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Book Excerpts: Treatment of Parathyroid Cancer
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Chvostek's sign:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
Test for Trousseau's sign, a reliable indicator of hypocalcemia. Closely monitor the patient for signs of tetany, such as carpopedal spasms or circumoral and extremity paresthesia.
Be prepared to act rapidly if a seizure occurs. Perform an electrocardiogram to check for changes associated with hypocalcemia that can predispose the patient to arrhythmias. Place the patient on a cardiac monitor.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hyperparathyroidism:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment varies, depending on the cause of the disease. Treatment of primary hyperparathyroidism may include surgery to remove the adenoma or, depending on the extent of hyperplasia, all but half of one gland (the remaining part of the gland is necessary to maintain normal PTH levels). Surgery may relieve bone pain within 3 days. However, renal damage may be irreversible.
Preoperatively — or if surgery isn’t feasible or necessary — other treatments can decrease calcium levels. These include forcing fluids; limiting dietary intake of calcium; promoting sodium and calcium excretion through forced diuresis using normal saline solution (up to 6 L in life-threatening circumstances), furosemide, or ethacrynic acid; and administering oral sodium or potassium phosphate, subcutaneous calcitonin, I.V. plicamycin, or I.V. biphosphonates.
Therapy for potential postoperative magnesium and phosphate deficiencies includes I.V. administration of magnesium and phosphate, or sodium phosphate solution given orally or by retention enema. In addition, during the first 4 to 5 days after surgery, when serum calcium falls to low normal levels, supplemental calcium may be necessary; vitamin D or calcitriol may also be used to raise serum calcium levels.
Treatment of secondary hyperparathyroidism must correct the underlying cause of parathyroid hypertrophy. Vitamin D therapy or, in the patient with renal disease, administration of an oral calcium preparation (calcium acetate, if possible) for hyperphosphatemia, are typically used, although surgical excision may be necessary. In the patient with renal failure, dialysis is necessary to lower calcium levels and may have to continue for the remainder of the patient’s life. In the patient with chronic secondary hyperparathyroidism, the enlarged glands may not revert to normal size and function even after calcium levels have been controlled.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of spinal cord tumors generally includes decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it isn't usually indicated for metastatic tumors. If the tumor is slowly progressive or if it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous. If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy with dexamethasone minimizes cord edema and temporarily relieves symptoms until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time. Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy. Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to opioid analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through small-diameter nerve fibers. Chemotherapy generally hasn't proven effective against most spinal tumors, but may be recommended in some cases.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chvostek's sign:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Test for Trousseau’s sign, a reliable indicator of hypocalcemia. Closely monitor the patient for signs of tetany, such as carpopedal spasms or circumoral and extremity paresthesia.
Be prepared to act rapidly if a seizure occurs. Perform an electrocardiogram to check for changes associated with hypocalcemia that can predispose the patient to arrhythmias. Place the patient on a cardiac monitor.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Thyroid enlargement:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Instruct the patient to watch for signs and symptoms of hypothyroidism, such as lethargy, restlessness, dry skin, and sensitivity to cold. Advise the patient with Graves’disease to use artificial tears frequently if proptosis causes his eyes to become dry. If the hyperthyroid patient is receiving therapy with radioactive iodine, tell him not to expectorate or cough freely after treatment because his saliva is radioactive for 24 hours.
Inform the patient that lifelong thyroid hormone replacement therapy is necessary after thyroidectomy or radioactive destruction of the thyroid gland. Tell him to watch for signs of an overdose, such as nervousness and palpitations.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hyper-parathyroidism:
Treatment
(Handbook of Diseases)
Effective treatment varies, depending on the cause of the disease.
Primary disease
Treatment for primary hyperparathyroidism may include surgery to remove the adenoma or, depending on the extent of hyperplasia, all but one-half of one gland (the remaining part of the gland is necessary to maintain normal PTH levels). Such surgery may relieve bone pain within 3 days. However, renal damage may be irreversible.
Clinical tip Patients with primary hyperparathyroidism should be considered for surgery when:
❑ calcium levels are greater than or equal to 1 mg/dl above normal
❑ osteoporosis is present
❑ recurrent peptic ulcer disease is present
❑ nephrolithiasis is present
❑ impaired kidney function is noted
❑ patient is young or consistent follow-up is unavailable.
Preoperatively — or if surgery isn’t feasible or necessary — other treatments can decrease calcium levels. They include forcing fluids, limiting dietary intake of calcium, and promoting sodium and calcium excretion through forced diuresis using normal saline solution (up to 6 L in life-threatening circumstances), furosemide, or ethacrynic acid.
Other treatments include administering oral sodium or potassium phosphate, subcutaneous calcitonin, I.V. plicamycin, or I.V. biphosphonates. In primary hyperparathyroidism, surgery is the only definitive therapy. There are no effective long-term medical therapies for hyperparathyroidism.
Therapy for potential postoperative magnesium and phosphate deficiencies includes I.V. administration of magnesium and phosphate or sodium phosphate solution given by mouth or retention enema. In addition, during the first 4 to 5 days after surgery, when serum calcium falls to low normal levels, supplemental calcium may be necessary; vitamin D or calcitriol may also be used to raise the serum calcium level.
Secondary disease
Treatment of secondary hyperparathyroidism must correct the underlying cause of parathyroid hyperplasia. It consists of vitamin D therapy or, in the patient with kidney disease, administration of an oral calcium preparation for hyperphosphatemia.
In the patient with renal failure, dialysis is necessary to lower phosphorus levels and may have to continue for the remainder of the patient’s life.
In the patient with chronic secondary hyperparathyroidism, the enlarged glands may not revert to normal size and function even after calcium levels have been controlled.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chvostek's sign:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Test for Trousseau’s sign, a reliable indicator of hypocalcemia. Closely monitor the patient for signs of tetany, such as carpopedal spasms or circumoral and extremity paresthesia.
Be prepared to act rapidly if a seizure occurs. Perform an electrocardiogram to check for changes associated with hypocalcemia, which can predispose the patient to arrhythmias. Place the patient on a cardiac monitor.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to watch for signs and symptoms of hypothyroidism, such as lethargy, restlessness, dry skin, and sensitivity to cold. If the patient has Graves’disease, proptosis may cause his eyes to become dry, so advise him to use artificial tears frequently. If the hyperthyroid patient is receiving therapy with radioactive iodine, tell him not to expectorate or cough freely after treatment because his saliva is radioactive for 24 hours. If the patient has a goiter, support him as he expresses his feelings related to his appearance.
After thyroidectomy or radioactive destruction of the thyroid gland, explain to the patient that lifelong thyroid hormone replacement therapy is necessary. Tell him to watch for signs of overdose, such as nervousness and palpitations.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Chvostek's sign:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Collect blood samples for serial calcium studies to evaluate the severity of hypocalcemia and the effectiveness of therapy.
▪ Administer oral or I.V. calcium supplements.
▪ Assess for Chvostek's sign when evaluating a patient postoperatively.
Patient teaching
▪ Explain to the patient the early signs and symptoms of hypocalcemia that require immediate medical attention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Thyroid enlargement:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, which may include needle aspiration, ultrasound, and radioactive thyroid scanning.
▪ Prepare the patient for surgery or radiation therapy, if necessary.
▪ Provide specific interventions, depending on whether the patient is hypothyroid or has thyroiditis.
▪ Provide postoperative care for the patient who has undergone thyroidectomy.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Explain the signs and symptoms of hypothyroidism to report.
▪ Explain posttreatment precautions to the patient undergoing radioactive iodine therapy.
▪ Teach thyroid hormone replacement therapy and signs of thyroid hormone overdose to report.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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