The nurse is caring for a patient who has impetigo contagios…
Questions
The nurse is cаring fоr а pаtient whо has impetigо contagiosa. Monitoring for which of the following complications should be included in the plan of care?
Hyperpаrаthyrоidism (Study Outline) Fоr study оnly—this is not medicаl advice or a substitute for professional care. 1. Background Definition:Excess secretion of parathyroid hormone (PTH) → hypercalcemia and hypophosphatemia, due to increased bone resorption, renal calcium reabsorption, and vitamin D activation. Types: Primary: Autonomous PTH overproduction (elevated calcium, elevated PTH). Causes: Parathyroid adenoma (≈85%), hyperplasia, or carcinoma. Secondary: Compensatory PTH elevation due to chronic hypocalcemia (low or normal calcium, high PTH). Causes: Chronic kidney disease (↓ vitamin D activation, phosphate retention), malabsorption, vitamin D deficiency. Tertiary: Autonomous PTH secretion after prolonged secondary stimulation (high calcium and very high PTH, often in ESRD). Epidemiology: More common in women >50 years. Primary hyperparathyroidism is the most frequent cause of outpatient hypercalcemia. Pathophysiology: PTH ↑ bone resorption (osteoclast activation via osteoblast signaling). ↑ renal calcium reabsorption and phosphate excretion. ↑ 1,25-(OH)₂ vitamin D (calcitriol) → ↑ intestinal calcium absorption. 2. History Often Asymptomatic (Incidental Hypercalcemia). Classic Mnemonic – “Stones, Bones, Groans, and Psychiatric Overtones”: Stones: Nephrolithiasis, nephrocalcinosis. Bones: Bone pain, fractures, osteitis fibrosa cystica (“brown tumors”). Groans: Abdominal pain, constipation, pancreatitis, peptic ulcers. Psychiatric Overtones: Fatigue, depression, confusion, anxiety. Other Symptoms: Polyuria, polydipsia (nephrogenic diabetes insipidus due to hypercalcemia). Weakness, muscle aches. Historical Clues: Lithium or thiazide diuretic use (can increase calcium). History of neck irradiation or multiple endocrine neoplasia (MEN 1 or 2A). 3. Exam Findings General: Lethargy, dehydration (from polyuria). HEENT: May have neck mass if large adenoma or hyperplasia. Cardiovascular: Hypertension, arrhythmias possible. Musculoskeletal: Bone tenderness, fractures, decreased bone density. Abdomen: Abdominal tenderness from stones or pancreatitis. Neurologic: Depression, confusion, or mild cognitive impairment. 4. Making the Diagnosis Step 1 – Confirm Hypercalcemia: Total serum calcium: elevated. Ionized calcium: confirm if albumin abnormal. Phosphate: decreased in primary disease. Step 2 – Measure Intact PTH: Primary hyperparathyroidism: ↑ PTH, ↑ Ca²⁺, ↓ phosphate. Secondary: ↑ PTH, ↓/normal Ca²⁺, ↑ phosphate (esp. CKD). Tertiary: markedly ↑ PTH, ↑ Ca²⁺, ↑ phosphate (autonomous). Step 3 – Additional Tests: 24-hour urinary calcium: Elevated in primary; low in familial hypocalciuric hypercalcemia (FHH). Serum creatinine and eGFR: evaluate for CKD (secondary cause). Vitamin D level: to rule out deficiency. Bone mineral density (DEXA): to assess osteoporosis. Imaging for localization (preoperative): Sestamibi scan or neck ultrasound for parathyroid adenoma. Gold Standard: Elevated serum calcium + elevated or inappropriately normal PTH. 5. Management (Exam Concepts) (Conceptual overview only—no dosing or treatment regimens.) Primary Hyperparathyroidism: Definitive treatment: surgical removal of adenoma or hyperplastic glands. Indications for surgery (exam clues): Serum Ca²⁺ >1 mg/dL above normal. Symptomatic (stones, bone disease, neuropsychiatric). Reduced bone density or age
Pituitаry Adenоmа (Study Outline) Fоr study оnly—this is not medicаl advice or a substitute for professional care. 1. Background Definition:Benign tumors of the anterior pituitary, classified by size and hormone secretion: Microadenoma: