13. Nurse Sam is evaluating a 66-year-old male patient who reports increased sleep, frequent urination, loss of appetite, weakness, irritability, depression, and bone pain that limits outdoor activities. Based on these symptoms, which disorder should Nurse Sam suspect?
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EXPLANATION
✔Correct answer:
Hyperparathyroidism. The symptoms reported by the patient—such as increased sleep, frequent urination, loss of appetite, weakness, irritability, depression, and bone pain—are characteristic of hyperparathyroidism. This condition involves the overproduction of parathyroid hormone (PTH), which leads to hypercalcemia (elevated levels of calcium in the blood) and subsequent complications.
Hyperparathyroidism is typically caused by a benign adenoma of the parathyroid glands. Excess PTH increases calcium resorption from bones, decreases calcium excretion by the kidneys, and increases intestinal calcium absorption. This results in hypercalcemia, which can manifest as weakness, depression, irritability, and bone pain due to bone demineralization. The increased calcium levels also lead to polyuria (frequent urination) as the kidneys try to excrete the excess calcium, causing dehydration and compensatory sleepiness.
Imagine the parathyroid glands as the thermostat controlling the calcium levels in the body. In hyperparathyroidism, the thermostat is stuck on high, causing excessive calcium to be released from the bones into the bloodstream, which can cause a range of symptoms, including bone pain and frequent urination.
Nurse Sam should ensure that the patient is assessed for hyperparathyroidism through blood tests measuring serum calcium, phosphate, and PTH levels. Monitoring the patient’s symptoms and educating him about the potential complications of hyperparathyroidism are also crucial steps.
- Encourage the patient to stay hydrated to help manage hypercalcemia.
- Provide education on the importance of regular follow-up appointments and monitoring blood calcium levels.
- Discuss dietary modifications that may help manage calcium levels, such as limiting high-calcium foods.
- Assist the patient in managing symptoms such as bone pain through pain relief strategies and mobility aids if necessary.
✘Incorrect answer options:
Diabetes mellitus. While frequent urination can occur in diabetes mellitus due to high blood glucose levels, other symptoms like increased sleep, loss of appetite, and bone pain are not typical. Instead, diabetes mellitus often presents with increased thirst, increased hunger, and weight loss.
Diabetes insipidus. Diabetes insipidus is characterized by excessive thirst and urination due to the kidneys' inability to concentrate urine. However, it does not usually cause symptoms like increased sleep, loss of appetite, weakness, or bone pain.
Hypoparathyroidism. Hypoparathyroidism leads to low levels of PTH, resulting in hypocalcemia. Symptoms of hypocalcemia include muscle cramps, tingling in the fingers and toes, and tetany, which are different from the symptoms described by the patient.
References
- Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.
- Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.