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The pituitary glad regulates?
- growth
- metabolism
- pigmentation
- sexual development
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The posterior pituitary secretes _____.
- vasopressin
- AKA antidiuretic hormone ADH
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Surgical removal of the pituitary gland is called _____.
hypophysectomy
- nursing care - watch for postoperative postnasal drip and keep HOB elevated. Watch for the presence of glucose (indicates CSF), it is a light yellow color at the edge of the clear drainage on the dressing called "halo sign"
- teach pt to report postnasal drip
- avoid coughing
- avoid bending from waist-increases ICP
- avoid toothbrushing for 2 weeks
- avoid straining during bowel movement
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Diabetes insipidus is caused by _________.
- ADH deficiency-results in the excretion of lg volumes of dilute urine, leading to polyuria and dehydration.
- pts will have decreased mentation (weak & confused)
- hyponatremia
-
Meds for DI
Desmopressin-synthetic vasopressin is the drug of choice.
-
Syndrome of inappropriate antidiuretic hormone SIADH
In SIADH, vasopressin is secreted even when plasma osmolarity is low or normal
ADH continues to be released evven when plasma is hypo-osmolar. Water is retained, which results in dilutional hyponatremia and fluid overload.
***vasopressin AKA ADH
-
Hyperthyroid
The anterior pituitary released an excess of TSH.
-
Manifestations of Grave's Disease
- Hyperthyroidism causes Grave's Disease
- Goiter
- exophthalmos
- pretibial myxedema-dry front of lower legs
-
Physical manifestations of hypothyroid
- cool pale skin
- dry skin
- dry, brittle hair
- Bradycardia
- hypotension
- decreased basal metabolic rate
- cold intolerance
- slowness or slurring of speech
- lethargy, confusion
- weight gain
- constipation
-
Myexedema coma
treatment?
- Severe hypothyroidism
- Gradually give thyroid hormone IV to replace it.
-
Physical manifestations of hyperthyroid
- thin
- tachycardic
- warm
- heat intollerant
- insomnia
- increased RR
- increased appetite
- diarrhea
- irritability
-
What are you concerned about for a postop thyroidectomy?
- swelling=respiratory distress
- keep a trach at the bedside
- also monitor for bleeding
- thyroid storm
-
Hallmark of hyperthyroidism
heat intolerance
- diaphoresis
- visual changes may be first prob pt notices...esp exopthalmos with Grave's
-
Drug for hypothyroid
levothyroxine
-
What electrolytes will pay close attention to in postop thyroidectomy?
calcium & photphorus balance because these are regulated by the parathyroid glands which could be damaged during a thyroidectomy.
-
What test will be ran for a pt with exopthalmos?
T3 & T4
-
Suspect _____ when a pt presents with a round or puffy face, with a dull expression.
myxedema coma
-
Vitiligo, or patch skin pigment is related to hypofunction of ______
adrenal glands
-
Striae are caused by _______
adrenocortical excess
-
Cushing's disease is causes by ______
hyperpituitarism-ACTH (adrenocorticotropic hormone) release causes excessive production of glucocorticoids, mineralcorticoids, and androgens, leading to cushing's disease.
-
What endocrine condition would you suspect with a pt who has a high fever, tachycardia, and severe hypertension.
- thyroid storm
- Immediately report a temp increase of even 1 degree
- If temp increases assess the pts cardiac status
-
Promoting comfort for thyroid storm
- Reduce stimulation, encourage rest, quiet, limiting visitors, & postponing nonessential care
- Reduce room temp-heat intolerance
- fresh ice water at all times
- change bed linens, diaphoresis
- cool showers
-
Drug therapy for thyroid storm
- Antithyroid drugs
- Preferred drugs are the thionamides (propylthiouracil PTU, methimazole (tapazole))
- These drugs block thyroid hormone production by preventing iodide from binding in the thyroid gland
-
What drug is used to treat hyperthyroid in patients who won't tolerate any other antithyroid drugs?
Lithium-its use is limited because of side effects such as depression, diabetes insipidus, tremors, N&V
-
Numbness and a decreased sense of smell are common after _____
hypophysectomy
-
The key manifestations of diabetes insipidus are _____&______.
Increase in the frequency of urination and excessive thirst.
-
___ is considered if urine output is more than 4L during a 24 hour period
DI-from a deficiency of ADH
-
When DI is severe, ADH is replaced by a synthetic form of vasopresin called _____
desmopressin
-
Suspect ______ with a bounding pulse, increasing JVD, crackles, peripheral edema, reduced urine output.
SIADH
-
In _____ water is retained resulting in dilutional hyponatremia, this leads to fluid overload.
SIADH
-
Adrenal insufficiency is AKA?
Addison's Disease
-
Lethargy, fatigue, muscle weakness, salt cravings, vigilito, N&V, and weight loss are all S&S of _____
Adrenal insufficiency (Addison't disease)
-
Two diseases caused by oversecretion of adrenal hormones are:
Cushing's disease (Syndrome), and hyperaldosteronism
-
Cushing's Disease is caused by the exaggerated secretion of _____ from the adrenal cortex.
cortisol
-
In _______ you will see a buffalo hump, truncal obesity, and moon face.
Cushing's disease
-
Pts with ____ have an increased risk of infection due to a decreased immune function.
Cushing's disease
-
What medications would you ask about with pts who present with Cushing's disease?
glucocorticoid therapy because it is a common cause of hypercortisolism
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