Endocrine - Disorders of pituiatry/ADH Flashcards
Hyperpituitarism is ____ of the _____ pituitary gland, resulting in over-secretion of _____ or more _____ pituitary hormones.
- Hyperfunction
- Anterior pituitary gland
- One or more anterior pituitary hormones.
2 causes of hyperpituitarism?
- Over-activity
* Adenoma (tumor)
What are 3 findings that can be seen with pituitary tumor?
- Bilateral hemianopia (disturbances of outter half of visual fields of both eyes)
- headaches
- increased ICP
3 Diagnostic tests that are used to visualize pituitary gland in ____?
- X-ray, MRI, CAT SCAN
* Visualize pituitary gland in sella turcica
An example of hyperpituitarism with overproduction of GH. What is this called in children and what is this called in adults?
- Children - gigantism
* Adults - Acromegalia
In gigantism, extreme ____, when over secretion occurs ____epiphyseal closure. What will be seen?
- Extreme Height
- BEFORE epiphyseal closure
- Musculo-skeletal deformities
Acromegalia occurs ______ closure of ______. Enlargement of bones in ____, ___, and ____. What will the face look like? What may this person have difficulty doing?
- AFTER closure of epiphyseal
- Enlarged bones in Skull, Hands, and feet
- Face will be coarse and heavy with heavy lips and large tongue
- Dysphagia - difficulty swallowing
What is a GH inhibitor used to treat Acromegalia? Two other treatments?
- Octreotide
* Irradiation of pituitary and Hypophysectomy
What is a hypophysectomy?
When is this indicated?
- Partial or total removal or the pituitary gland
* pituitary tumors or other cancers
Most common approach to hypophysectomy is ______. Incision is made in _____ and ____, the _____ is entered through ____ and ____ sinuses.
- Transsphenoidal
- incision made in Inner aspect of upper lip and gingival
- Sella turcica is entered through
- Nose and sphenoid sinuses
Postop hypophysectomy, nurse should observe for target ___- _____, such as _____ insufficiency, _____thyroid, and ____ _____.
- Observe for target organ insufficiency.
- Adrenal insufficiency
- Hypothyroid
- Diabetes Insipidus
what two labs/numbers should be monitored for postop hypophysectomy complications? What does these signify?
- I/O - Greater than 800cc/2hours
- Specific gravity less than 1.005
- Diabetes insipidus
Patient positioning after transsphenoidal hypophysectomy? Why?
- Head of bed elevated 30 degrees
* Decreases headache, pressure on sella turcica.
Postop transsphenoidal hypophysectomy, What are 2 signs and symptoms of CSF drainage? What should be done if tested positive for glucose? Nursing interventions?
- Clear drainage from nose or postnasal drip (constant swallowing).
- If positive for glucose, send sample to lab for beta-2-transferrin test
- Elevate head of bed and call doctor.
If pituitary gland is totally removed:
- Client will have permanent _______.
- _____follow-up & hormone replacement of ____, ____, and _____ . Wear ______.
- Permanent diabetes insipidus
- Lifelong hormone replacement - THYROID, CORTISONE, SEX HORMONES
- Wear medic alert bracelet
5 causes of hypopituitarism
- Tumor
- Trauma
- Surgical removal
- Irradiation
- Congenital
Treatment for hypopituitarism?
Fertility? Growth?
- Replacement hormones
- FSH/LH - gonadotrophins
- Somatropin given for dwarfism
Two signs of assessed in hypopituitarism if tumor present?
- Bitemporal hemianopia
* Headach
When there is dehydration ____ is _____?
ADH IS RELEASED
When there is overhydration ___ is _____
ADH is inhibited
Alcohol ____ release of ADH. Results in what?
- Inhibits ADH
* Increased urine production and dehydration.
Antidiuretic Hormone acts on the _____to ____.
ADH is also called ______.
- ADH acts on kidneys to reabsorb water
* Vasopressin
ADH deficiency, results in _____. Characterized by excessive____ and ____. This is known as what? Who is this more common in?
- DECREASED water absorption
- Excessive thirst and urination
- DIABETES INSIPIDUS
- more common in males
A NEUROGENIC cause of diabetes insipidus is?
*Hypofunction of POSTERIOR pituitary gland (trauma, familial, tumor, infeciton)
A NEPHROGENIC cause of diabetes insipidus?
*Decreased ability of kidneys to respond to ADH and concentrate urine.
Assessment findings of DI - GI/GU? 3 things.
- Polydipsia
- Polyuria (5-25 liters/24 hours)
- Constipation
Assessment findings of DI - Vital signs? 2 things.
- Tachycardia (can progress to shock)
* Elevated temp from dehydration
Assessment findings of DI - skin - 3 things
- Dry Skin
- Poor Skin turgor
- Dry Mucous membranes
Assessment findings of DI - Neuro - 3 things
- Dizziness
- Weakness
- Fatigue/loss of sleep from constant urination
(all related to dehydration)
What will a plasma screening show in a client with DI? 2 things.
- Hypernatremia (Na not being excreted)
* Hyperosmolality (increased particles in blood)
What will a Urine screening show in a client with DI? 2 things
- Dilute specific gravity w/ value below 1.005 (low concentration)
- Decreased Urine osmolality
test used to screen for DI that involves not drinking any liquid for several hours to see how your body responds. What will be seen if client has DI?
- Water deprivation test
- if water deprived, normally adh would be increased and only small amounts of concentrated urine would be released..In DI, client would have polyuria of unconcentrated urine due to lack of ADH.
What is the purpose of an ADH evaluation? What levels would be seen?
- Differentiates cause of DI
- Neurogenic - ADH level decreased
- Nephrogenic - ADH level increases (urine is more concentrated)
What are two treatments used for ADH hormone replacement? How are they administered and which one is for prolonged activity?
- Vaspopressin - (pitressin) - Given IM
* Desmopressin (DDAVP) - Given intranasally - prolonged activity
What are three nursing interventions for DI?
- IV fluid replacement
- Monitor I+O
- Monitor Daily Weight
Excessive ADH secretion, which leads to ____ is known as ____.
- FLUID RETENTION
* SIADH
4 causes of SIADH?
- Head trauma/increased ICP
- Tumors
- Infection
- Malignant tumor cells
6 s/s of SIADH
- Decreased Urine output
- Decreased Deep tendon reflexes
- Fatigue
- Headache
- Nausea
- Anorexia
A client with SIADH may be placed on ____ restrictions.. What type of Fluid can be given if ordered? How and why?
- Fluid restrictions
- Hypertonic fluid such as 3% saline can be given intravenously (AND SLOWLY). This pulls water from overly hydrated cells.
What are 3 signs of fluid retention that may be seen in SIADH?
- Crackles
- Weight Gain
- Distended jugular veins
What are two serum values that can be looked at for SIADH and what will they look like?
- Hyponatremia - below 135
* Hyposmolality - Below 275 (normal range is 275-295)
4 things the nurse should monitor in a client with SIADH?
- Vitals
- I+O
- Elytes
- Daily weights
What type of precautions should a client with SIADH be placed on and why?
- Seizure precautions
* Hyponatremia can cause seizures and coma.
