Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med Surg 2 > pituitary disorders > Flashcards

pituitary disorders Flashcards

1
Q

disorders caused by

A
  • Disease of the pituitary gland or the hypothalamus
  • Trauma
  • Tumor
  • Vascular lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

acromegaly

A

Hypersecretion of growth hormone (GH) that occurs after puberty.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

key features of acromegaly

A
  • Enlargement of skeletal extremities, height, shoe size
  • Protrusion of jaw
  • Headaches, visual problems, blindness
  • Muscle weakness
  • Organ enlargement: will fall overtime
  • more stress of body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

acromegaly medications

A

Octreotide (Sandostatin)-synthetic GH
Parlodel (Permax)- dopamine agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

thereaputic measures for acromegaly

A
  • Surgical removal of pituitary gland; surgery is generally the first treatment option.
  • Replacement therapy will be needed following removal of the pituitary gland and may need needed following radiation therapy
    + Corticosteroids
    +Thyroid hormones
  • Radiation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dwarfism

A

Hypersecretion of GH during fetal development or childhood that results in limited growth congenital or result from damage to the pituitary gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does dwarfism look like

A
  • Head and extremities are disproportionate to torso
  • Face may appear younger
  • Short stature, slow or flat growth rate
  • Progressive bowed legs and lordosis
  • Delayed adolescence or puberty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

diagnostic procedure for dwarfism

A
  • Comparison of height/weight against growth charts, slowed growth rate will be noted
  • Serum growth hormone level
    +Most providers will also evaluate other hormonal levels to ensure that no secondary deficiencies exist
    + MRI of the head (to assess pituitary gland)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

deficiency of ADH causes

A

diabetes insipidus (DI).
- DI is characterized by the excretion of a large quantity of diluted urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Excessive secretion of ADH causes

A

the syndrome of inappropriate antidiuretic hormone (SIADH).
- In SIADH, the kidneys retain water, urine output decreases, and extracellular fluid volume is increased.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Posterior pituitary disorders result in

A

fluid and electrolyte imbalances.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diabetes insipidus

A

Caused from a deficiency of ADH
- Reduces the ability of the distal renal tubules in the kidneys to collect and concentrate urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DI results in

A
  • Excessive diluted urination: looks like water
  • Excessive thirst:dry on inside
  • Electrolyte imbalance
  • Excessive fluid intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk Factors of Diabetes Insipidus

A
  • Head injury
  • Tumor or lesion
  • Surgery or irradiation near or around the pituitary gland
  • Infection
    + Meningitis
    + Encephalitis
  • Patients who are taking lithium carbonate or demeclocycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

two main clinical findings

A

polyuria
polydipsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DI polyurina

A

a- brupt 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Di polydipsia

A

excessive thirst
consumption of 2 to 20 L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clinical findings DI

A

Nocturia: voiding at night
Sunken eyes
Tachycardia
Hypotension
Loss or absence of skin turgor
Dry mucous membranes
Weak, poor peripheral pulses
Weight loss, muscle weakness
Headache, Dizziness, Fatigue
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Urine chemistry: DI

A

Think DILUTE.
- Decreased urine specific gravity (less than 1.005)
- Decreased urine osmolality (less than 200 mOsm/L)
- Decreased urine pH
- Decreased urine sodium
- Decreased urine potassium

As urine volume increases, urine osmolality decreases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DI: serum chemistry

A

Think CONCENTRATED

  • Increased serum osmolality (greater than 300 mOsm/L)
  • Increased serum sodium
  • Increased serum potassium
  • As serum volume decreases, the serum osmolality increases.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

diagnsotic test for posterior pituitary gland include

A
  • The water deprivation test
    +Monitor body weight, hourly urine output.
  • ADH
  • Serum and urine electrolytes and osmolality
  • Urine specific gravity
  • MRI of hypothalamus and pituitary
  • 24-hour urine
22
Q

water deprivation

A

The expected reference range for osmolality is 285 to 295 mOsm/kg H2O.

Osmolality increases with dehydration and decreases with over hydration, so it provides important information about fluid and electrolyte balance.

23
Q

contraindications for water deprivation

A
  • Renal insufficiency
  • Uncontrolled diabetes mellitus
  • Hypovolemia
  • Adrenal or thyroid hormone deficiency
24
Q

vasopressin test

A
  • This is an easy and reliable diagnostic test.
  • Dehydration is induced by withholding fluids.
  • A subcutaneous injection of vasopressin produces urine output with an increased specific gravity and osmolality.
  • The test is positive for DI if the kidneys are unable to concentrate urine despite increased plasma osmolarity.
25
Q

nursing implications for vasopressin

A
  • Obtain baseline weight
  • Serum electrolytes, osmolarity, and urine specific gravity (as ordered)
  • Monitor hourly vital signs, urine specific gravity, osmolarity, and body weight.
  • Discontinue the test and rehydrate the client for a loss of more than 2 kg in body weight.
  • Monitor for severe dehydration.
  • Early indications of dehydration can be postural hypotension, tachycardia, and dizziness.
  • Be prepared to discontinue the test if these indicators develop.
26
Q

di medications

A
  • Desmopressin acetate (DDAVP): could need for life
  • Vasopressin (Pitressin)
  • If DI is nephrogenic in origin, thiazide diuretics will be prescribed.
27
Q

di medications for pt. education

A
  • Lifetime vasopressin replacement therapy
  • Report weight gain or loss, polyuria, or polydipsia to the provider
  • Monitor fluid intake and urine output
  • Avoid foods with diuretic action: caffeine
28
Q

A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse anticipate?
A. Absence of glucose
B. Decreased specific gravity
C. Presence of ketones
D. Presence of red blood cells

A

B

29
Q

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 to 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 “Muscle weakness is a symptom of diabetes insipidus.”

A

D

30
Q

SIADH: Syndrome of Inappropriate Antidiuretic Hormone

A

Excessive release of ADH, also known as vasopressin, secreted by the pituitary gland.

31
Q

SIADH results in

A

inability to excrete an appropriate amount of urine thus developing fluid retention and dilutional hyponatremia.

32
Q

siadh leads to

A

Leads to renal reabsorption of water causing renal excretion of sodium leading to:
- water intoxication
- cellular edema
- dilutional hyponatremia

33
Q

siadh risk factors

A

Malignant tumors
Increased intrathoracic pressure
Head injury
Meningitis
Stroke
Tuberculosis

34
Q

siadh risk medications

A

chemotherapy agents
SSRIs
Opioids
antibiotics

35
Q

siadh early manifestations

A
  • Headache: increase in cebral pressure
  • Weakness
  • Anorexia: not wanting to eat
  • Muscle cramps
  • Weight gain
36
Q

siadh physical assessment findings

A
  • Confusion
  • Lethargy
  • Cheyne-Stokes respirations
    When the serum sodium level drops further, seizures, coma, and death can occur
37
Q

siadh: manifestations of fluid volume excess

A

Tachycardia
Bounding pulses
Possible hypertension
Crackles in lungs
Distended neck veins
Taut skin
Intake is greater than output.

38
Q

siadh urine chem

A

Think CONCENTRATED
- Increased urine sodium
- Increased urine osmolarity
- As urine volume decreases, urine osmolarity increases

39
Q

siadh blood chem

A

Think DILUTE
- Decreased serum sodium (dilutional hyponatremia)
- Decreased serum osmolarity (less than 270 mEq/L)
- As serum volume increases, serum osmolarity decreases

40
Q

siadh nursing care fluids and vitals

A
  • Restrict oral fluids to 500 to 1,000 mL/day to prevent further hemodilution (first priority)
  • During fluid restriction, provide comfort measures for thirst
  • Flush all enteral and gastric tubes with 0.9% sodium chloride, instead of water, to replace sodium and prevent further hemodilution
  • Monitor I&O
  • Report decreased urine output
  • Monitor vital signs for increased blood pressure, tachycardia, and hypothermia
    -Auscultate lung sounds to monitor for pulmonary edema (can develop rapidly and is a medical emergency)
41
Q

siadh nursing care

A
  • Monitor for decreased serum sodium/osmolarity and elevated urine sodium/osmolarity
  • Weigh the patient daily
    A weight gain of 1 kg (2.2 lb) indicates a gain of 1 L of fluid. Report this to
    the provider
  • Report altered mental status
  • Reduce environmental stimuli and position as needed
  • Provide a safe environment
  • Maintain seizure precautions
  • Monitor for indications of heart failure, which can occur from fluid overload.
  • Use of a loop diuretic can be indicated.
42
Q

siadh meds

A
  • Tetracycline derivative (demeclocycline)
    Unlabeled use to correct fluid and electrolyte imbalances by stimulating urine flow
    Contraindicated in impaired kidney function.
  • Vasopressin antagonists (tolvaptan, conivaptan)
    Promote water excretion without causing sodium losses
  • Loop diuretic (furosemide)
    Used to increase water excretion from the kidneys
43
Q

siadh nursing considerations for vasopressin

A

Administration initiated in the acute care setting.
Monitor blood glucose levels.
Monitor serum sodium levels.
Monitor intake and output.
Monitor bowel patterns.

44
Q

siadh furosemide nursing considerations

A

Use with caution because loop diuretics cause sodium excretion and can worsen hyponatremia.

45
Q

siadh: hypertonic sodium chloride

A

In severe hyponatremia/water intoxication, administration of 200 to 300 mL hypertonic IV fluid (3% to 5% sodium chloride).
Monitor for fluid overload and heart failure (distended neck veins, crackles in lungs).

46
Q

pt. ed w siadh

A
  • Advise the patient to report difficulty breathing or shortness of breath
  • Include information about medications with discharge instructions
  • Advise the patient to monitor for indications of hypervolemia and any neurological changes, which can lead to seizures.
  • Advise the patient to notify the provider of indications of hyponatremia
  • Advise the patient to avoid consumption of alcohol.
47
Q

siadh complications

A

water intoxication
cerebral/pulmonary edema
severe hyponatriemia

48
Q

siadh nursing actions

A

Monitor neurologic status frequently
Maintain seizure precautions
Administer medications as prescribed
Monitor serum sodium level
Monitor for early manifestations of water intoxication

49
Q

Monitor for early manifestations of water intoxication

A
  • Lung crackles
  • Distended neck veins
  • Changes in neurological state (confusion, headaches, twitching, disorientation)
  • Edema
  • Decreased urinary output
50
Q

A nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse expect?
(Select all that apply.)
A. Low sodium
B. High potassium
C. Increased urine osmolality
D. High urine sodium
E. Increased urine specific gravity

A

a,c,d,e

Med Surg 2 (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions