Week Seven Modules Flashcards
the anterior pituitary hormone produces which hormones?
the posterior pituitary hormone produces what hormone?
adreno-corticoid hormone (ACTH) and thyroid stimulating hormone (TSH)
vasopressin/ anti-diuretic hormone
what is the job of both the pituitary and adrenal glands?
secrete hormones for cellular regulation of the entire body as well as fluid and electrolyte balance
what is the main function of the anterior pituitary?
what is the main function of the posterior pituitary?
regulates growth, metabolism, and sexual development
secretes vasopressin which helps to maintain fluid and electrolyte imbalance
what is the main function of the adrenal gland hormones?
provide life sustaining assistance
issues with the anterior pituitary can cause what kinds of diseases?
if the patient is experiencing cushing’s disease this means there is _____ levels of cortisol
if the patient is experiencing addison’s disease this means there is ____ levels of cortisol
addison’s disease and cushing’s disease
high
low
what is the etiology of cushing’s disease?
cushing’s disease means that there is anterior pituitary _____
how are adenomas classified?
most common cause is a pituitary adenoma (tumor)
hyperfunction
classified by the hormone that is secreted
what are some common s/s we’d expect to see with cushing’s disease?
elevated plasma cortisol levels, weight gain, truncal obesity, “moon face”, and loss of bone density
what are some nursing interventions for cushing’s disease?
first, you’ll want to do an assessment of the complicating conditions such as CV, DM, and infections
monitor VS, daily weight, and glucose
emotional support –> due to appearance changes such as truncal obesity
when it comes to providing emotional support for your patient, you’ll want to remember
patients may feel ____ or _____
remain _____ to the patient’s condition
offer _____ and unconditional acceptance
unattractive; unwanted
sensitive
respect
what are some expected diagnostic tests for a patient who has been diagnosed with cushing’s disease?
chem 7 (especially Na+, K+, and glucose); 24 urine tests, serum cortisol level, and dexamethasone suppression test
what are the normal ranges for serum cortisol?
what are the normal ranges for the dexamethasone suppression test?
at 8 am: normal ranges are from 5 - 23 mcg/dL
at 4pm: normal ranges are from 3 - 13 mcg/dL
low dose: >50%
high dose: same as above
how can we surgically manage cushing’s disease due to anterior pituitary hyperfunction?
before any of these surgical procedures occur what might the patient’s pre-op teaching consist of?
hypophysectomy; trasnphenoidal approach or transnasal approach; if tumor cannot be reached, then craniotomy
teach the patient about mustache dressing (dri pad placed under the nose), do not cough, brush teeth (oral rinse is okay), bend over, or blow your nose
what does post-op care look like for a patient who has cushing’s disease?
assess VS, assess congestion and mental status, assess the OR site and observe for drainage, teach drug plan, and teach the patient to report any s/s of hyperpituitarism
addison’s disease = _______
what is the etiology of addison’s disease?
adrenocortical insufficiency
all 3 classes of adrenal corticosteriods are reduced and these patients also have low cortisol levels
addison’s disease may cause things like _____ or lack of pituitary ACTH _____
up to 80% of addison’s disease cases are due to an _______ response
ACTH deficiency; secretion
autoimmune
what is the function of ACTH?
what are some functions of androgens?
regulate the levels of cortisol which is released by the adrenal glands
in women, androgen plays a key role in the hormonal cascade that starts puberty;
regulates the function of bone, liver, kidneys, and muscle
name some functions of cortisol
controls blood sugar levels, regulates metabolism, reduces inflammation, assists with memory, and has a controlling effect on the salt/water balance
what are some signs and symptoms of addison’s disease?
has a slow onset, symptoms are not evident until 90% of the adrenal cortex is destroyed, anorexia, nausea, progressive weakness, bronze colored skin, and salt craving
what are some nursing interventions for addison’s disease?
life long hormone therapy (glucocorticoids & mineralcorticoids); monitor the patient while correcting fluid and electrolyte imbalances; take VS and blood sugar; and guard the patient against infection
another nursing intervention we want to be agile about is making sure we obtain _____ and monitor _____
daily weights; intake/output
what does the patient teaching plan look like for an individual who has been diagnosed with addison’s disease?
educate the patient about the need for lifelong replacement therapy, lifelong medical supervision, prevention of infection, prevent falls, and wear a medication alert ID bracelet
another important teaching tip we might want to mention to a patient with addison’s disease would be what?
always carry an emergency medical kit that contains 100 mg IM (intramuscular) hydrocortisone, syringes, and instructions for use
what are some abnormal lab findings we would expect to see in a patient with addison’s disease?
hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, and anemia
what is an ACTH stimulation test?
a test where base line cortisol and ACTH levels are drawn, patient is given an IV injection of synthetic ACTH, and then cortisol and ACTH levels are rechecked