438 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Encourage follow-up appointment with the physician to have calcium levels checked. ● Instruct family and patient regarding the need for lifelong medication therapy.
Diagnostic Testing ● Serum calcium levels are low, phosphate levels are high, magnesium levels are low, and PTH levels are low ● Decreased bone mineral density ● Bone or soft tissue abnormalities as confirmed by x-ray or computed tomography (CT) scans ● Evidence of prolonged QT interval confirmed by 12-lead electrocardiogram (ECG) Nursing Interventions ● A thorough physical assessment and history should be taken to determine whether the patient has experienced muscle spasms, muscle twitching, seizure activity, vomiting, or headaches. ● Thorough knowledge of medications used to treat hypopar- athyroidism, such as calcium and vitamin D, is necessary. ● In beginning phase of diagnosis, the patient may require IV calcium infusions. The nurse must frequently check the IV site for symptoms of infiltration or extravasations. Carefully check and recheck calcium dose and dilution order and follow facility IV calcium infusion protocols. ● Once the patient’s calcium has normalized, the nurse must evalu- ate oral tolerance of vitamin D and calcium for 24 hours to make sure the patient can tolerate the medication before discharge. ● Vital signs are assessed frequently. ● Seizure precautions are exercised until calcium levels normalize. ● Cardiac telemetry may be indicated, and the nurse should carefully monitor cardiovascular status. ● Assessment for hyperreflexia of the muscles should be performed frequently while calcium levels are unstable. ● The nurse must provide dietary recommendations to the patient/family.
HYPERPARATHYROIDISM
Hyperparathyroidism is rare in children. This condition is a result of overproduction of PTH from the parathyroid gland. It is most common in females during adolescence. The classic symptoms are severe malaise, constipation, dehydration, head- ache, and vomiting. Cardiac abnormalities such as heart block and shortening of the QT segment may be present on ECG (Ilie, 2020). Assessment Hyperparathyroidism assessment includes the following measures. Clinical Presentation ● Signs and symptoms may include bone and joint pain, bone loss or evidence of osteoporosis, bone fractures, muscle weak- ness, abdominal pain, heartburn, nausea, vomiting, constipa- tion, lack of appetite, kidney stones, excessive thirst, excessive urination, depression, anxiety, memory loss, and drowsiness or fatigue. Diagnostic Testing ● Serum calcium is elevated along with elevated PTH levels. ● X-ray or bone densitometry reveals signs of bone loss. ● Renal calculi may be present in the kidneys. Nursing Interventions ● Postoperative care of the child with a parathyroidectomy focuses on maintaining the airway and breathing. ● The nurse should assess the surgical site for edema that may lead to altered respiratory status. ● Frequently assess for sign and symptoms of infection and hematoma. ● The nurse should administer IV fluids as ordered and keep track of intake and output. ● Careful monitoring of electrolytes is also important. Caregiver Education ● Instruct parents to monitor for signs and symptoms of infec- tion at the operative site. ● Nutrition guidance should include food and liquids high in calcium and vitamin D, because removal of the parathyroid glands can cause the patient to be deficient in both. ● Parents should be taught signs and symptoms of hypocalce- mia and when to alert the physician. ● Remind parents and the patient that calcium and vitamin D supplements are a lifelong therapy.
CLINICAL JUDGMENT Chvostek's Sign
Assessment of hyperreflexia of the muscles can be performed by tapping on the facial nerve. If a spasm occurs in the facial muscles, then a positive Chvostek's sign has occurred. This confirms that the child has muscle spasms, pain, cramping, and twitches. This is an important test for infants and small children, because they are unable to communicate pain or muscle spasms.
Caregiver Education ● Encourage dietary compliance, such as avoiding caffeine and limiting the intake of carbonated beverages. ● Encourage foods high in calcium and vitamin K. ● Instruct parents to give calcium and vitamin D with acidic sub- stances such as orange juice or foods containing lemon juice. ● Provide dietary instruction regarding alternative dietary supplements in addition to calcium and vitamin D, such as magnesium, boron, and vitamin K.
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