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Module 4 (MedSurg 2) > Pituitary Gland > Flashcards

Pituitary Gland Flashcards

1
Q

Functions of the Endocrine System

A

Maintain & regulate vital functions
Response to Stress and Injury
Growth & development of children and genes
Energy metabolism
Balance of fluids, electrolytes, and acid-base

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2
Q

During stress blood glucose

A

rises

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3
Q

Risk Factors for Overall Endocrine Disorders

A

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

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4
Q

General Assessment for Endocrine Health Information

A

Past history
Meds
surgery and tx (radiation)
exposure to toxins - FARMS,-CIDES, dust

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5
Q

Physical Assessment

A

VS
Skincare (wt distribution changes)
Ht and Wt
Mental and emotional status
Head-to-toe assessment
Photographs show overtime changes

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6
Q

If the confusion is not caused by a UTI, then try

A

thyroid levels

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7
Q

Endocrine r/t aging
Assessments for Metabolism

A

low cold tolerance
low appetite
low HR and BP

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8
Q

Endocrine r/t aging
Assessments for LOW ADH

A

dilute urine with low fluid intake

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9
Q

Endocrine r/t aging
Assessments for LOW ESTROGEN

A

LOW bone density
skin dry, thin, fragile

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10
Q

Nursing Actions r/t Aging Endocrine

A

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

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11
Q

Where is the pituitary gland located?

A

directly below the hypothalamus

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12
Q

The hypothalamus produces what to the pituitary?

A

releasing hormones

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13
Q

The pituitary gland is known as the

A

“master gland”

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14
Q

The posterior pituitary gland secretes

A

ADH (Vasopressin)
Oxytocin

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15
Q

The anterior pituitary gland secretes

A

GH
ACTH (adrenocorticosteroids)
TSH leading to T3 and T4
FSH and LH (testosterone, estrogen, and progesterone)
Prolactin

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16
Q

The hypothalamus, pituitary gland, and organs are a part of a

A

feedback loop

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17
Q

Anterior Pituitary Disorders

A

Acromegaly
Dwarfism
Cushing Syndrome and Disease

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18
Q

Acromegaly

A

Abe Lincoln and James Bond villians old movies
Large hands and feet size due to pituitary tumor making too much GH

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19
Q

Dwarfism

A

pedi mainly
lack of GH

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20
Q

Cushing’s Syndrome

A

occurs when your body makes too much cortisol, a hormone related to the body’s stress response.
- fatty hump, moon face, straie

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21
Q

Posterior Pituitary Disorders

A

Diabetes Insipidus (DI)
SIADH

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22
Q

Excessive Anterior Pituitary Disorders

A

Acromegaly
Cushing’s Disease (type of syndrome)
-excess ACTH impacts the adrenal glands

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23
Q

Deficiency Anterior Pituitary Disorders

A

Dwarfism
Hypopituitarism

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24
Q

Excessive Posterior Pituitary Disorders

A

SIADH

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25
Q

Deficiency Posterior Pituitary Disorders

A

DI

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26
Q

SIADH

A

increase the release of ADH
- leads to H2O excess
- Low Na

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27
Q

SIADH level of ADH

A

Increases

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28
Q

SIADH level of water

A

excess (water intoxication)

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29
Q

SIADH level of Na

A

low: Hyponatremia Dilutional
(diluted from excess water)

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30
Q

Causes of SIADH

A

Pituitary surgery
Head injury
CVA
recent infection
Malignant tumors secrete ADH independently

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31
Q

What malignant tumors secrete ADH independently?

A

Lung
Pancreas
Hodgkin’s lymphoma

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32
Q

What secretes ADH on its own without the pituitary gland?

A

Malignant tumors (lung, pancreas, Hodgkin’s lymphoma)

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33
Q

SIADH S/S

A

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

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34
Q

SIADH is represented by

A

Spongebob in salt water
- arms and legs are smaller compared to the middle

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35
Q

What is hyponatremia s/s

A

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

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36
Q

SIADH Labs
Urine osmolality
Serum Osmolality
Hct, BUN, Na

A

high urine Osm. and specific gravity
low serum osm., Hct, BUN, Na

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37
Q

SIADH Mgmt

A

fluid restriction 800-1000 mL (severe 500)
give IV or PONa slowly
Diuretics
Vasopressin antagonist
Labs

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38
Q

What assessments/monitoring needs to be done when managing SIADH?

A

VS, Cardiac &Neuro
Daily wt, I&Os

39
Q

What safety precautions need to be taken when managing SIADH?

A

confusion (Fall bundle)
seizure (side laying, suction, and pads)

40
Q

What medications are going to be given to a SIADH pt?

A

Vasopressin antagonist (Declomycin - demeclocycline)
Diuretic (Lasix - furosemide)
Sodium - PO/IV
Fluid restrictions including frozens to 800-1000

41
Q

If on fluid restriction severe?

A

500 mL

42
Q

Declomycin is a

A

vasopressin antagonist

43
Q

If the SIADH is caused by a tumor, what is the treatment options for them?

A

radiation
surgery

44
Q

When should you call a doctor about weight gain?

A

2 lbs in a day
5 lbs in a week
2 lbs = 1 kg = 1000mL = 1L of fluid added

45
Q

Nursing problems with SIADH mgmt

A

altered thought process
fatigue
nutrition = less than required
knowledge deficit teach and reteach

46
Q

Education for SIADH

A

Medications - Na slowly rise
Report wt gains
Fluid restrictions (include IV meds, ice cream, ice, and popsicles)
Daily wt

47
Q

Nurses need to evaluate for SIADH

A

compliance
cognition teaching
Labs normal
wt and fluids monitored
No seizures

48
Q

What does the urine of a SIADH look like?

A

thick
concentrated
sticky on the floor
LOW OUTPUT

49
Q

DI is a disorder of what pituitary gland

A

posterior

50
Q

DI relationship with ADH

A

LOW

51
Q

DI has __________ water loss through ________

A

excessive; polyuria

52
Q

The primary cause of DI

A

malfunction of the posterior pituitary

53
Q

The secondary cause of DI
MOST COMMON

A

trauma
CNS infection
recent CVA
surgery
CA - lung, breast

54
Q

Nephrogenic causes of DI

A

Kidneys are resistent to ADH
(electrolytes, medications, and genetics)

55
Q

What medication causes DI?

A

Lithium

56
Q

DI Assessment

A

low fluid vol
polyuria 4-30 L looks clear w/ water
polydipsia

57
Q

Does reducing the intake of DI pt affect the reduction in urine output?

A

no

58
Q

Labs for DI

A

LOW urine SG and osmolality
HIGH serum Na and osmolality
SLUDGE BLOOD

59
Q

What restrict needs to be in place for DI

A

SALT

60
Q

What is the major difference between DI and DM?

A

DI loses fluids not fat
extra peeing
clothes too big

61
Q

DI Testing

A

fluid deprivation test
plasma ADH levels and osmolality
urine osmolality (urine vs serum)
synthetic vasopressin trial

62
Q

Fluid deprivation Test

A

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

63
Q

DI Mgmt

A

Identify & correct the underlying cause
Fluid & electrolyte balance
Replace ADH – DDAVP (neurogenic DI)
Surgery – if pituitary problem

64
Q

Monitor what in DI mgmt

A

VS
CV (hypovolemia sue to heart problems)
NEURO
WT

65
Q

Labs needed for DI mgmt

A

electrolytes
serum vs urine osmolality

66
Q

What drugs do you give a DI pt?

A

ADH (Vasopressin)
DDAVP (Desmopressin acetate)

67
Q

Vasopressin main goal

A

renal conservation of water

68
Q

Vasopressin is used in

A

DI
Vasodilatory shock
Nocturnal enuresis

69
Q

Vasopressin adverse effects

A

vasoconstriction and increase BP
H/A
chest pain
water intoxication - overdose

70
Q

Vasopressin contraindicated

A

chronic renal failure

71
Q

Vasopressin monitoring

A

BP, HR EKG
I&O - urine osmolality
dehydration vs. fluid overload

72
Q

Vasopressin Teachings

A

no alcohol
med alert ID
Limit fluid intake

73
Q

DDAVP is

A

desmopressin acetate

74
Q

DDAVP main goal

A

decrease output and increase urine osmolality

75
Q

DDAVP used for

A

neurogenic DI
nocturnal enuresis

76
Q

If a pedi has nocturnal enuresis, what drug would you give them?

A

DDAVP

77
Q

DDAVP adverse effects

A

erythema of injection site, nasal irritation, hyponatremia (seizure), does not raise BP

78
Q

DDAVP contraindications

A

no concurrent use of loop diuretics or glucocorticoids
Hold if creatinine clearance < 50 mL/min

79
Q

DDAVP monitor

A

I&O, urine and serum osmolality
daily wt

80
Q

DDAVP assessments

A

hypovolemia
hypervolemia

81
Q

DDAVP Teachings

A

no alcohol
med alert bracelet
administer (IV, SQ, nasal spray)

82
Q

DI nursing problems

A

fluid volume deficit
low cardiac output
knowledge deficit teach and reteach
risk of skin tear, constipation, injury

83
Q

What is the mascot of DI?

A

Cali raisins
shriveled up leads to skin breakdown and constipation
high concentrated blood

84
Q

DI education

A

Medications
Symptoms to report
fluid balance
daily wt

85
Q

DI Evaluation

A

med admin
labs
wt baseline
monitor output
skin turgor

86
Q

DI mnemonic
“How dry I am”

A

Dry
I&O, daily wt
Low specific gravity
Urinates lots
Treat = ADH, DDAVP
rEhydrate
DILUTE URINE (water)

87
Q

What surgery is used for pituitary tumors?

A

Transsphenoidal pituitary surgery
- Hypophysectomy

88
Q

Hypophysectomy is the

A

removal of pituitary glands
no scarring through the nose

89
Q

Hypophysectomy Major Risks

A

stroke
- vision loss
- meningitis
- CSF leak
- DI - can be permanent in 2-5% and treated by medication

90
Q

Hypophysectomy Post-Op

A

HOB greater than 45
Monitor for I&Os, electrolytes, osmolality
Incision PACKING monitor for spinal fluid
D/C Teaching

91
Q

D/C teaching of Hypophysectomy

A

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

92
Q

What is the halo effect?

A

cerebrospinal fluid drainage around the blood in circles
-dipstick for BG +
ICP activity monitoring for 1 month

93
Q

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

A

b)Drowsiness, listlessness, and headache

risk for water intoxication

Module 4 (MedSurg 2) (36 decks)

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