPTH) has evolved in parallel with the marked changes in diagnosis and surgical approach to the disease. Earlier diagnosis and vast advancements in surgical approach has shifted the paradigm of nursing intervention into the outpatient setting. RECENT FINDINGS: The early detection of 1 degrees HPTH has become more prevalent in the preceding three decades. The clinical profile has shifted to minimally symptomatic or asymptomatic patients who have excess serum PTH levels, along with hypercalcemia. A recent consensus conference proposed diagnostic guidelines relevant to the decision making process regarding the advisability of surgical intervention vs. medical management. With surgical intervention as the only definitive treatment for 1 degrees HPTH, the successful outcomes associated with outpatient minimally invasive parathyroidectomy have shifted the patterns of recommendation for surgery, even within the group of asymptomatic patients. SUMMARY: The endocrine nurse is integral in the successful team management of patients diagnosed with 1 degrees HPTH. From a nursing perspective, the paradigm has shifted from an inpatient focus centered around the progressive clinical signs and symptoms of the disease, to a comprehensive patient care model of assessment, education, and pre, peri and postoperative monitoring of patients who benefit from the demonstrated positive outcomes associated with parathyroid surgery in the outpatient setting.

Using elements of the nursing minimum data set for determining outcomes.

To measure the contribution of nursing activities to patient outcome achievement requires a standardized language for documentation and retrieval of critical data elements. This pilot study explored the utilization of elements of the Nursing Minimum Data Set (NMDS) in a sample of patients undergoing parathyroidectomy. Results support the importance of nursing management's role in creating reliable systems that capture the critical elements of care delivery. The successful use of any system for documentation and for research will be dependent on education of the staff in the various taxonomies being used.

Primary hyperparathyroidism: a case study.

Primary hyperparathyroidism is a hypercalcemic condition generated as a result of overproduction of parathyroid hormone (PTH) by one or more of the parathyroid glands. The cause is usually an abnormal group of cells forming a benign adenoma and rarely carcinoma. The condition is usually discovered by routine serum chemistry analysis showing hypercalcemia, hypophosphatemia, and elevated PTH levels. Elevated 24-hour urine calcium provides further confirmation. During the last decade, three procedures have been developed to help diagnose the affected parathyroid gland(s) in preparation for surgical intervention: computerized nuclear scanning with technetium-99-m sestamibi performed preoperatively; radio-guided probes; and rapid PTH assay (RPHA), both used intraoperatively. These three techniques have been reported to reduce the need for immediate frozen section diagnosis; shorten the length of the incision, surgical time, and length of hospital stay; produce less pain and discomfort; reduce surgical cost; and produce a quicker return to normal life. This article follows the surgical experience of a patient with a diagnosis of hyperparathyroidism and a history of postoperative nausea and vomiting who was scheduled as 23-hour stay.