A female adult client with a history of chronic hyperparathyroidism admits to being non-compliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?
A. Related to bone demineralization resulting in pathologic fractures.
B. Related to exhaustion secondary to an accelerated metabolic rate.
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces.
D. Related to tetany secondary to a decreased serum calcium level.
Correct Answer: A. Related to bone demineralization resulting in pathologic fractures.
Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and risk for injury. Primary hyperparathyroidism preferentially reduces cortical bone density and increases fracture risk at sites where cortical bone predominates, such as the distal forearm, with relative sparing of trabecular bone. For this reason, those with hyperparathyroidism should have a dual-energy x-ray absorptiometry that includes the distal third radius, a site composed almost exclusively of cortical bone, in addition to measurements at the spine and hip.
Option B: Hyperparathyroidism doesn’t accelerate the metabolic rate. The physical examination of a patient with primary hyperparathyroidism is usually normal. However, the physical examination can be helpful in finding abnormalities that could suggest other etiologies of hypercalcemia.
Option C: A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Patients with primary hyperparathyroidism and other causes of PTH-dependent hypercalcemia often have frankly elevated levels of PTH, while some will have values that fall within the reference range for the general population. A normal PTH in the presence of hypercalcemia is considered inappropriate and still consistent with PTH-dependent hypercalcemia.
Option D: Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn’t associated with tetany. Parathyroid hormone activates the parathyroid hormone receptor increasing resorption of calcium and phosphorus from bone, enhancing the distal tubular resorption of calcium, and decreasing the renal tubular reabsorption of phosphorus.
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