Ch 49 disorders of anterior pituitary Flashcards
condition characterized by overproduction of GH from a tumor. can cause gigantism in children. can lead to hyperglycemia and vision changes
acromegaly
treatment options acromegaly (3)
- hypophysectomy
- radiation
- drug: octreotide
why is hyperglycemia common with acromegaly
growth hormone blocks action of insulin, causing glucose intolerance and S+S of diabetes
assessment findings acromegaly (6)
- change in ring size, hat size
- joint pain
- change in facial features
- organomegaly
- hypertension
- deepening of voice
treatment of choice for acromegaly
hypophysectomy
important nursing considerations for pts after hypophysectomy surgery (4)
- avoid vigorous coughing, sneezing and blowing nose
- avoid bending over
- avoid use of toothbrushes until incision heals
- keep hob atleast 30 degrees
what puts pt at higher risk for developing meningitis after hypophysectomy surgery
(fluid with glucose >30=) CSF leakage from open connection with brain through nose
what hormones need to be replaced lifelong after hypophysectomy surgery (3)
- ADH
- cortisol
- thyroid
2 potential complications after hypophysectomy surgery
diabetes insepidus
meningitis
possible causes SIADH (3)
- head injury
- cancer
- anesthesia
S+S SIADH (7)
- less urine output (INCREASED URINE OSMOLALITY)
- dilutional hyponatremia
- muscle cramps
- pain
- weakness
- weight gain
- DECREASED BLOOD OSMOLALITY
treatment mild SIADH (3)
- restrict fluid (800-1000 mL/day)
- maybe give furosemide
- maybe give demeclocycline
treatment severe SIADH (2)
- hypertonic IV solution (3%NaCl) at SLOW infusion rate
- restrict fluid (500 mL/day)
treatment chronic SIADH (3)
- give lithium
- hob <10 degrees
- restrict fluid (800-1000 mL/day)
is there too much or too little ADH made in SIADH
too much
how might demeclocycline help with mild SIADH
blocks affect of ADH on renal tubules and results in more dilute urine
how might lithium help with chronic SIADH
blocks hormone production
is there too much or too little ADH made in diabetes insipidus
too little
how does DI effect urine osmolality and blood osmolality
decreases urine osmolality (100-600)
increases blood osmolality
how does SIADH effect urine osmolality and blood osmolality
increases urine osmolality
decreases blood osmolality
three types DI
- nephrogenic (problem with kidneys)
- central (not enough ADH)
- primary (excess water intake)
S+S DI (3)
- hypernatremia
- polydipsia
- nocturia
treatment central DI (3)
- D5W titrated to replace urine output
- DDAVP (or vasopressin - synthetic ADH)
- chlorpropamide (decreases thirst)
hormone replacement of choice for central DI
DDAVP
routes of admin for DDAVP (4)
- po
- IV
- subq
- nasal spray
treatment nephrogenic DI (3)
- low sodium diet
- thiazide diuretics
- indomethacin (NSAID increases renal responsiveness to ADH)
possible causes hypopituitarism (3)
- tumor
- stroke
- autoimmune
condition caused by severe postpartum hemorrhaging that can result in hypopituitarism
sheehan syndrome
very rare total failure of pituitary gland resulting in deficiency in all pituitary hormones
panhypopituitarism
treatment hypopituitarism (2)
- replace hormones (somatropin)
- surgery/radiation
various manifestations of hypopituitarism (4)
- dry and pale skin
- fatigue
- decreased facial hair, muscle mass, libido
- cold intolerance
