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LSC Ch 65 Endo
LSC Nursing
| Question | Answer |
|---|---|
| Anterior Pituitary Gland - Adenohypophysis | Over or Under Secretion of Hormones: GH, TSH, ACTH (Corticotropin), FSH, LH, MSH (melanocyte stim. horm), PRL (Prolactin) * MOST LIFE THREATENING |
| Hypopituitarism | Short Stature; GH: Decreased Somatomedin C-Decreased Bone Density, Decreased Se Cholesterol, Gonadotropins & FSH: Decreased testes & ovary stimulation |
| Assessment of Pituitary Hypofunction | Change in physical appearance, loss of 2ndary sex characteristics (facial & body hair loss in men women amenorrhea, breast atrophy, decreased pubic hair, Nuerological vision changes, |
| Dx Tests Pituitary Hypofunction | CT/MRI Enlargement in sella turcica Labs: Vary |
| Interventions of Hypopituitarism | Males: Androgen (testosterone)Therapy, Avoid in prostate CA, Gyencomastia, & Prostate Enlargement. Women: Estrogen & Progesterone Therapy, Risk: HTN & DVT's, Chlomid induces ovulation |
| Hyperpituitarism | Over production of: GH, Prolactin, TSH, ACTH, FSH, LH, MSH; cause: Pituitary adenoma (benign) or hyperplasia in anterior pituitary, may be genetic |
| Symptoms of Pituitary Tumor | Visual Changes, HA, Galactorrhea, AMenorrhea, Infertility Increased ICP |
| Gigantism | Excess secretion of GH before Puberty, rapid proportional growth in all lengths of bones |
| Acromegaly | Excess secretion of GH after growth plates have closed. increased skeletal thickness, hypertrophy of skin, enlargement of many organs liver & heart |
| Hyperglycemia in Acromegaly | Occurs because GH blocks the secretion of insulin |
| Progression Acromegaly | Increased Strength & metabolism, Replaced w/lethargy & weakness, compression optic nerve, skin: perspires, oily, Enlarged organs, HTN, Enlarged tonue - dysphagia, Deep voice-larynx hypertrophy, Hypogonadism - small glands |
| Psychosocial Assessment Acromegaly | Change in Appearance, Impact on personal relationships, infertility, Emotional Lability, Fear of Dx, surgery, tumor |
| Lab & Radiology Assessment: Acromegaly | Determine which hormone is in excess, Skull XR, CT/MRI's, Suppression tests (blood) |
| Common Nursing Dx for Acromegaly | Disturbed Body Image, Sexual Dysfunction, Addl... Pain, Fear, Anxiety, Ineffective coping, Activity Intolerance, Disturbed sensory perception, Deficient knowledge |
| Disturbed Body Image | Expected Outcomes: Reduce/Eliminate HA & Visual Disturbances, Reverse as many body changes as possible, Sense of congruence between reality and body presentation |
| Dopamine Agonists | Bromocriptine mesylate (Parlodel) give w/meals, SE: orthostatic hypotension, gastric irritation, abd pain, N&V, constipation, HA; cardiac SE rare, go to ER if chest pain; start dose slowly gradually increase; not during pregnancy |
| Somatostatin Analogs | Octreotide (Sandostatin), Pegvisomant (Somavert), Decrease neg. feedback, block grwth hormone receptors; Weekly IM Inj SE: Gallbladder disease |
| Rad Therapy Acromegaly | not immediate tx, long term tx slow to show results, gamma knife: increased accuracy, brachytherapy-seeds inside tumor |
| Hypophysectomy | Remove pituitary & tumor, reverses some body changes, improves sex cannot reverse organ enlargement, skeletal, & visual changes, Nasal packing 2-3 days w/mustache dressing, *CANT brush teeth, cough, sneeze or bend forward (Increased ICP) |
| Post OP Care | Monitor Neuro Stats, watch for complications DI, CS leak, Infection, Inc. ICP, KEep HOB elevated 30 degrees, report post nasal drip or halo sign on dresssings, avoid cough, lifelong meds for whole gland removal thyroid & glucocorticoids |
| Drugs for sexual dysfunction | Bromocriptine, Hormone Replacement Androgens or Estrogen/ progesterone |
| Diabetes Insipidus | Insufficient release of ADH, Polyuria: water excreted in excess- unabsorbed by tubules, DEHYDRATION: severe (causes decreased BP, Decreased Cardiac Output, Tenting of Skin), U/O>4-30L/day, Fluid replacement to prevent shock |
| Common Nursing Dx for DI | Deficient Fluid Volume, Decreased Cardiac Output, Impaired Oral Mucous Membranes, Potential for Dysrhuthmias |
| Nursing Interventions DI | Accurate & Frequent I&O (Hourly), Low Specific Gravity, dilute almost like H2O, Monitor for dehydration, weigh daily, drink fluids to equal U/O |
| Partial Deficit DI Drug Therapy | Chlorpropamide (Diabinese), stimulates remaining ADH, check allergies to sulfa, teach symptoms of hypoglycemia, carry concentrated sugar |
| Complete Deficit DI Drug Therapy | Vasopressin Therapy in Hospital & DDAVP Desmopressin at home; DOn't drink more than 3L/day, Blow nose B4 using spray, sit up, hold breath: keep med in contact w/nasal mucosa, Lifetime tx |
| Pt Education DI | Monitor for Signs of DI, if Wt gain or loss, contact MD, MEdications can cause fluid overload, HA, Acute Confusion, Wear a Medical Bracelet |
| Syndrome of Inappropriate ADH (SIADH) | Vasopressin secreted even when not needed, Water Retention, Dilutional Hyponatremia (Na+), Increased GFR inhibits renin and aldosterone release leading to increased NA loss or Hyponatremia |
| Assessment SIADH | Symptoms of H20 Retention (Na level <115), Lethargy w/decreasing LOC to coma, HA, Hostility, confusion, Seizures, |
| Diagnostic Assessment SIADH | Urine Osmolarity Increases (Concentrated Urine), Plasma Osmolarity Decreases, Urine Na levels and specific gravity increase |
| Non Surgical Interventions for SIADH | Fluid Restriction 500mL/24hrs, Includes parenteral meds, need good oral hygeine, remind not to swallow; measure I&O daily wt, IV's: 3% NaCl replaces Na, Diuretics if HF present |
| Drug Therapy SIADH | Demclomycin preferred, SE: yeast infections, Need good oral care, rinse toothbrush in 10%bleach, eat yogurt, Monitor for Fluid Overload: pulm edema & HF(can occur quickly), bounding rapid HR, JVD Distention, perpheral edema, Moist Lung Sounds |
| Interventions for SIADH | Safety due to confusion, Neuro stats q2-4hrs, muscle twitching progressing to seizures or coma, Quiet Environment |
| Addison's Disease | Most common cause is withdrawl of glucocorticoid meds (prednisone), hypoglycemia, Reduced urea nitrogen excretion- anorexia/wt. loss, Reduced aldosterone secretion: K+ excretion reduced Hypokalemia, Hyponatremia, Hypovolemia, Low androgen levels hair |
| Addison's Crisis | Acute Insufficiency, Response to stressful event, severe fluid & electrolyte loss: rapid loss Na, High K, Hypovolemia, Hypotension, Tachycardia, Death, causes: Steroids, Stress Ulcers |
| Hx Assessment Addison's Disease | Decreased activity level, Muscle weakness Salt craving, GI Problems, Anorexia, N, V, D, Wt. loss, Menstrual changes/impotence |
| Physical Assessment Addison's Disease | Symptoms previously listed, hyperpigmentation, hypoglycemia, Volume Depletion, Hyperkalemia-cardiac dysrrhythmias |
| Diagnostic tests Addison's | Decreased BG, Decreased Na+, Decreased Cortisol, Increased K+, Increased BUN, Low levels Cortisol in UA, Skull XR check pituitary, ACTH stim test- lack response of cortisol |
| Interventions for Addison's | Daily wt, I&O, VS, watch for sighns of crisis, replacement hormones 2/3 in am, 1/3 in pm, Cortisol: glucose, Aldosterone: Na & H2O, Mineralcorticoids to maintain electrolyte balance |
| Corticosteroids for Addison's | Great & Dangerous drugs, SE Hungry, Moon Face, Buffalo Hump, Fragile Skin, Weak bones, stress ulcers, |
| Corticosteroids Medication Info | Weaning: acute use<6days, chronic>7days, must wean/taper doses to cease drug (assists adrenal gland to slowly make them), Sudden withdrawal of LT use leads to Crisis/death, Increased stress requires increased dosing (surg, trauma, emotional, etc) |
| Doses for Corticosteroids | Prefer to give in AM if once a day dosing, sometimes use every other day dosing, take w/meals (GI irritation), Prednisone half life 18-36hrs Elderly more prone to adrenal suppression, exacerbated symptoms |
| Adrenal Gland Hyperfunction | excess cortisol: cushings, excess aldosterone: hyperaldosteronism, excess androgens: sex, The 3 S's Sugar, Salt, & SEX, Adrenal Tumor: excess catecholamines epinephrine & norepinephrine bad for heart |
| Cushings Disease | less responsive to hormones, decreased metabolism, increased body fat, buffalo hump, moon face, changes in activity or sleep patterns, fatigue, muscle weakness, bone pain, frequent infections, easy bruising, GI problems, menses |
| Androgen production | Acne, Excessive Hair Grwth, Clitoral Hypertrophy, Decrease estrogen production, no menstration |
| Assessment Cushing's Disease | Emotional, mood swings, irritability, confusion, depression, fatigue and sleep difficulties, |
| Diagnostic Tests For Cushing's | INCREASE: Cortisol, ACTH, BG, Na, DECREASE: Lymphocyte, Ca, K, Cortisol elevated in UA, XR, CT, MRI: lesions on adrenal gland, Increased salivary cortisol level, Dexamethasone Suppression tests: normally cortisol is suppressed by this test-elevated |
| Nursing Dx: for Cushing's | *Excess Fluid Volume, *Risk For Infection, *Risk for Injury, Disturbed Body Image, Sleep Deprivation, Risk for falls, Deficient Knowledge, Imbalanced Nutrition |
| Interventions: Excess Fluid Volume: Cushing's | Mitotane (Lysodren) Interferes w/ACTH, Nutrition Therapy, Fluid & Na Restrictions, Monitor signs of fluid status: I&O, wt, Schedule fluids throughout day, Specific Gravity- Low, IV's need to be included in total intake |
| Rad Therapy for Cushing's | Pituitary Adenomas: not always effective- destroys normal tissue |
| Surgical Mgmt Cushing's | Hypophysectomy: pituitary adenoma, Adrenalectomy: Adrenal Tumor |
| PreOp Care Cushing's | Regulate Electrolyte Imbalance, Cardiac Monitoring, Hyperglycemia, Prevent infections, Safety- decrease risk of falls*Glucocorticoids during surgery to prevent adrenal crisis after removal of tumor |
| Post Op Care Cusing's | Monitor closely for signs of shock, skin b/d, pathological fx, GI bleeding |
| Risk For Injury Cushing's | skin assessment & protection, use tape sparingly, gentle handling, monitor wounds for healing, drug therapy for gastric ulcers - H2 Receptor Blockers |
| Risk For Infection Cushing's | Corticosteroids mask infections, may only have low grade fever, pus type wound drainage, Monitor vS for minor ele. of temp, Skin care hygeine & lubrication, Pulmonary Hygeine, CDB, assess lungs |
| Potential for Acute Adrenal Insufficiency (Cushing's) | Highest risk: pt taking glucocorticoids, Adrenal gland atrophy, stop producing glucocorticoids, life threatening if stopped suddenly - need to wean |
| Hyperaldosteronism | Increased Na & Fluid Retention, Increased Aldosterone Secretion, Increased Blood volume & BP, K Loss |
| Assessment Hyperaldosteronism | HA, Fatigue, Muscle weakness, Nocturia, Polydipsia, Polyuria, Paresthesia |
| Interventions Hyperaldosteronism | Surg - Adrenalectomy, K levels must be Normal First, Tx & outcome same for SIADH |
| Pheochromocytoma | Tumor of Adrenal medulla, excess release of epinephrine & Norepinephrine, Overstimulation of Sympathetic Nervous System |
| Assessment Hx Pheochromocytoma | *HTN, Severe HA, Profuse Diaphoresis, Flushing, Apprehension/sense of doom, Chest Pain, N&V, Heat Intolerance, Wt Loss, Tremors |
| Interventions | Surgery, Control BP prior to surg, calm environment, care similar to post adrenalectomy, monitor HTN or hypotension closely, Hypovolemia, Hemorrhage & shock, treat w/blood & plasma, I&O, if inoperable Treat HTN w/alpha & beta adrenergic blockers MonitorBP |
Created by:
ginabeana
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