NSG410 Exam 4 Blueprint
-Caused by excess growth hormone (GH) secretion, usually from a benign pituitary
adenoma.
Acromegaly: What is it, what causes it, how -Gradual onset; often undiagnosed for years.
do you identify it (p.1305-1306) -Identified by: Enlarged hands, feet, and facial features (coarse features, thickened
lips, protruding jaw);
Joint pain, sleep apnea, hyperglycemia, enlarged organs (heart, liver, lungs)
-GH stimulates bone/muscle growth, protein synthesis, fat metabolism, and decreases
carb metabolism.
Growth Hormone: Function and S/S of
-Hypo: ↓ bone density, ↓ muscle strength, ↑ cholesterol, pathologic fractures
hypo/hyper (p.1304-1306)
-Hyper: Acromegaly symptoms (see above), barrel chest, hyperglycemia, organ
enlargement
-Hormone replacements: Cortisol, thyroid hormone, gonadal hormones, vasopressin
Hypophysectomy: Hormone replacements, if posterior pituitary removed
post-op education (p.1308 & Box 54.3, -Post-op education: Avoid coughing, sneezing, bending at waist (↑ ICP); Use
p.1308) floss/mouth rinse instead of brushing; Monitor nasal drainage for CSF leak (halo
sign); Teach hormone self-administration
-Manifestations: Water retention, dilutional hyponatremia, low urine output, ↑ urine
osmolarity, ↓ serum sodium, bounding pulse, lethargy, seizures
SIADH: Clinical manifestations, -Interventions: Fluid restriction, monitor neuro status, seizure precautions, daily
interventions, suspected orders (p.1310-1311) weights, I&O, oral rinses
-Orders: Hypertonic saline (3% NaCl), vasopressin antagonists (conivaptan,
tolvaptan), diuretics if sodium near normal
-Vasopressin receptor antagonists: Conivaptan (IV), Tolvaptan (oral).
SIADH: Treatment (medications) (p.1310-1311)
-Diuretics (limited use), hypertonic saline, demeclocycline (rarely used)
-Monitor: Serum sodium, neuro status, fluid overload signs (crackles, edema), urine
SIADH: Monitoring and sodium relationship output, weight.
(p.1310-1311) -Sodium: Dilutional hyponatremia due to water retention; sodium loss via kidneys
worsens hyponatremia
, -Manifestations: Polyuria (4–30 L/day), polydipsia, dehydration, hypotension, dry
DI: Clinical manifestations, urine specific mucosa, poor skin turgor
gravity, urine output, BP (p.1309) -Urine specific gravity: <1.005 (very dilute).
-BP: ↓ due to fluid loss; risk for shock if fluids withheld
-Synthetic vasopressin (ADH) replacement for AVP-D (central DI).
Desmopressin: Mechanism and -Routes: Oral, sublingual, subQ, intranasal.
adverse reactions (p.1309) -Adverse reactions: Hyponatremia (seizures, coma), chest tightness, mucosal
ulceration, fluid overload
Difference between SIADH and DI
-Pre-op: Correct electrolyte imbalances (esp. potassium), glucocorticoids given to
Adrenalectomy: Pre-op and post-op prevent adrenal crisis
education, medications (p.1317) -Post-op: Monitor for shock, electrolyte changes, infection; Lifelong hormone
replacement if bilateral adrenalectomy; Temporary replacement if unilateral
-Manifestations: Moon face, buffalo hump, truncal obesity, striae, muscle wasting,
fragile skin, hypertension, hyperglycemia, immunosuppression
Cushing's: Clinical manifestations, nursing
-Interventions: Monitor fluid overload, infection, skin integrity; Drug therapy:
interventions (p.1315-1318 & Box 54.9, p.1315)
Ketoconazole, mifepristone, pasireotide; Nutrition: ↓ sodium, ↑ calcium/protein;
Safety: Fall prevention, skin protection
-Manifestations: Fatigue, weight loss, hyperpigmentation, hypotension, salt craving,
hyperkalemia, hyponatremia
Addison's: Clinical manifestations, nursing
-Interventions: Hormone replacement: Hydrocortisone, prednisone, fludrocortisone;
interventions, diet, potassium, dx (p.1312-
Monitor electrolytes, glucose, cardiac rhythm; Emergency: IV hydrocortisone, fluids,
1314 & Box 54.6, p.131 & Table 54.2, p.1313
glucose, insulin for hyperkalemia
& Box 54.7, p.1314)
-Diet: High sodium, low potassium if hyperkalemic.
-Diagnosis: ACTH stimulation test, cortisol levels, electrolytes
Pituitary adenoma secreting GH
What is the primary cause of acromegaly? Rationale: Acromegaly results from excess GH, typically due to a benign pituitary
adenoma (p.1305)
3 multiple choice options
Which of the following are signs of growth B. Pathologic fractures
hormone deficiency in adults? (Select C. Decreased bone density
all that apply) D. Increased serum cholesterol
A. Increased muscle mass
B.Pathologic fractures Rationale: GH deficiency leads to ↓ bone/muscle strength and ↑ cholesterol (p.1304)
C. Decreased bone density
D.Increased serum cholesterol
E.Hyperglycemia
After a hypophysectomy, which hormone A. Cortisol
replacements are typically required? C. Thyroid hormone
(Select all that apply) D. Estrogen/testosterone
A. Cortisol E. Vasopressin
B.Insulin
C.Thyroid hormone Rationale: These hormones are replaced depending on which pituitary regions are
D.Estrogen/testosterone removed (p.1308)
E. Vasopressin
-Caused by excess growth hormone (GH) secretion, usually from a benign pituitary
adenoma.
Acromegaly: What is it, what causes it, how -Gradual onset; often undiagnosed for years.
do you identify it (p.1305-1306) -Identified by: Enlarged hands, feet, and facial features (coarse features, thickened
lips, protruding jaw);
Joint pain, sleep apnea, hyperglycemia, enlarged organs (heart, liver, lungs)
-GH stimulates bone/muscle growth, protein synthesis, fat metabolism, and decreases
carb metabolism.
Growth Hormone: Function and S/S of
-Hypo: ↓ bone density, ↓ muscle strength, ↑ cholesterol, pathologic fractures
hypo/hyper (p.1304-1306)
-Hyper: Acromegaly symptoms (see above), barrel chest, hyperglycemia, organ
enlargement
-Hormone replacements: Cortisol, thyroid hormone, gonadal hormones, vasopressin
Hypophysectomy: Hormone replacements, if posterior pituitary removed
post-op education (p.1308 & Box 54.3, -Post-op education: Avoid coughing, sneezing, bending at waist (↑ ICP); Use
p.1308) floss/mouth rinse instead of brushing; Monitor nasal drainage for CSF leak (halo
sign); Teach hormone self-administration
-Manifestations: Water retention, dilutional hyponatremia, low urine output, ↑ urine
osmolarity, ↓ serum sodium, bounding pulse, lethargy, seizures
SIADH: Clinical manifestations, -Interventions: Fluid restriction, monitor neuro status, seizure precautions, daily
interventions, suspected orders (p.1310-1311) weights, I&O, oral rinses
-Orders: Hypertonic saline (3% NaCl), vasopressin antagonists (conivaptan,
tolvaptan), diuretics if sodium near normal
-Vasopressin receptor antagonists: Conivaptan (IV), Tolvaptan (oral).
SIADH: Treatment (medications) (p.1310-1311)
-Diuretics (limited use), hypertonic saline, demeclocycline (rarely used)
-Monitor: Serum sodium, neuro status, fluid overload signs (crackles, edema), urine
SIADH: Monitoring and sodium relationship output, weight.
(p.1310-1311) -Sodium: Dilutional hyponatremia due to water retention; sodium loss via kidneys
worsens hyponatremia
, -Manifestations: Polyuria (4–30 L/day), polydipsia, dehydration, hypotension, dry
DI: Clinical manifestations, urine specific mucosa, poor skin turgor
gravity, urine output, BP (p.1309) -Urine specific gravity: <1.005 (very dilute).
-BP: ↓ due to fluid loss; risk for shock if fluids withheld
-Synthetic vasopressin (ADH) replacement for AVP-D (central DI).
Desmopressin: Mechanism and -Routes: Oral, sublingual, subQ, intranasal.
adverse reactions (p.1309) -Adverse reactions: Hyponatremia (seizures, coma), chest tightness, mucosal
ulceration, fluid overload
Difference between SIADH and DI
-Pre-op: Correct electrolyte imbalances (esp. potassium), glucocorticoids given to
Adrenalectomy: Pre-op and post-op prevent adrenal crisis
education, medications (p.1317) -Post-op: Monitor for shock, electrolyte changes, infection; Lifelong hormone
replacement if bilateral adrenalectomy; Temporary replacement if unilateral
-Manifestations: Moon face, buffalo hump, truncal obesity, striae, muscle wasting,
fragile skin, hypertension, hyperglycemia, immunosuppression
Cushing's: Clinical manifestations, nursing
-Interventions: Monitor fluid overload, infection, skin integrity; Drug therapy:
interventions (p.1315-1318 & Box 54.9, p.1315)
Ketoconazole, mifepristone, pasireotide; Nutrition: ↓ sodium, ↑ calcium/protein;
Safety: Fall prevention, skin protection
-Manifestations: Fatigue, weight loss, hyperpigmentation, hypotension, salt craving,
hyperkalemia, hyponatremia
Addison's: Clinical manifestations, nursing
-Interventions: Hormone replacement: Hydrocortisone, prednisone, fludrocortisone;
interventions, diet, potassium, dx (p.1312-
Monitor electrolytes, glucose, cardiac rhythm; Emergency: IV hydrocortisone, fluids,
1314 & Box 54.6, p.131 & Table 54.2, p.1313
glucose, insulin for hyperkalemia
& Box 54.7, p.1314)
-Diet: High sodium, low potassium if hyperkalemic.
-Diagnosis: ACTH stimulation test, cortisol levels, electrolytes
Pituitary adenoma secreting GH
What is the primary cause of acromegaly? Rationale: Acromegaly results from excess GH, typically due to a benign pituitary
adenoma (p.1305)
3 multiple choice options
Which of the following are signs of growth B. Pathologic fractures
hormone deficiency in adults? (Select C. Decreased bone density
all that apply) D. Increased serum cholesterol
A. Increased muscle mass
B.Pathologic fractures Rationale: GH deficiency leads to ↓ bone/muscle strength and ↑ cholesterol (p.1304)
C. Decreased bone density
D.Increased serum cholesterol
E.Hyperglycemia
After a hypophysectomy, which hormone A. Cortisol
replacements are typically required? C. Thyroid hormone
(Select all that apply) D. Estrogen/testosterone
A. Cortisol E. Vasopressin
B.Insulin
C.Thyroid hormone Rationale: These hormones are replaced depending on which pituitary regions are
D.Estrogen/testosterone removed (p.1308)
E. Vasopressin
