What is the nursing priority for the client experiencing hyperparathyroidism?

We are committed to providing our patients with experienced and distinguished surgeons and outstanding care. Our interdisciplinary, highly specialized surgical program for parathyroid disease continually evolves, as a consequence of our dedication to giving our patients the most advanced treatment options. The recovery period and what the patient should expect is outlined below. This is an overview developed after being involved in guiding a large number of patients through their recovery.

Minimally-Invasive Parathyroidectomy – Post Surgery Instructions

Monitoring Your Progress

You should rest for the first 24 hours after surgery. If you have any questions regarding your progress, call us right away. Make an appointment at the CENTER one week after surgery, unless you are from out of town.

Incision

Your incision is covered with a protective tape called Steri-strip. Apply an ice pack to the lower neck the first 24 hours. You can shower and wash your hair as usual the day after surgery, but do not soak or scrub the incision. Please pull the tape off 4 days after surgery. After the tape removal, apply antibiotic ointment (Neosporin) to the incision twice a day for 5 days, then switch to vitamin E ointment twice a day and sunblock (SPF 35) in the morning for the next 2 months. Keeping the incision out of the sun will help it heal better.

You might notice bruising around your incision or upper chest. Swelling above the incision will last for several weeks. In addition, the scar may become pink and hard. This hardening will peak at about 3 weeks and may result in some tightness, which will disappear over the next 2 to 3 months. Firm massaging of the scar starting 2 weeks after surgery will help.

Pain

In the majority of cases, the procedure is done under local anesthesia and the pain is minimal. Tylenol can generally control this pain. Some prefer Vicodin, but usually strong medications are not necessary. When a breathing tube is used for anesthesia, the main complaint after surgery is pain with swallowing.

Voice

Your voice is generally not affected because in most cases local anesthesia is used, and a breathing tube is not necessary.

Activity

Your activity level depends on the amount of discomfort you have. You can resume sports activities 2 weeks after surgery. Most patients are able to return to work in the first week. You are able to drive as soon as your head can be turned comfortably.

Low Calcium Levels After Surgery

In all patients who have parathyroid surgery, the remaining parathyroid glands that have not been doing any work, do not function properly immediately after surgery. This is usually temporary and causes the blood calcium level to drop below normal (this is called hypocalcemia).

Symptoms of Hypocalcemia

• Numbness and tingling in your hands, soles of your feet and around your lips
• Some patients experience a “crawling” sensation in the skin
• Muscle cramps
• Severe headaches

These symptoms appear between 24 and 48 hours after surgery. It is rare for them to start after 72 hours.

Hypocalcemia Prevention

Prior to the surgery we will give you specific instructions (table below) as to how much calcium and vitamin D replacement you will need to take after surgery. This is dependent on your pre-surgery calcium levels and the number of glands that are diseased.

Hypocalcemia Symptom Treatment

Patients with calciums of less than 14 prior to surgery: at any point if symptoms develop, you should take 8 extra Citracal Petites pills and call Dr. Larian ASAP.

Patients with calciums more than 14 prior to surgery, or with hyperplasia: if symptoms develop, you should take an extra 2000 milligrams of Calcium, and an extra Rocalcitrol, and call Dr. Larian ASAP.

After Surgery Blood Tests

(You will be given prescriptions for these tests)

• One month after surgery: Calcium, PTH & Vitamin D Levels.

Bleeding

If bleeding occurs, you will notice immediate swelling in the neck and difficulty breathing. This is extremely rare but it is an absolute emergency. If it does occur, CALL 911 immediately.

If you would like to know more about post-surgery healing, schedule a consultation with our surgeon or give us a call at 310.461.0300 today!

Bob Adams, a 62-year-old African American man, has been receiving outpatient hemodialysis for 6 years. Two years ago, he began experiencing severe bone pain in both arms and legs. At that time, blood tests showed his serum parathryroid hormone (PTH) was 1,200 pg/mL, serum calcium was 9.3 mg/dL, and phosphorus was 6.7 mg/dL.

Current estimates indicate that about 10% of U.S. adults are affected by chronic kidney disease (CKD), which is defined by a glomerular filtration rate (GFR) of less than 60 mL/min for more than 3 months (normal GFR is 90 to 120 mL/min). End-stage renal disease (ESRD), which is categorized as stage 5 CKD, is defined by a GFR of less than 15 mL/min. (See On the rise.)

Complications of CKD and ESRD include cardiovascular diseases, anemia, osteoporosis, depression, and electrolyte imbalances. This article explores secondary hyperparathyroidism (SHPT), also referred to as renal hyper­para­thyroidism, a less familiar but common long-term consequence of CKD and ESRD.

Pathophysiology of SHPT

Understanding the pathophysiology of SHPT begins with an explanation of the parathyroid glands, two pairs of which are located on the back of each side of the thyroid. Their main function is secretion of PTH to regulate serum calcium levels, increasing when levels are low and decreasing when they’re high. They do this by producing calcium-sensing receptor (CaSR), a G protein that controls PTH levels. (See PTH explained.)

On the rise

• On December 31, 2014, there were 678,383 prevalent cases of end-stage renal disease (ESRD), representing a 3.5% increase from the 655,435 cases in 2013; 63.1% of all prevalent ESRD patients were receiving hemodialysis therapy, 6.9% were being treated with peritoneal dialysis, and 29.6% had a functioning kidney transplant.

• The number of ESRD incident cases plateaued in 2010, and the number of ESRD prevalent cases continues to rise by about 21,000 per year.

• Compared to Whites, ESRD prevalence in 2014 was about 3.7 times greater in African Americans, 1.4 times greater in Native Americans, and 1.5 times greater in Asians.

• Chronic kidney disease is growing most rapidly in people 65 and older.

Source: United States Renal Data System. Chapter 1: Incidence, prevalence, patient characteristics, and treatment modalities. 2016.

What is the nursing priority for a client experiencing hyperparathyroidism?

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