MedSurg Chapter 44 Pituitary and Adrenal Disorders

Pituitary Gland - Anatomy and Physiology of Pituitary Gland Adrenocorticotropic hormone (ACTH); controls growth, development, & function of the cortex of the adrenal glands. Disorders of the Pituitary Gland Hyperpituitarism - Cause verproduction of !H can lead to gigantism or acromegal". #ituitar" adenomas that secrete hormones ma" cause amenorrhea, galactorrhea (i.e., a$normal mil% secretion), h"perth"roidism, and Cushing s"ndrome in addiction to gigantism & acromegal", &eight !ain Gigantism (occurs in earl" childhood or pu$ert") 'efore the epiph"seal plates on the ends of these $ones close, the diaph"sis or long shaft of the $one ma" continue to grow to great lengths when stimulated $" excess !H. Acromegaly (more common than gigantism) 'ig 'one #eople (xcess !H production occurs after epiph"seal closure. The closed epiph"ses prevent longitudinal growth of the $ones, instead, $ones ) in thic%ness and width. Ta #a le 44-! Diagnostic test " procedures - Pituitary Disorders Glucose tolerance test* (valuates glucose dose to detect +, & H"perpituitarism. Ta%en to measure glucose levels at specified intervals. oratory studies - The glucose tolerance test is the most relia$le test for acromegal".

Drug therapy ctreotide (.andostatin), somatostatin analog, is most commonl" prescri$ed drug for patients with acromegal". +opamine agents li%e ca$ergoline (+ostinex) suppress the secretion of !H. $ursing inter%ention& ,onitor weight, '#, pulse, respirations, urine output. Assess for edema. /efrigerate ampules. +iscard if does colored or contains visi$le particles. Teach pt to give self in0ections; advise to ta%e exactl" as prescri$ed and never ta%e dou$le doses. Assess for changes in $lood glucose. Caution a$out drowsiness & di11iness. 2er" expensive Postoperati%e $ursing Care of the Patient 'ith Hyperpituitarism (is) for *n+ury 3 Coughing, straining, vomiting, or snee1ing can create enough intracranial pressure to disrupt the surgical site and cause C.4 lea%age or even $leeding. Patient Teaching for Hypophysectomy, Postoperati%e -ncourage self care -.cess/Deficient 0luid 1olume ,onitor pulse, '#, and 5& (is) for *nfection 'e especiall" alert for stiffness of the nec% & headache, these are s"mptoms of meningitis. Hypopituitarism - Signs " Symptoms &hen a state of panh"popituitarism exists, a s"ndrome called Simmonds cachexia is present. #atient has muscle & organ wasting & disruptions of digestion & meta$olism. Dia etes *nsipidus Cause (excessive output of dilute urine) 6ephrogenic +5 is an inherited defect in which the renal tu$ules of the %idne" do not respond to A+H, resulting in inade7uate water rea$sorption $" the %idne"s. Signs " Symptoms - Common .8. are massive diuresis, deh"dration, and thirst. +eh"dration is characteri1ed $" h"potension, tach"cardia, di11iness, 9 s%in turgor, wea%ness, and possi$le fainting episodes.

Medical Diagnosis - ,anagement of +5 is geared to controlling the .8.s of the disease & possi$l" reversing the cause of the s"ndrome. 52 fluid volume replacement and vasopressors are re7uired to maintain ade7uate '#. Syndrome of *nappropriate Antidiuretic Hormone Signs " Symptoms ,aintain s"mptoms of .5A+H initiall" reflect the effects of dilutional h"ponatremia and water retention* wea%ness, muscle cramps or twitching, anorexia, nausea, diarrhea, irrita$ilit", headache, and weight gain without edema. Disorders of the Adrenal Glands - Adrenal Hypofunction 2Addison Disease3 Pathophysiology .%in h"perpigmentation, particularl" sun3exposed areas, pressure points, 0oints, creases of the $od", is another possi$le sign. 5n prepu$escent people, facial, pu$ic, and axillar" hair ma" fail to grow entirel". Acute Adrenal Crisis 2Addisonian Crisis3 An" factor that causes stress in the person can initiate a crisis, (x; include infection, illness, trauma, and emotional or ps"chiatric distur$ances. ,anifestations of an addisonian crisis include s"mptoms of mineralocorticoid and glucocorticoid deficienc" $ut are more severe* h"potension, tach"cardia, deh"dration, confusion, h"ponatremia, h"per%alemia, h"percalcemia and h"pogl"cemia. Ta le 44-4 Acute Adrenal Crisis *nter%ention - 5nitial dose of h"drocortisone (.olu3Cortef) 52 push, followed $" infusion over : Hrs. (ational To provide a loading dose & maintenance infusion (Half3life of 52 h"drocortisone, ;<3=< minutes, $lood level must $e maintained $" continuous infusion. 5f $lood level falls, the patient ma" have a relapse. $ursing Care Plan& Patient 'ith Addison Disease *neffecti%e Self-Health Management - &ear a medical alert tag, carr" an emergenc" %it with dexamethasone (steroid). (is) for *n+ury 'e alert for postural h"potension and other signs of h"povolemia. 5nstruct the pt who has di11iness with position changes to call for help when getting out of $ed and to rise slowl" to prevent falls. Adrenal Hypersecretion 2Cushing Syndrome3 - Cause The single exogenous cause of Cushing s"ndrome is prolonged administration of high doses of corticosteroid agents. ,ost common cause of Cushing s"ndrome. Pathophysiology - The following are hallmar% findings that lead to a diagnosis of Cushing s"ndrome* - Truncal, o$esit" (excess adipose in $od") - #rotein wasting (slender extremities & ver" thin & fria$le s%in)
- ,oonface (facial fullness)

(is) for *nfection 4 (xposure to people with infections should $e avoided due to the patient>s 9 resistance to infection. Pheochromocytoma #ts with a pheochromoc"toma exhi$it episodes of h"pertension, h"permeta$olism, and h"pergl"cemia. Classic clinical findings are h"pertension with a diastolic pressure of ??@ mm Hg or ). #ounding headache and diaphoresis (profuse sweating).

Chapter 45 Thyroid " Parathyroid Disorders Thyroid Gland - Anatomy " Physiology of Thyroid Gland T.H, hormone stimulates the th"roid gland to secrete hormones that affect the production and use of energ". Age-(elated Changes in Thyroid 0unction Th"roid conditions are overloo%ed in older adults, .8. are su$tle, with at"pical presentation, attri$uted to aging process. &eight changes ma" not occur in the older person as the" do with "ounger people with th"roid disorders. Ta le 45-! Diagnostic Test " Procedures Thyroid Disorders #a oratory Studies (levated TA indicates h"perth"roidism and excessive th"roid hormone replacement. TB and TA 9 with h"poth"roidism. Disorders of the Thyroid Gland Hyperthyroidism - Complications 5f untreated, h"perth"roidism ma" lead to th"rotoxicosis (th"roid storm or crisis). Th"rotoxicosis is excessive stimulation caused $" ) th"roid hormone levels that produce dangerous tach"cardia & h"perthermia. Medical Treatment - Three ,ethods used to treat h"perth"roidism* (?) drug therap", (C) surger", (B) radiation therap". Drug Therapy &hen a pt is on drugs that interfere with TA secretion, monitor for s"mptoms of h"poth"roidism (cold intolerance, edema, weight gain). Thionamide Agents* examples of thionamide agents are prop"lthiouracil (#TD) & methima1ole (Tapa1ole). .igns of infection, such as sore throat or fever, should $e reported to the ph"sician immediatel". Ta le 4-6 Drug Therapy Thyroid Conditions Thyroid Hormone (eplacement Drugs Drug $ursing *nter%ention ."nthroid lder pts are more suscepti$le to toxicit" .aturated .olution /educe the unpleasant taste & tooth staining potential $" having patient use a straw of potassium 5odine (..E5) ,onitor s"mptoms of excess iodine. !ive ..E5 after meals. $ursing care of $onsurgical pt 'ith Hyperthyroidism - *nter%ention F 7hen treated as an outpatient, teaching is related to preparing pt for self-care8 Distur ed Sleep Pattern - (ncourage $edtime rituals, which ma" $e helpful in preparing for sleep. Hyperthermia - H"perth"roid patient usuall" have some heat intolerance $ecause of their high meta$olic rate. (is) for *n+ury (xophthalmos is a condition in which deposits of fat and fluid $ehind the e"e$alls ma%e them $ulge outward. /eassure pt that condition usuall" goes awa" after treatment of h"perth"roidism. $utrition Considerations C. Gac% of iodine is associated with development of goiter (enlargement of the th"roid gland) in adults and cretinism in infants. B. 5odi1ed salt is the $est wa" to o$tain an ade7uate amount of iodine in the diet.

$ursing care of the Pt ha%ing a Thyroidectomy - Preoperati%e Care As% pt to return demonstrations of activities such as deep $reathing and supporting the head during position changes. *nter%entions - *neffecti%e Air'ay Clearance 5t is especiall" important to monitor and document rate and ease of respirations after th"roidectom". /espirator" distress can result from compression of the trachea or from a spasm of the lar"nx caused $" nerve damage or h"pocalcemia. 'efore pt returns from surger", suction e7uipment, a lar"ngoscope, endotracheal tu$e C, and an emergenc" tracheotom" tra" availa$le. Decreased Cardiac 9utput 4re7uentl" inspect dressing for $leeding, ta%e 28., $ecause dressing is on front of nec%, $lood might flow under the dressing to the $ac% of nec%. 'e sure to chec% $ehind patients nec% and upper $ac% to detect this. Hypothyroidism - Cause and (is) 0actor 4oods and drugs act as goitrogen agents, meaning that the" suppress th"roid hormone production. (xamples of foods that are goitrogen agents if ta%en in large 7uantities are so"$eans, turnips, ruta$agas. Medical Treatment H"poth"roid patients usuall" re7uire lifelong replacement therap". (is) for *mpaired S)in *ntegrity +r" s%in, is common with h"poth"roidism, is prone to $rea%down. Gi$erall" appl" lotions and creams to help maintain moisture and control itching. Self-Care Deficit F Teach patient s"mptoms of h"perth"roidism that might occur with excessive hormone replacement (tach"cardia, weight loss, nervousness). $ursing Assessment of Parathyroid 0unction Physical -.amination .imple test - Chvoste% sign is a spasm of facial muscle, when face is tapped over facial nerve. Troussau sign - is a carpopedal spasm, occurs when a '# cuff is inflated a$ove pt s"stolic '#, left in place for C 3 B min. Both are indicative of hypocalcemia. Disorders of the Parathyroid Glands - Hyperparathyroidism ,ost nota$le effect of h"perparath"roidism is elevation of serum calcium (i.e., h"percalcemia. High levels of #TH cause calcium to shift from the $ones into the $loodstream. 5f h"perparath"roidism is untreated, then severe deminerali1ation of $one tissue occurs. 'ones can $ecome $rittle, thus resulting in serious fractures. *mpaired :rinary -limination ,aintain accurate inta%e and output records $ecause h"percalcemia can cause urinar" calculi and serious %idne" damage. Hypoparathyroidism Signs and Symptoms .8. of h"pocalcemia are painful muscle cramps, fatigue and wea%ness, tingling and twitching of the face and hands, metal and emotional changes, dr" s%in, and urinar" fre7uenc". -;T(AS if you 'ant them& ?. Hormones secreted $" the anterior pituitar" are* ACTH, GH, #H C. A pt who states* H5 will $e so glad to loo% li%e m"self againIJ C9((-CT (esponse is <Treatment 'ill )eep your symptoms from getting 'orse ut 'ill not re%erse all of them= B. #t complains of nec% stiffness after removal of pituitar" adenoma, what do "ou doK #oo) for signs of infection. A. #ts with h"popituitarism who to have children must $e treated with* #H, and 0SH @. ,ain s"mptom of .5A+H is 'ater retention. ;. &hat records must $e maintained for the pt with +5K :rine specific gra%ity L. 4luid and electrol"te im$alances in Addison disease include whatK Hyper)alemia and Hyponatremia :. '# ::8A<, #ulse ?<:, thread" and dr" s%in and mucous mem$ranes are all signs ofK Acute adrenal crisis =. 6ursing care for pt with Cushing s"ndrome includeK Apply moisturi>ers to dar), toughened areas of s)in8 Tell pt that mood s'ings and irrita ility 'ill lessen 'ith treatment . ?<. The primar" function of th"roid hormones is to regulateK Meta olism ??. A pt with severe h"poth"roidism is $eing admitted to "our nursing unit, what action is appropriateK Ha%e e.tra lan)ets put in the room8

?C. ?B. ?A. ?@. ?;.

4indings most li%el" in a pt with sever h"erth"roidismK Heart rate of !6? pm, @P of !A?/B? mm Hg8 The term used to descri$e a h"perth"roid pt has prominent, $ulging e"e$allsK -.ophthalmos8 5mmediate postoperative period after th"roidectom" priorit"K Maintain a patent air'ay. #urpose of measuring serum th"roglo$ulin in a pt with th"roid cancerK Detect recurrence of the thyroid cancer . /elationshiop $etween #TH and serum calciumK Secretion of PTH C 'hen serum calcium is lo'8 C secretion of PTH causes the )idneys to retain calcium. ?L. #arath"roid adenoma removed C da"s ago, pt complaining of muscle cramps in her hands and feet, "ou suspectK Hypocalcemia. ?:. 6ursing implications in administering iodide solutions to a patient include which of the followingK Dilute in mil) or +uice, and pro%ide a stra'.