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Transcript
Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders Keith Rischer RN, MA, CEN 1 Today’s Objectives… Compare and contrast pathophysiology & manifestations of pituitary/adrenal gland dysfunction. Identify, nursing priorities, and client education associated with pituitary/adrenal gland dysfunction. Interpret abnormal laboratory test indicators of pituitary/adrenal gland dysfunction. Analyze assessment to determine nursing diagnoses and formulate a plan of care for clients with pituitary and adrenal gland dysfunction. Describe the mechanism of action, side effects and nursing interventions of pharmological management with pituitary and adrenal gland dysfunction. 2 Patho: Endocrine System Endocrine glands • • • • • • Pituitary glands Adrenal glands Thyroid glands Islet cells of pancreas Parathyroid glands Gonads Hormones • Negative feedback mechanism 3 Patho: Pituitary Gland Anterior • • • • • Growth hormone Thyroid Stimulating Hormone (TSH) Adrenocorticotropic Hormone (ACTH) Follicle Stimulating Hormone (FSH) Luteinizing Hormone (LH) Posterior • Vasopressin Antidiuretic hormone (ADH) 4 Anterior Hypo-pituitarism Causes • Tumor • • • Brain or pituitary Anorexia Shock Growth hormone Gonadatropins • chart 66-1 p.1459 Women Men TSH ACTH 5 Anterior Hypo-pituitarism Labs • • T3, T4 Testerone, estradiol levels Nursing interventions • Replacement of deficient hormones Androgen therapy – gynecomastia can occur Estrogens and progesterone Growth hormone • Assess function of target organ thyroid 6 Anterior Hyper-pituitarism Causes • Pituitary tumors or hyperplasia Gigantism Acromegaly 7 Hypophysectomy Post op Care • Closely monitor neuros • Assess for postnasal drip “halo sign” • Avoid coughing early after the surgery. • Keep HOB elevated • Assess for meningitis • Replace hormones and glucocorticoids as needed • Diabetes insipidus Assess I&O closely first 24 hours 8 Posterior Pituitary Gland: Diabetes Insipidus Patho • Antidiuretic hormone • deficiency Water unable to be reabsorbed 9 Diabetes Insipidus: Clinical Manifestations CV • • • Renal • Dramatic increased u/o Skin • Tachycardia Hypotension Heme concentration Dry mucous membranes Neuro • • • Thirst Irritable Lethargy to unresponsive 10 Diabetes insipidus: Interventions Nursing Diagnostic Statements • • Priorities • • Deficient fluid volume r/t… Decreased cardiac output r/t… Early detection dehydration Maintain adequate hydration Desmopressin acetate (DDAVP) intranasally • • Synthetic vasopressin I&O-daily weights 11 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Patho • Vasopressin (ADH) • Water retained Increased Dilutional hyponatremia Causes • • • • Cancer Infection Chemo agents COPD 12 SAIDH:Clinical Manifestations Fluid retention • Neuro • • • Lethargy HA Altered LOC CV • Hyponatremia Tachycardia Renal • u/o decrease 13 SAIDH: Nursing Interventions Nursing diagnostic priorities • • Fluid restriction Drug therapy • • Decreased cardiac output r/t… Fatigue Diuretics Hypertonic saline (3%) Neurologic assessment • • Orientation Safe environment 14 Adrenal Glands Patho • • • Aldosterone Cortisol Catecholamines Epinephrine – Beta receptors Norepinephrine – Alpha receptors • Deduced aldosterone levels Hyperkalemia – acidosis Hyponatremia – hypovolemia 15 Adrenal Glands: Hypofunction Acute adrenal insufficiency • • Addisonian crisis Causes Steroids stopped abruptly Clinical manifestations • • Muscle weakness, fatigue, constipation Hypoglycemia • • Diaphoresis, tachy, tremors Blood volume depletion Hyperkalemia cardiac arrest-rhythm changes 16 Addison’s Disease: Interventions Promote fluid balance and monitor for fluid deficit. • Careful I&O • Record weight daily Assess vital signs every 1 to 4 hours, assess for dysrhythmias or postural hypotension. Monitor laboratory values • Na • K • Glucose Cortisol and aldosterone replacement therapy Diet - ↑ sodium, ↓ potassium, ↑ Carbs 17 Adrenal Gland: Hyperfunction Patho Pheochromocytoma Cushing’s syndrome • Causes Primary/secondary malignancies Steroids • • Lymphocytes Inflammatory/immune response 18 Cushing’s Disease: Clinical Manifestations Obesity • Changes in fat distribution Facial hair for women Thin skin Blood vessels fragile Acne Immunosupression HTN • Moon face Water/sodium retention Lab changes • • • • Glucose WBC Sodium Potassium 19 Nursing Priorities Excess fluid volume r/t… Risk for infection r/t… Deficient knowledge 20 Medical Management Drug therapy • • Mitotane If caused by side effect of medication try to decrease or change meds Radiation therapy • Pituitary tumors 21 Cushings: Surgical Management Total hypophysectomy Adrenalectomy Preoperative care • Correct lyte imbalances Postoperative care • • • Prevent skin breakdown Pathologic fractures Education regarding lifelong steroid use Take with meals Never skip doses Weigh daily 22