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adults > hypothalamus/pituitary glands and disorders > Flashcards

hypothalamus/pituitary glands and disorders Flashcards

1
Q

what does the hypothalamus do

A
  • regulates secretion of both anterior and posterior pituitary hormones
  • synthesizes oxytocin and ADH and transports these hormones to posterior pituitary for storage
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2
Q

what are the two pathways from the hypothalamus to the pituitary

A
  • neural stalk: path to the posterior pituitary
  • pituitary portal blood syatem pathway: uses blood flow from hypothalamus to get to the anterior pituitary
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3
Q

what are the three distinct sections of the pituitary

A
  • anterior (adenohypophysis)
  • posterior (neurohypophysis)
  • pars intermedia (little dividing wall, kinda useless)
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4
Q

what are the anterior hormones

A
  • follicle stimulating hormone (FSH)
  • luteinizing hormone (LH)
  • prolactin (PRL)
  • adrenocorticotropic hormone (ACTH)
  • thyroid stimulating hormone (TSH)
  • growth hormone (GH)
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5
Q

what are the posterior pituitary hormones

A
  • vasopressin (ADH)
  • oxytocin
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6
Q

are pituitary tumors slow growing or speedy fast growing

A

slow growing and benign

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7
Q

whats the difference between primary and secondary pituitary tumors

A

primary: actual gland affected
secondary: something else is causing it

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8
Q

whats the difference between a functional and nonfunctional pituitary tumor

A

functional: things work as normal with sx
nonfunctional: shutting off or an excess of hormones

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9
Q

what are some clinical manifestations of pituitary tumors

A

HA, vision changes, endocrine disorders, change in LOC

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10
Q

describe assessment and diagnostic findings for pituitary tumors

A
  • energy level changes, GI issues, strength, skin/hair changes, visual acuity
  • CT, MRI to show tumor
  • check hormone levels
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11
Q

whats used for medical management of pituitary tumors

A

surgery -> anterior or posterior or both

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12
Q

describe hypophosectomy

A
  • done transsphenoidally
  • nose packed after for three days: watch drainage and test for sugar (indicates CSF leak)
  • keep HOB elevated, monitor neuro status, BP, and sugar
  • have to replace cortisol and TH, especially if anterior pituitary taken out
  • monitor for diabetes insipidus
  • deep breathe hourly but dont cough bc you can disturb incision
  • gentle oral care
  • monitor for sx of meningitis (stiff neck, HA, photophobia)
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13
Q

describe the etiology and pathophysiology of hypopituitarism

A
  • deficient secretion of GH, TSH, FSH, LF, and ACTH
  • complication of radiation therapy
  • tumor, congenital defects, pituitary ischemia
  • 75% of gland dysfunctional before symptoms
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14
Q

what are some therapeutic interventions for hypopituitarism

A
  • cortisol replacement
  • thyroid replacement
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15
Q

what are some nursing interventions for hypopituitarism

A
  • monitor for diabetes insipidus
  • monitor for gonadal failure and loss of secondary sex organs
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16
Q

name two posterior pituitary disorders

A
  • diabetes insipidus
  • SIADH
17
Q

describe diabetes insipidus

A
  • deficiency of ADH (inability to conserve water)
  • hypernatremia, cells like raisin bc its all in the bloodstream
  • piss up to 18L/day
  • happens a lot w trauma to the head
18
Q

describe SIADH

A
  • excessive amounts of ADH
  • hold on to fluid
  • cells swell like a grape
  • hyponatremia
19
Q

describe the etiology and pathophysiology of diabetes insipidus

A
  • neurogenic causes: trauma to head, tumor, herpes encephalitis
  • infections of CNS
  • nephrogenic: kidneys arent responding to ADH, no concentrating piss, low specific gravity
  • drugs can cause it: lithium, hypercalcemia, hypothalamus defects
20
Q

what are some clinical manifestations of diabetes insipidus

A
  • CV: hypotension, tachycardia, weak peripheral pulses, hemoconcentration (increased H&H and BUN)
  • renal: increased UO (>250 ml/hr), dilute urine (low specific gravity - 1.001-1.005)
  • integumentary: poor skin turgor, dry mucus membranes
  • neuro: polydipsia, craving cold water, signs of dehydration and hypernatremia (irritability, lethargy to coma, ataxia)
21
Q

whats used in the assessment and diagnostic findings of diabetes insipidus

A
  • fluid deprivation (hold fluids for 8-12 hours)
  • 25hr fluid I+O
  • decreased plasma levels of ADH
  • increased plasma and decreased urine osmolality
  • trial of desmopressin and IV fluids
22
Q

whats used for the medical management of diabetes insipidus

A
  • antidiuretic hormone replacement (DDAVP, pitressin, lipressin)
  • if renal cause: indomethacin and aspirin
  • treat underlying cause if possible
  • give fluids to replace the loss and correct Na+ levels
  • increase oral fluids
  • chlorpropramide (antidiabetic) and thiazide diuretics (makes piss more concentrated)
23
Q

whats included in nursing management of diabetes insipidus

A
  • I&O
  • weigh daily
  • specific gravity of urine
  • monitor fluid and electrolyte status
  • monitor response to ADH replacement
  • educate on proper med techniques (i.e. nasal sprays, injections)
  • advise patient to avoid alcohol because it suppresses ADH secretion
  • wear medical alert bracelet
24
Q

what are some causes/risk factors of SIADH

A
  • disorders of lungs (bronchogenic carcinoma, severe pneumonia, pneumothorax)
  • CNS disorders (head injuries, hemorrhage, brain surgery/tumor, infection)
  • malignant tumors (malignant cells release ADH)
  • meds (vincristine, antidepressants, nicotine, thiazide diuretics)
25
Q

what are some clinical findings associated with SIADH

A
  • HA
  • N/V
  • diarrhea
  • anorexia
  • mental sluggishness
  • changes in LOC - lethargy
  • dminished deep tendon reflexes
  • hyponatremia
  • weight gain
  • VS: increased HR and hypothermia
  • increased specific gravity
26
Q

describe the medical management of SIADH

A
  • treat underlying cause
  • fluid restriction
  • sodium restriction
  • medications like diuretics
27
Q

whats included in nursing care of SIADH

A
  • I&O
  • daily weight
  • fluid restriction
  • urine and blood chemistries
  • monitor neurologic status (high risk for seizures, reduce overstimulation, prevent water intoxication)
  • low sodium -> 3% saline -> pulls water from cells to blood to be excreted

adults (51 decks)

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