Disorders of the Pituitary Gland (Hypophysis) PDF

DISORDERS OF THE ENDOCRINE SYSTEM 081‐NP02L023 ELO A · Version 2.0 DISORDERS OF THE PITUITARY SYSTEM (HYPOPHYSIS) Foundations and Adult Health Nursing, 8th ed., Ch. 51, pp. 1698‐1709, 1709‐1718, 1718‐1723 TERMINAL LEARNING OBJECTIVE Given a patient with a disorder of the pituitary system determine...

DISORDERS OF THE ENDOCRINE SYSTEM 081‐NP02L023 ELO A · Version 2.0 DISORDERS OF THE PITUITARY SYSTEM (HYPOPHYSIS) Foundations and Adult Health Nursing, 8th ed., Ch. 51, pp. 1698‐1709, 1709‐1718, 1718‐1723 TERMINAL LEARNING OBJECTIVE Given a patient with a disorder of the pituitary system determine approaches for safe and effective patient care. ENABLING LEARNING OBJECTIVE: A Discuss pituitary disorders of the endocrine system ANATOMY AND PHYSIOLOGY Endocrine Glands and Hormones Endocrine Exocrine ANATOMY AND PHYSIOLOGY Negative Feedback Inhibition PITUITARY GLAND ANTERIOR PITUITARY Tropic Hormones Somatotropin Adrenocorticotropic Thyroid‐stimulating Gonadotropic Luteinizing Non‐tropic Hormones Prolactin POSTERIOR PITUITARY Anti‐diuretic Oxytocin CHECK ON LEARNING Briefly explain stimulation of the pituitary gland, i.e., negative feedback loop. CHECK ON LEARNING What is the definition of hormones? (Select the best answer.) a. Hormones are chemical messenger's balance. b. Hormones are chemical messengers which travel to target organs and promote metabolic changes. c. Hormones attach to receptor sites and cause an uneven distribution. d. Hormones only mimic the target organs response and do not cause a metabolic change. CHECK ON LEARNING What takes place when hormones reach the target organ? a. A metabolic change takes place. b. No metabolic change. c. A partial change. d. All the above. ACROMEGALY Greek meaning: “extremities enlargement” Somatotropin CLINICAL MANIFESTATIONS ASSESSMENT SUBJECTIVE OBJECTIVE DIAGNOSTIC EVALUATION HISTORY CLINICAL MANIFESTATIONS OPHTHALMOLOGIC EXAM CT SCAN LABORATORY TESTS MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL TRANSSPHENOIDAL MEDICATION HYPOPHYSECTOMY DOPAMINE AGONIST SOMATOSTATIN IRRADIATION ANALOGS GH INHIBITORS NURSING IMPLICATIONS Joints Pain Relief Headache Painful Communication Difficult Physical Appearance Self‐Esteem Impotence CHECK ON LEARNING Even with adequate medical or surgical treatment, the physical changes are irreversible, and the patient is prone to developing complications. True or False CHECK ON LEARNING You are the nurse assigned to data collection on new patients. The information gathered from the patient is as follows: Neurological (headaches, visual disturbances), muscle weakness, sexual problems (male impotency). What nursing diagnosis would be considered? a. Fatigue b. Activity intolerance c. Pain d. Sexual difficulties CHECK ON LEARNING After reviewing the physician notes, the nurse reads the patient has been diagnosed with acromegaly. The most correct definition for acromegaly is: a. Bone enlargement and joint involvement b. Enlargement of the cranium and lower jaw c. Enlarged hands and feet d. Overproduction of somatotropin (growth hormone, or GH) in the adult CHECK ON LEARNING What tests can be anticipated in diagnosing acromegaly? a. Growth hormone suppression test b. Complete metabolic panel c. Complete blood count d. 3‐hour glucose tolerance test  GIGANTISM Before Puberty Over secretion of GH CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION GH Suppression Test MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Tumor MEDICATION Tissue Pituitary IRRADIATION Hormones NURSING IMPLICATIONS Early Increased growth rates Identification 2 percentile deviation Emotional Self‐Image support Provide understanding Patient Understanding the condition Teaching Regular follow‐up with Endocrinologist PROGNOSIS Life span is longer Still less than average CHECK ON LEARNING When comparing acromegaly and gigantism, what is the difference between the two diagnosis?  DWARFISM GH deficiency Height below 3rd percentile CLINICAL MANIFESTATIONS ASSESSMENT Subjective Objective DIAGNOSTIC EVALUATION RADIOGRAPHIC STUDIES MRI / CT SCAN OF PITUITARY PLASMA LEVELS OF GH GENETIC TESTING MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL MEDICATION Tumor GH Hormones NURSING IMPLICATIONS Early Decreased growth rates Identification Behaviors that can indicate tumor Emotional Parents may feel guilty support Age‐appropriate clothing Patient Understanding the condition Teaching Emphasize abilities and strengths PROGNOSIS Life span is normal Unless poor management of complications CHECK ON LEARNING The following characteristics will be seen in patients with dwarfism. a. Child is a great deal shorter than peers but proportionate b. Sexual development is usually normal, but delayed c. May produce normal offspring d. All the above CHECK ON LEARNING What is considered a definitive diagnosis? a. Decreased plasma levels of growth hormones b. Increase in plasma levels of growth hormones c. Both a decrease and an increase of growth hormones d. None of the above CHECK ON LEARNING What patient teaching is important prior to the lab tests? a. Patient must remain NPO after midnight b. Can have PO beverages but not solid food c. Does not have to remain NPO after midnight d. Must limit PO intake to water only CHECK ON LEARNING The school nurse is taking height and weight measurements for all children at the beginning of the school year. Measurements for one of the students shows a deviation over two percentile levels from the median. What should the nurse do? a. Call the parents and ask about the child’s birth weight and height b. Contact the parents and suggest they take the child to the health care provider c. Recheck the child’s height and weight once a month for the next several months d. Track the child’s growth over time and compare findings to siblings and classmates  DIABETES INSIPIDUS (DI) Metabolic Disorder of the Pituitary gland Decreased production of ADH CLINICAL MANIFESTATIONS ASSESSMENT SUBJECTIVE OBJECTIVE DIAGNOSTIC EVALUATION CLINICAL MANIFESTATIONS LABORATORY TESTS CT SCAN MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL HORMONE NONE REPLACEMENT LIMIT CAFFEINE IV FLUIDS NURSING IMPLICATIONS Due to electrolyte imbalance, frequent Risk for Injury trips to the bathroom Falls assessment Fluid Volume Excessive urine output deficit Assess for dehydration Patient Medical alert tag Teaching Do not limit fluids PROGNOSIS Depends on the cause With treatment patient may live a normal life  SIADH (Syndrome of Inappropriate Antidiuretic Hormone) Continuous release of ADH CLINICAL MANIFESTATIONS ASSESSMENT SUBJECTIVE OBJECTIVE DIAGNOSTIC EVALUATION Serum osmolality Urine specific gravity MEDICAL / SURGICAL MANAGEMENT MEDICAL SURGICAL Fluid Resection restriction Hypertonic IV Radiation solution Medications Chemotherapy NURSING IMPLICATIONS R/t decreased urinary output Fluid Volume Daily weight, I&O, monitor labs, fluid restriction, restrict overload salt Potential for R/t fluid restriction of 500/day Compromised Oral Frequent oral care, avoid alcohol‐based mouthwash, mucus membranes divide the fluid allotment i.e.; 250 ml in morning, 150 in evening, and 100 for the night Understands treatment plan Patient Teaching Signs and Symptoms of SIADH PROGNOSIS Potentially dangerous but treatable Early diagnosis and medical treatment improve prognosis CHECK ON LEARNING Which patient has the greatest risk for developing SIADH? a. Has malignant cancer b. Has dormant tuberculosis c. Suffered head trauma d. Received opioid medication CHECK ON LEARNING SIADH is potentially dangerous but treatable. If signs and symptoms are recognized early and intervention is appropriate, the prognosis is good. What happens if the treatment is withheld? CHECK ON LEARNING List three symptoms of water intoxication CHECK ON LEARNING The main purpose of ADH in the body is to regulate water balance. Using the statement water follows sodium, if the pituitary releases too much ADH, then the following clinical manifestations would be: a. Hyponatremia b. Hemodilution c. Fluid overload d. All the above without peripheral edema CHECK ON LEARNING A person who suffers from inappropriate secretion of ADH will not manifest symptoms until the sodium reaches what level? a. 140 mEq/L b. 135 mEq/L c.