Medical Surgery Endocrine 1

Medical Surgery Endocrine 1 Glucose over 250 and higher are at risk for? - Answer- DKA Hypopituitarism - Answer- 1. Hypo-secretion of 1 or more pituitary hormones caused by tumors, trauma, encephalitis, autoimmunity or stroke 2. Often effected growth hormone (GH) and gonadatrophic hormones, but thyroid-stimulating hormone (TSH), (ACTH), (ADH) may be involved. Hypopituitarism Assessment - Answer- a. Mild to moderate obesity b. Reduced cardiac output c. Infertility, sexual dysfunction d. Fatigue, low blood e. Tumors of the pituitary also cause headaches aches and visual disturbances Hypopituitarism Interventions - Answer- a. Client may need hormone replacement for the specific deficient hormones b. Provide emotional support to the client and family c. Encourage the client and family to express feelings related to disturbed body image ir sexual dysfunction d. Client education is needed regarding the signs and symptoms of hypofunction and hyperfunction related to insufficient or excess hormone replacement. Hyperpituitarism (acromegaly) - Answer- Hypersecretion of growth hormone by anterior pituitary gland in an adult; cause primarily by pituitary tumors Hyperpituitarism Assessment - Answer- a. Large hands and feet b. Thickening and protrusion of the jaw c. Arthritic changes and joint pain, impingement syndromes d. Visual disturbances f. oily, rough skin g. Organomegaly h. HTN, atherosclerosis, cardiomegaly, heart failure i. Dysphagia j. Deepening of the voice k. Thickening of the tongue, narrowing of the airway, sleep apnea l. Hyperglycemia m. Colon polyps, increased colon cancer Hyperpituitarism Interventions - Answer- a. Provide pharmacological interventions to suppress GH or block GH action b. Prepare the client for radiation of the pituitary gland c. Prepare the client for hypophysectomy if planned d. Provide pharmacological and nonpharma. interventions for joint pain e. Emotional support to the client and family, and encourage the client and family and encourage the client and family to express feelings related to disturbed body image Hypophysectomy - Answer- Removal of a pituitary tumor via craniotomy or sublanial transsphenoidial(endoscopic or transnasal) approach (the latter approach is preferred b/c it is associated w/ fewer complications Craniotomy Complications - Answer- Increased intracranial pressure, bleeding, meningitis and hypopituitarism Sublabial transsphenodial surgery complications - Answer- Cerebrospinal fluid leak, infection, diabetes insipidus and hypopituitarism Sublabial Surgery - Answer- An incision made along the gum line of the inner upper lip Hypophysectomy Post op care interventions - Answer- 1.Monitor vital signs vital signs, neurological status and level of consciousness 2.Elevate the head of the bed 3. Monitor for increased inter cranial pressure 4. Monitor for signs of DI monitor I and O 5. Clients may need long term ADH, thyroid and cortisol replacement therapy 6. Watch for meningitis and infection 7. Administer antibiotics, analgesics and antipyretics 8. Oral rinses as prescribed no toothbrush for 10 days to 2 weeks 9. Watch for signs of over treatment 10. Instruct client to wear medic alert. Diabetes Insipidus - Answer- 1. Hypo-secretion of ADH by the posterior pituitary gland, can be caused by stroke, trauma or surgery, or it may be idiopathic. 2. Kidney tubules fail to reabsorb water 3. In nephrogenic ADH production is adequate but kidneys do not respond appropriately to ADH DI Assessment - Answer- a. Excretion of large amounts of dilute urine b. Polydipsia c. Dehydration d. Inability to concentrate urine e. Low USG. normal 1.003-1.030 f. Fatigue g. Muscle pain and weakness h. headache i. Postural hypotention that may progress to vascular collapse w/o rehydration j. Tachycardia Interventions for DI - Answer- a