ATI: Chapter 77 - Pituitary Disorders Flashcards
The _____ gland (hypophysis) is known as the master gland due to its regulation of many bodily functions.
pituitary
Located underneath the hypothalamus, at the base of the skull, the pituitary gland is regulated by the _______.
hypothalmus
The hypothalamus is divided into two lobes; anterior (_______) and posterior (_______), which secrete regulatory hormones.
adenohypophysis
neurohypophysis
The hormones associated with the posterior pituitary are produced in the ________ and stored in the posterior pituitary, where they are released into the circulation as needed.
hypothalamus
Anterior Pituitary hormones (6)
Thyroid stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH) Luteinizing hormone Follicle stimulating hormone Prolactin Growth Hormone (GH)
FLATPG
Thyroid stimulating hormone stimulates the ______.
thyroid gland
The thyroid stimulating hormone is released from the ______ pituitary gland.
anterior
Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to secrete _________.
glucocorticoids
Luteinizing hormone in women stimulate maturation of ______ and _____.
ova and ovulation
Luteinizing hormone in men stimulate ______.
sperm production
Prolactin stimulates ______ production during lactation.
breast milk
Growth hormone (GH) stimulates protein synthesis and growth of ________
muscle and bone
Posterior pituitary hormones (2)
antidiuretic hormone (ADH) vasopressin Oxytocin (OT)
Antiduiuretic hormone (ADH) (vasopressin): increases re-absorption of water in the ______.
kidneys
Oxytocin (OT) stimulates ______ of uterus following delivery.
contraction
Oxytocin (OT) stimulates ejection of _____ during lactation.
breast milk
Altered function of the pituitary gland can be caused by disease of the pituitary gland or the ________, trauma, tumor, or vascular lesion.
hypothalamus
Hyperfunction or hypofunction of the anterior and posterior pituitary gland can occur ______ of one another.
independently
Over secretion of ACTH from the anterior pituitary gland in results in ________.
Cushing’s disease
Over secretion of GH results in ______ in children and _______ in the adult client.
gigantism
acromegaly
In the adult client, acromegaly manifests as ______ of body parts without affectign the client’s height.
enlargement
Under secretion of GH in children results in ______.
dwarfism
Insufficient secretion of hormones in the anterior pituitary typically affects all the hormones, termed _________.
panhypopituitarism
Panhypopituitarism affects the target organs of the hormones produced in the anterior pituitary, including the thyroid, _______, and gonads.
adrenal cortex
A deficiency of ____ causes diabetes insipidus (DI),
ADH
Diabetes insipidus is characterized by the excretion of a large quantity of _______.
diluted urine
Excessive secretion of ADH causes _______.
SIADH
In SIADH, the ____ retain water, urine output decreases, and extracellular fluid volume is increased.
kidneys
Posterior pituitary disorders result in fluid and ______.
electrolyte imbalances
_______is characterized by excess growth hormone in adults, which causes an increase in size of body parts but not height.
Acromegaly
Manifestations of acromegaly are widespread, including overgrowth of _____; bones of the forehead, jaw, feet and _____; and enlargement of organs including the liver and the heart.
skinhands
If acromegaly is untreated can cause hypertension, _______, and heart problems.
diabetes mellitus
Onset of _____ is gradual and can progress for years before becoming noticeable
acromegaly
Risk Factors for acromegaly
age (adulthood) benign tumors (pituitary adenoma)
Acromegaly expected findings
severe headaches visual disturbances (diplopia, decreased visual acuity) thick lips with coarse facial structures joint pain decreased libido enlarged hands and feet hyperglycemia barrel-shapped chest lower jaw protrusion increasing head size change in voice characteristics change in menstrual pattern sleep apnea increases in intracranial pressure (decreased LOC, pupillary changes, sever hypertension, widened pulse pressure, bradycardia, seizures)
Growth hormone level is measured as a baseline and following administration of _______, typically 0.5 g/kg or 1000 g with a growth hormone suppression test. Elevated glucose levels are expected to suppress GH; however, clients who have ______ will show only a slight decrease or no decrease at all in GH levels.
glucose
acromegaly
For a growth hormone suppression test you need to obtain baseline GH and glucose levels, administer prescribed glucose, obtain GH and blood levels at ____, _____, and _____ minutes after glucose administration.
10, 60, 120 minute
Clients should receive nothing but water for ___ to _____ hours preceding the growth hormone suppression test.
6 to 8 hours
Diagnostic Procedures for Acromegaly (3)
xrays of the skull
CT or MRI of the head
Cerebral angiography
________ identify abnormalities of the sella tircica, the location of the pituitary gland within the skull associated with acromegaly.
x-rays of the skull
______ or _______ of the head identify soft tissue lesions associated with acromegaly.
CT or MRI
__________ is used to evaluate for the presence of vascular malformation or aneurysms with acromegaly.
cerebral angiography
Hypophysectomy is the removal of the _________ through an endoscopic transnasal (most common) or oronasal (transsphenoidal) approach. If these approaches do not provide access to the tumor, a craniotomy is indicated.
pituitary gland
Preop to a hypophysectomy instruct the client not to brush his teeth, blow his nose, or _______ postoperatively. These actions can increase intracranial pressure.
bend at the waist
Prior to hypophysectomy assess ______ related to physical manifestations of disorder.
self-concept
Postoperative to hypophysectomy monitor _______ status.
neurological
Postoperative to hypophysectomy monitor drainage to __________.
mustache dressing (drip pad)
Postoperative to hypophysectomy notify the provider of the presence of glucose in the ________, which is an indication of leakage of cerebrospinal fluid).
drainage
Postoperative to hypophysectomy maintain the client in a _________ position.
high-fowlers
Postoperative to hypophysectomy monitor _______, especially greater output than intake (DI)
fluid balance
Postoperative to hypophysectomy encourage deep breathing exercises, but limit ______ as this increases intracranial pressure and can cause a leak of ________.
coughing cerebrospinal fluid (CSF)
Postoperative to hypophysectomy assess for manifestations of _____.
meningitis.
Postoperative to hypophysectomy administer _______.
replacement hormones
________ (bromocriptine mesylate, cabergoline) inhibit the release of GH.
Dopamine agonists
Instruct the client to notify the provider immediately if _____, dizziness, or watery nasal discharge occurs while taking bromocriptine. This can indicate cardiac dysrhythmia, coronary artery spasms, or _______>
chest pain
leakage of CSF
_______ (octreotide, lanreotide) inhibit GH release.
somatostatin analogs
________ (pegvisomant) prevents GH receptor activity and blocks production of insulin-like growth factor.
growth hormone receptor blocker
_______ therapy shrinks pituitary tumor over a period of time.
radiation
Hormone replacement therapy will be _____ after a hypophysectomy.
lifelong
Avoid activities that increase _______ after a hypophysectomy.
intracranial pressure
Report ______ or increased swallowing after a hypophysectomy.
postnasal drip
Rinse mouth frequently to minimize effects of ________ after a hypophysectomy.
mouth breathing
Use ______ and flossing to clean teeth. Avoid brushing teeth due to risk of trauma to the operative site after a hypophysectomy.
oral rinses
Consume a diet high in fiber to minimize ______ to defecate after a hypophysectomy.
straining
________ results from a deficiency of ADH, which is secreted by the posterior lobe of the pituitary gland (neurohypophysis).
Diabetes insipidus (DI)
Decreased ADH reduces the ability of the distal renal tubules in the kidneys to collect and concentrate urine, resulting in excessive diluted urination, ______, electrolyte imbalance, and excessive fluid intake.
excessive thirst
Types of Diabetes Insipidus
Primary
Secondary
Nephrogenic
Drug-Induced
______ diabetes insipidus is a lack of ADH production or release; caused by defects in the hypothalamus or pituitary gland.
primary
_____ diabetes insipidus is a lack of ADH production or release; caused by infection, tumors, in or near the hypothalamus or pituitary gland, _______, or brain surgery.
Secondary
head trauma
________ diabetes insipidus is inherited; renal tubules do not react to ADH.
nephrogenic
_________ diabetes insipidus is when lithium carbonate or demeclocyline can alter the way the kidneys respond to ADH.
drug-induced
Clients who have a head injury, tumor or lesion, surgery or irradiation near or around the pituitary gland or infection (meningitis, encephalitis) are risk factors for _______.
diabetes insipidus
Clients who are taking _______ or demeclcycline are at risk for diabetes insipidus.
lithium carbonate
Older adult clients are at higher risk for dehydration due to lower water content of the body, decreased thirst response, decreased ability of the __________, increased use of diuretics, swallowing difficulties, or inadequate food intake. (Risk factor for DI)
kidneys to concentrate urine
An expected finding of DI includes ______ (abrupt onset of excessive urination, urinary output of 4 to 30 L/day of dilute urine): failure of the renal tubules to collect and reabsorb water.
polyuria
An expected finding of DI is _______, excessive thirst, consumption of 2 to 20 L/day.
polydipsia
Other expected findings of DI includes fatigue, nocturia, and ______.
dehydration
An expected finding of DI is dehydration, as evidenced by extreme thirst, weight loss, _____, headache, constipation, and dizziness.
muscle weakness
Physical assessment findings of Diabetes Insipidus
Sunken eyes tachycardia hypotension loss or absence of skin turgor dry mucous membranes dry mucous membranes weak, poor peripheral pulses decreased cognition
With DI there will be an electrolyte imbalance such as increased ______.
sodium
With DI the urine chemistry is very _______>
diluted
With DI there will be a decreased urine specific gravity, less than _____.
1.005
With DI there will be decreased urine osmolality, less than ______ mOsm/L.
200
With DI there will be decreased urine pH, sodium, and _____.
potassium
As urine volume increases with DI, urine osmolality _______.
decreases
The serum chemistry of a patient with DI will be ________.
concentrated
Pts with DI have increased serum osmolality, greater than _____ mOsm/L.
300
Pts with DI have increased serum potassium and _______.
sodium
Serum volume decreases, the serum osmolaltiy increases with pts with ______.
DI
The _______ is positive for DI if the kidneys are unable to concentrate urine despite increased plasma osmolarity.
water deprivation test (ADH simulation test)
For DI patients obtain a baseline weight, vital signs, serum electrolytes and osmolarity, and _______ and osmolarity.
urine specific gravity
With DI pts monitor _____ vital signs, urine specific gravity, osmolarity, and body weight.
hourly
Discontinue a water deprivation test (ADH stimulation test) if the client has more than a 2kg body weight loss and ____.
rehydrate
Monitor for the early indications of _______ with the water deprivation test that include postural hypotension, tachycardia, and ______.
dizziness
When a pt is have a water deprivation test (ADH stimulation test) explain the test to the client and advise the client to report any ______, headache, or nausea.
dizziness
A subq injection of _____ produces urine output with an increased specific gravity if the client has central diabetes inspdidus.
vasopressin
Administer vasopressin subq and obtain a urine sample for osmolality ____to ____ after administration.
30 to 60 minutes
Explain the test procedure to the client with a vasopressin test. Advise the client to notify the nurse of any dizziness, ____, or nausea.
headache
With Di monitor vital signs, _____, central venous pressure, I&O, specific gravity, and lab studies (potassium, sodium, BUN, creatinine, specific gravity, osmolarity).
urinary output
A DI pt should be weighed _____.
daily
Promote the prescribed diet (regular diet with restriction of foods that exert a ______, such as caffeine) with DI patients.
diuretic effects
IV therapy: Hydration (I&O must be matched to prevent dehydration) and ________ replacement for DI.
electrolyte replacement
With DI patients promote safety: keep bedside rails up while client is in bed, and provide assistance with _______ due to dizziness or muscle weakness. Ensure easy access to a bathroom or bedpan.
ambulation
With Di patients add bulk foods and fruit juices to the diet if constipation develops. A _______ might be needed.
laxative
With DI patients assess skin turgor and ______.
mucous membranes
With DI patients provide skin and mouth care, and apply a lubricant to cracked or sore lips. Use a soft toothbrush and _________ to avoid trauma to the oral mucosa. Use alcohol free skin care products, ane apply emollient lotion baths.
mild mouthwash
Encourage a DI client to ______ in response to thirst.
drink fluids
Desmopressin, which is a _________, or aqueous vasopressin administered intranasally, orally, or parentally for the treatment of DI.
synthetic ADH
The use of ________, a synthetic ADH for DI patients, results in increased water absorption from kidneys and decreased urine output.
desmopressin
With ADH replacement medications, desmopressin or aqu, patients, monitor vital signs, urinary output, central venous pressure, I&O, specific gravity, and lab studies (potassium, sodium, ______, ______, specific gravity, osmolarity).
BUN
creatinine
Doses of desmopressin or aquaeous vasopressin can be adjusted depending on ______.
urine output
Give vasopressin cautiously to clients who have coronary artery disease because the medication can cause _________.
vasoconstriciton
Monitor for headache, confusion, or other indications of _________ with ADH replacement agents.
water intoxication
ADH replacement agents
desmopressin
aqueous vasopressin
Educate the DI client regarding ______ self administration of vasopressin therapy.
lifelong
For an intranasal dose of ADH replacement agents, teach the client to ________ and sit upright prior to inhalation.
clear nasal passage
Instruct the client to monitor weight daily and notify the provider of a gain greater than _______ in 24 hours with ADH replacement agents.
0.9 kg (2 lbs)
Instruct the client to ______ if directed and notify the provider of headache or confusion with ADH replacement agents.
restrict fluids
DI patients may require, home assistance for fluid, medication, and ______ might be required.
dietary managment
With DI patients instruct the client on medications for _____.
home use
Instruct the client to weight daily, eat a ______ diet, wear medical alert wristband and monitor fluid (I&O) with DI patients.
high fiber
Teach the client to monitor for indications of _______ (weight loss, dry cracked lips, confusion, weakness) with DI patients.
dehydration
Advise the client to restrict fluids as prescribed to prevent water intoxication, and avoid consumption of ______ with DI patients.
alcohol
Untreated DI can cause ______, hyperosmolarity, hypernatremia, circulatory collapse, unconsciousness, central nervous system damage, and seizures.
hypovolemia
Excessive urine output from DI can cause severe dehydration with can lead to _____.
complications
Monitor fluid blance and prevent dehydration by providing ______ with DI.
fluids
Advise the clients to seek early medical attention for any indications of ______ and follow care instructions.
DI
SIDAH or Schwartz-Bartter syndrome, is an excessive release of ADH, also known as vasopressin, secreted by the ______ lobe of the pituitary gland (neurophypophysis).
posterior
Excess ADH leads to renal reabsorption of water and suppression of __________, causing renal excretion of sodium leading to water intoxication, cellular edema, and _______.
renin-angiotensin mechanism
dilutional hyponatremia
Fluid shifts within _______ causes decreased serum osmolarity wtih SIADH.
compartments
Conditions that stimulate the hypothalamus to hypersecrete ADH include malignant tumors, increased intrathoracic pressure (such as with positive pressure ventilation), head injury, ______, stoke, tb, and medications (chemo agnaents, TCAs, SSRIs, opiods, fluoroquinolone antibiotics)
meningitis
Early manifestations of SIADH include headache, weakness, anorexia, _______, and weight gain (without edema because water, not sodium is retained).
muscle cramps
As the serum sodium level decreases with SIADH, the client experiences ________, hostility, sluggish deep tendon reflexes, nausea, vomiting, diarrhea, and ________ with dark yellow concentrated appearance.
personality changes
oliguria
Confusion, lethargy, and _______ respirations herald impending crisis with SIADH. When the serum sodium levels drops further, seizures, _____, and death can occur.
Cheyne Stokes
coma
With SIADH, manifestations of fluid volume excess include tachycardia, boundign pulses, possible hypertension, crackles in lungs, distended neck veins, ______, and weight gain without edema. Intake is greater than output.
taut skin
With SIADH the urine chemistry is _______ and the blood chemistry is _____..
concentrated
diluted
With a urine lab for SIADH there is a _______ in the sodium and osmolarity.
icnrease
As urine volume decreases with SAIDH, urine osmolarity _____.
increases
Decreased serum sodium with SIADH results in ________.
dilutional hyponatremia
Decreased serum osmolarity with SIADH results in less ________.
270 mEq/L
As serum volume ______ with SIADH, serum osmolarity decreases.
increases
Restrict oral fluids to _____ to ______ mL/day to prevent further hemodilution (first priority). During fluid restriction, proivde comfort measures for thirst, such as mouth care, ice chips, ______, and staggered water intake.
500 to 1000 mL/day
lozenges
Flush all enteral and gastric tubes with 0.9% sodium chloride, instead of water to replace the ______ and prevent further hemodilution with SIADH patients.
sodium
For SIADH, monitor I&O. Report _____ output.
decreased
Monitor vital signs for increased _______, tachycardia, and hypothermia with SIADH patients.
bp
Ausculate lung sound to monitor for _________ (can develop rapidly and is a medical emergency) with SIADH patients.
pulmonary edema
Monitor for decreased serum sodium/osmolarity and elevated ______ with SIADH patients.
urine sodium/osmolarity
With SIADH patients weigh the clients daily. A weight gain of ______ indicates a gain of 1 L of fluid. Report this to the provider.
1 kg or 2.2 lbs
Report altered _______ (headache, confusion, lethargy, seizures, coma) with SIADH patients.
mental status
Reduce _____ and position the client as needed with SIADH patients.
environmental stimuli
Provide safe environment for clients who have altered levels of consciousness with SIADH patients and maintain ______.
seizure precautions
Monitor for indications of _____, which can occur from fluid overload with SIADH. Use a loop diuretic can be indicated.
heart failure
Unlabled use of tetracycline derivatives (demeclocyline) is to correct _______ by stimulating urine flow with SIADH.
fluid and electrolyte imblances
Tetracycline derivative (demeclocycline) is contraindicated in clients who have impaired _____.
kidney function
Monitor for effective treatment with tetracycline derivatives (demeclocyline), such as increased ______ and decreased __________.
increased serum sodium/osmolarity
decreased urine sodium osmolarity
Instruct the client to avoid taking demecloycline at the same time as _____, _____, magnesium supplements, antacids containing aluminum, or milk products.
calcium, iron
Advise the client to monitor for indication of a _____, such as a white, cheese like film inside of the mouth with the use of tetracylcine derivatives (demeclocyline)
yeast infection
Advise the client to avoid prolonged exposure to sunlight. Protective clothing should be worn with _______.
tetracycline derivatives (demeclocyline)
Instruct the client to notify the provider if _____ develops with tetracycline derivative (demeclocyline).
diarrhea
Vasopressin antagonists (tolvapatan, conivapatan) promote water excretion without causing _____.
sodium losses
With vasopressin antagonists administration should be initiated in the acute care setting. Monitor blood glucose, serum sodium, intake and output, and _______.
bowel patterns
Advise the client to perform frequent _____ when taking vasopressin antagonists.
oral care
Instruct the client to monitor for indications of _________, such as weakness with the use of vasopressin antagonists.
dehydration
Loop diuretics (furosemide) is used to increase water excretion from the ____.
kidneys
Use loop diuretics with caution because loop diuretics cause _______ excretion and can worsen hyponatremia.
sodium
Advise the client to ______ slowly in case of postural hypotension with the use of loop diuretics.
change positions
Advise the client to notify the provider of findings of hyponatremia, such as nausea, _______, and vomitting when taking loop diuretics.
decreased appetite
Medications to treat SIADH (3)
tetracylcine derivative (demeclocyline)
loop diuretics (furosemide)
vasopressin antagnoists (tolvaptan, conivaptan)
A therapeutic procedure for SIADH is giving _______ via IV to elevate the sodium level enough to alleviate neurologic compromise.
hypertonic sodium chloride
In severe hyponatremia/water intoxication, administration of ____ to _____ mL hypertonic IV fluid (3 to 5% sodium chloride.
200 to 300 mL/
Monitor for fluid overload and _______ when giving hypertonic sodium chloride IV fluid with SIADH patients.
heart failure
When giving a patient hypertonic sodium chloride IV fluid explain the procedure, advise the client to report difficulty _____ or ________, which can indicate heart failure.
breathing or SOB
Include information about meds and ______ instructions with hypertonic sodium chloride IV fluid.
discharge
Instruct the client to obtain daily weights, wear a _____, and restrict fluid intake when giving hypertonic sodium chlorid IV fluids.
medical alert bracelet
Advise the client to monitor for indications of hypervolemia (weight gain, difficulty breathing) and any __________ (tremors, disorientation) which can lead to seizures.
neurological changes
Advise the client to notify the provider of indications of hyponatremia, such as nausea, decreased appetite and ________ with hypertonic sodium chloride IV fluid.
vomitting
Advise the client to avoid consumption of ____ when have hypertonic sodium chloride IV fluids.
alcohol
Home care can be required for fluid, medication, and _______ with SIADH patients.
dietary mangement
Without prompt treatment, SIADH can lead to these complication, which can result in coma or death; water intoxication, __________, and severe hyponatremia
cerebral/pulmonary edema
With SIADH complications monitor for early manifestations of water intoxication such a lung crackles, _______ frequently, seizure precautions, serum sodium level, and administer meds as prescribed.
neurologic status
Instruct the client and family about fluid restrictions and offer information about the condition and ______ .
treatment
Provide support to ease the client’s _____ with complications of SIADH.
fears
Treatment for SIADH can result in central pontine myelinolysis characterized by _______ that is caused by the destruction of the myelin sheath in the brainstem (pons).
nerve damage
The most common cause of central pontine myelinolysis (SIADH complication) is a rapid changed in _____ levels in the body. This most commonly occurs when a client is being treated for hyponatremia and the sodium levels rise to fast.
sodium
During treatment with a vasopressin antagonist, hypertonic saline, or loop diuretics, ______ and serum sodium should be monitored every 2 to 4 hours. Report any deterioration in ________ status immediately with central pontine myelinolysis.
plasma osmolarity
A nurse is caring for a client who has syndrom of inapporpriate antidiurectic hormone (SIADH). Which of the following findings should the nurse expect?
A. Decreased serum sodium B. urine specific gravity 1.001 C. serum osmolarity 230 D. Polyuria E. Increased thirst
A Decreased serum sodium
C serum osmolarity 230
A nurse is assessing a client for diabetes insipidus. The nurse should expect which of the following findings?
Increased hematocrit
Urine specific gravity greater than 1.030 is caused by an _____ in the secretion of ADH.
increase
Increased thirst is an expected finding in a client who has _______.
diabetes insipidus
A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis lab findings should the nurse anticipate?
A. absence of glucose
B. decreased specific gravity
C. presence of ketones
D. Presence of red blood cells
B. decreased specific gravity
Ketones in the urine is indicative of ______.
diabetes mellitus
Red blood cells int eh urine is indicative of ______.
diabetes mellitus
Glucose in teh urine is indicative of ______.
diabetes mellitus
A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching?
A. I can drink up 2 quarts of fluid a day
B. I will need to use insulin to control my blood glucose levels.
C. i should expect to gain weight during this illness
D. Muscles weakness is a symptom of DI
D. Muscles weakness is a symptom of DI
Weight ___ is a manifestation of diabetes insipidus.
loss
A nurse is planning care for a client who has acromegaly and is postoperative following a transphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan?
A. maintain the client in low folwers position
B.Encourage deep breathing and coughing
C. Encourage the client to brush his teeth when awake and alert.
D. Observe dressing drainage for the presence of glucose.
D. Observe dressing drainage for the presence of glucose. (glucose indicates the presence of CSF)
A nurse is planning care for a client who has acromegaly and is postoperative following a transphenoidal hypophysectomy. What position should he be in?
high fowlers
______ should be limited in the client who is postoperative, as this increases ICP and can cause a CCSF leak.
coughing
______ teeth can cause a leak of CSF and is contraindicated.
brushing teeth
