title: Outpatient parathyroidectomy: a new paradigm from a nursing perspective.
abstract: OBJECTIVE
  Nursing assessment and management regarding the care of patients with primary hyperparathyroidism (1 degrees HPTH) has evolved in parallel with the marked changes in diagnosis and surgical approach to the disease. Earlier diagnosis and vast advancements in surgical approach has shifted the paradigm of nursing intervention into the outpatient setting.
  
  
  RESULTS
  The early detection of 1 degrees HPTH has become more prevalent in the preceding three decades. The clinical profile has shifted to minimally symptomatic or asymptomatic patients who have excess serum PTH levels, along with hypercalcemia. A recent consensus conference proposed diagnostic guidelines relevant to the decision making process regarding the advisability of surgical intervention vs. medical management. With surgical intervention as the only definitive treatment for 1 degrees HPTH, the successful outcomes associated with outpatient minimally invasive parathyroidectomy have shifted the patterns of recommendation for surgery, even within the group of asymptomatic patients.
  
  
  CONCLUSIONS
  The endocrine nurse is integral in the successful team management of patients diagnosed with 1 degrees HPTH. From a nursing perspective, the paradigm has shifted from an inpatient focus centered around the progressive clinical signs and symptoms of the disease, to a comprehensive patient care model of assessment, education, and pre, peri and postoperative monitoring of patients who benefit from the demonstrated positive outcomes associated with parathyroid surgery in the outpatient setting.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA. pdonovan@yale.edu
authors.forename: Patricia I
authors.initials: PI
authors.lastname: Donovan
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000451:nursing* / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000451:nursing*; D024802:Nurse's Role; D009730:Nursing Assessment; D010045:Outpatients; D016105:Parathyroidectomy / Q000379:methods* / Q000451:nursing*; D010348:Patient Care Team; D011182:Postoperative Care