Transcript 401-Pituitary-Adrenal-Glands

Nursing Care & Interventions in
Clients with Pituatary/Adrenal
Gland Disorders
Keith Rischer RN, MA, CEN
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Today’s Objectives…
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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.
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Patho: Endocrine System
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Endocrine glands
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Pituitary glands
Adrenal glands
Thyroid glands
Islet cells of pancreas
Parathyroid glands
Gonads
Hormones
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Negative feedback
mechanism
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Patho: Pituitary Gland
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Anterior
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Growth hormone
Thyroid Stimulating
Hormone (TSH)
Adrenocorticotropic
Hormone (ACTH)
Follicle Stimulating
Hormone (FSH)
Luteinizing Hormone (LH)
Posterior
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Vasopressin
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Antidiuretic hormone
(ADH)
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Anterior Hypo-pituitarism
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Causes
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Tumor
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Brain or pituitary
Anorexia
Shock
Growth hormone
Gonadatropins
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chart 66-1 p.1459
Women
Men
TSH
ACTH
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Anterior Hypo-pituitarism
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Labs
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T3, T4
Testerone, estradiol levels
Nursing interventions
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Replacement of deficient hormones
 Androgen
therapy
– gynecomastia can occur
 Estrogens
and progesterone
 Growth hormone
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Assess function of target organ
 thyroid
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Anterior Hyper-pituitarism
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Causes
• Pituitary tumors or
hyperplasia
 Gigantism
 Acromegaly
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Hypophysectomy
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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
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Assess I&O closely first 24
hours
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Posterior Pituitary Gland: Diabetes
Insipidus
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Patho
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Antidiuretic hormone
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deficiency
Water unable to be
reabsorbed
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Diabetes Insipidus: Clinical Manifestations
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CV
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Renal
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Dramatic increased u/o
Skin
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Tachycardia
Hypotension
Heme concentration
Dry mucous membranes
Neuro
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Thirst
Irritable
Lethargy to unresponsive
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Diabetes insipidus: Interventions
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Nursing Diagnostic Statements
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Priorities
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Deficient fluid volume r/t…
Decreased cardiac output r/t…
Early detection dehydration
Maintain adequate hydration
Desmopressin acetate (DDAVP) intranasally
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Synthetic vasopressin
I&O-daily weights
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Syndrome of Inappropriate Antidiuretic
Hormone Secretion (SIADH)
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Patho
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Vasopressin (ADH)
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Water retained
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Increased
Dilutional hyponatremia
Causes
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Cancer
Infection
Chemo agents
COPD
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SAIDH:Clinical Manifestations
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Fluid retention
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Neuro
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Lethargy
HA
Altered LOC
CV
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Hyponatremia
Tachycardia
Renal
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u/o decrease
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SAIDH: Nursing Interventions
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Nursing diagnostic priorities
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Fluid restriction
Drug therapy
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Decreased cardiac output r/t…
Fatigue
Diuretics
Hypertonic saline (3%)
Neurologic assessment
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Orientation
Safe environment
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Adrenal Glands
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Patho
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Aldosterone
Cortisol
Catecholamines
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Epinephrine
– Beta receptors
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Norepinephrine
– Alpha receptors
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Deduced aldosterone
levels
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Hyperkalemia
– acidosis
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Hyponatremia
– hypovolemia
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Adrenal Glands: Hypofunction
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Acute adrenal insufficiency
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Addisonian crisis
Causes
 Steroids
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stopped abruptly
Clinical manifestations
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Muscle weakness, fatigue, constipation
Hypoglycemia
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Diaphoresis, tachy, tremors
Blood volume depletion
Hyperkalemia
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cardiac arrest-rhythm changes
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Addison’s Disease: Interventions
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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
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Adrenal Gland: Hyperfunction
Patho
 Pheochromocytoma
 Cushing’s syndrome
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Causes
 Primary/secondary
malignancies
 Steroids
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Lymphocytes
Inflammatory/immune response
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Cushing’s Disease: Clinical Manifestations
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Obesity
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Changes in fat distribution
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Facial hair for women
Thin skin
Blood vessels fragile
Acne
Immunosupression
HTN
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Moon face
Water/sodium retention
Lab changes
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Glucose
WBC
Sodium
Potassium
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Nursing Priorities
Excess fluid volume r/t…
 Risk for infection r/t…
 Deficient knowledge
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Medical Management
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Drug therapy
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Mitotane
If caused by side effect of medication
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try to decrease or change meds
Radiation therapy
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Pituitary tumors
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Cushings: Surgical Management
Total hypophysectomy
 Adrenalectomy
 Preoperative care
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Correct lyte imbalances
Postoperative care
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Prevent skin breakdown
Pathologic fractures
Education regarding lifelong steroid use
 Take
with meals
 Never skip doses
 Weigh daily
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