Pituitary Gland Flashcards
Functions of the Endocrine System
Maintain & regulate vital functions
Response to Stress and Injury
Growth & development of children and genes
Energy metabolism
Balance of fluids, electrolytes, and acid-base
During stress blood glucose
rises
Risk Factors for Overall Endocrine Disorders
Age - usually elderly
Trauma –to an organ or close to endo organs
Heredity
Environmental factors (chemicals, radiation from thyroid)
Consequences of other disorders - COPD, long steroid use
General Assessment for Endocrine Health Information
Past history
Meds
surgery and tx (radiation)
exposure to toxins - FARMS,-CIDES, dust
Physical Assessment
VS
Skincare (wt distribution changes)
Ht and Wt
Mental and emotional status
Head-to-toe assessment
Photographs show overtime changes
If the confusion is not caused by a UTI, then try
thyroid levels
Endocrine r/t aging
Assessments for Metabolism
low cold tolerance
low appetite
low HR and BP
Endocrine r/t aging
Assessments for LOW ADH
dilute urine with low fluid intake
Endocrine r/t aging
Assessments for LOW ESTROGEN
LOW bone density
skin dry, thin, fragile
Nursing Actions r/t Aging Endocrine
Monitor thyroid labs and meds
Layer clothing
nutrition
constipation/diarrhea
altered LOC
Offer fluids every 2 hours (if not contraindicated) due to increased risk for dehydration
handle with care due to injury risk
reposition every 2 hours
moisturize skin
Where is the pituitary gland located?
directly below the hypothalamus
The hypothalamus produces what to the pituitary?
releasing hormones
The pituitary gland is known as the
“master gland”
The posterior pituitary gland secretes
ADH (Vasopressin)
Oxytocin
The anterior pituitary gland secretes
GH
ACTH (adrenocorticosteroids)
TSH leading to T3 and T4
FSH and LH (testosterone, estrogen, and progesterone)
Prolactin
The hypothalamus, pituitary gland, and organs are a part of a
feedback loop
Anterior Pituitary Disorders
Acromegaly
Dwarfism
Cushing Syndrome and Disease
Acromegaly
Abe Lincoln and James Bond villians old movies
Large hands and feet size due to pituitary tumor making too much GH
Dwarfism
pedi mainly
lack of GH
Cushing’s Syndrome
occurs when your body makes too much cortisol, a hormone related to the body’s stress response.
- fatty hump, moon face, straie
Posterior Pituitary Disorders
Diabetes Insipidus (DI)
SIADH
Excessive Anterior Pituitary Disorders
Acromegaly
Cushing’s Disease (type of syndrome)
-excess ACTH impacts the adrenal glands
Deficiency Anterior Pituitary Disorders
Dwarfism
Hypopituitarism
Excessive Posterior Pituitary Disorders
SIADH
Deficiency Posterior Pituitary Disorders
DI
SIADH
increase the release of ADH
- leads to H2O excess
- Low Na
SIADH level of ADH
Increases
SIADH level of water
excess (water intoxication)
SIADH level of Na
low: Hyponatremia Dilutional
(diluted from excess water)
Causes of SIADH
Pituitary surgery
Head injury
CVA
recent infection
Malignant tumors secrete ADH independently
What malignant tumors secrete ADH independently?
Lung
Pancreas
Hodgkin’s lymphoma
What secretes ADH on its own without the pituitary gland?
Malignant tumors (lung, pancreas, Hodgkin’s lymphoma)
SIADH S/S
fluid vol. excess in the belly
Wt gain w/o peripheral edema
H/A, alter LOC, seizure risk
Concentrated amber urine
fatigue, N/V
water intoxication
SIADH is represented by
Spongebob in salt water
- arms and legs are smaller compared to the middle
What is hyponatremia s/s
Seizures and Stupor
Abdominal cramping, attitude confusion
Lethargic
Tendon reflex low
Low urine output
Orthostatic hypotension and overactive BS
Shallow resp. (late due to muscle weakness)
Spasms of muscles
SIADH Labs
Urine osmolality
Serum Osmolality
Hct, BUN, Na
high urine Osm. and specific gravity
low serum osm., Hct, BUN, Na
SIADH Mgmt
fluid restriction 800-1000 mL (severe 500)
give IV or PONa slowly
Diuretics
Vasopressin antagonist
Labs
What assessments/monitoring needs to be done when managing SIADH?
VS, Cardiac &Neuro
Daily wt, I&Os
What safety precautions need to be taken when managing SIADH?
confusion (Fall bundle)
seizure (side laying, suction, and pads)
What medications are going to be given to a SIADH pt?
Vasopressin antagonist (Declomycin - demeclocycline)
Diuretic (Lasix - furosemide)
Sodium - PO/IV
Fluid restrictions including frozens to 800-1000
If on fluid restriction severe?
500 mL
Declomycin is a
vasopressin antagonist
If the SIADH is caused by a tumor, what is the treatment options for them?
radiation
surgery
When should you call a doctor about weight gain?
2 lbs in a day
5 lbs in a week
2 lbs = 1 kg = 1000mL = 1L of fluid added
Nursing problems with SIADH mgmt
altered thought process
fatigue
nutrition = less than required
knowledge deficit teach and reteach
Education for SIADH
Medications - Na slowly rise
Report wt gains
Fluid restrictions (include IV meds, ice cream, ice, and popsicles)
Daily wt
Nurses need to evaluate for SIADH
compliance
cognition teaching
Labs normal
wt and fluids monitored
No seizures
What does the urine of a SIADH look like?
thick
concentrated
sticky on the floor
LOW OUTPUT
DI is a disorder of what pituitary gland
posterior
DI relationship with ADH
LOW
DI has __________ water loss through ________
excessive; polyuria
The primary cause of DI
malfunction of the posterior pituitary
The secondary cause of DI
MOST COMMON
trauma
CNS infection
recent CVA
surgery
CA - lung, breast
Nephrogenic causes of DI
Kidneys are resistent to ADH
(electrolytes, medications, and genetics)
What medication causes DI?
Lithium
DI Assessment
low fluid vol
polyuria 4-30 L looks clear w/ water
polydipsia
Does reducing the intake of DI pt affect the reduction in urine output?
no
Labs for DI
LOW urine SG and osmolality
HIGH serum Na and osmolality
SLUDGE BLOOD
What restrict needs to be in place for DI
SALT
What is the major difference between DI and DM?
DI loses fluids not fat
extra peeing
clothes too big
DI Testing
fluid deprivation test
plasma ADH levels and osmolality
urine osmolality (urine vs serum)
synthetic vasopressin trial
Fluid deprivation Test
WITHHOLD fluid for 8-12 hours
- measure body weight in the beginning and every 2 hours weight again
- if you notice 3-5% body weight loss, then stop test and Dx as DI
Can lose up to 30L in a day
DI Mgmt
Identify & correct the underlying cause
Fluid & electrolyte balance
Replace ADH – DDAVP (neurogenic DI)
Surgery – if pituitary problem
Monitor what in DI mgmt
VS
CV (hypovolemia sue to heart problems)
NEURO
WT
Labs needed for DI mgmt
electrolytes
serum vs urine osmolality
What drugs do you give a DI pt?
ADH (Vasopressin)
DDAVP (Desmopressin acetate)
Vasopressin main goal
renal conservation of water
Vasopressin is used in
DI
Vasodilatory shock
Nocturnal enuresis
Vasopressin adverse effects
vasoconstriction and increase BP
H/A
chest pain
water intoxication - overdose
Vasopressin contraindicated
chronic renal failure
Vasopressin monitoring
BP, HR EKG
I&O - urine osmolality
dehydration vs. fluid overload
Vasopressin Teachings
no alcohol
med alert ID
Limit fluid intake
DDAVP is
desmopressin acetate
DDAVP main goal
decrease output and increase urine osmolality
DDAVP used for
neurogenic DI
nocturnal enuresis
If a pedi has nocturnal enuresis, what drug would you give them?
DDAVP
DDAVP adverse effects
erythema of injection site, nasal irritation, hyponatremia (seizure), does not raise BP
DDAVP contraindications
no concurrent use of loop diuretics or glucocorticoids
Hold if creatinine clearance < 50 mL/min
DDAVP monitor
I&O, urine and serum osmolality
daily wt
DDAVP assessments
hypovolemia
hypervolemia
DDAVP Teachings
no alcohol
med alert bracelet
administer (IV, SQ, nasal spray)
DI nursing problems
fluid volume deficit
low cardiac output
knowledge deficit teach and reteach
risk of skin tear, constipation, injury
What is the mascot of DI?
Cali raisins
shriveled up leads to skin breakdown and constipation
high concentrated blood
DI education
Medications
Symptoms to report
fluid balance
daily wt
DI Evaluation
med admin
labs
wt baseline
monitor output
skin turgor
DI mnemonic
“How dry I am”
Dry
I&O, daily wt
Low specific gravity
Urinates lots
Treat = ADH, DDAVP
rEhydrate
DILUTE URINE (water)
What surgery is used for pituitary tumors?
Transsphenoidal pituitary surgery
- Hypophysectomy
Hypophysectomy is the
removal of pituitary glands
no scarring through the nose
Hypophysectomy Major Risks
stroke
- vision loss
- meningitis
- CSF leak
- DI - can be permanent in 2-5% and treated by medication
Hypophysectomy Post-Op
HOB greater than 45
Monitor for I&Os, electrolytes, osmolality
Incision PACKING monitor for spinal fluid
D/C Teaching
D/C teaching of Hypophysectomy
brushing teeth/oral care
- don’t stretch upper lips
caution activity increases ICP
corticosteroid and thyroid hormone replacement
foley for 48 hours
stool softeners to not strain with constipation
Try if needed to cough/sneeze with your mouth open (avoid an increase of ICP)
no lifting
no bending head bc gravity
What is the halo effect?
cerebrospinal fluid drainage around the blood in circles
-dipstick for BG +
ICP activity monitoring for 1 month
A patient with a urinary creatinine clearance of 55 mL/min is prescribed desmopressin [DDAVP]. It is most important for the nurse to assess the patient for what?
a)Irritability, muscle weakness, and back pain
b)Drowsiness, listlessness, and headache
c)Fever, tachycardia, and hypotension
d)Decreased skin turgor, weight loss, and dry skin
b)Drowsiness, listlessness, and headache
risk for water intoxication
