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Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders Keith Rischer RN, MA, CEN.

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Presentation on theme: "Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders Keith Rischer RN, MA, CEN."— Presentation transcript:

1 Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders
Keith Rischer RN, MA, CEN

2 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.

3 Patho: Endocrine System
Endocrine glands Pituitary glands Adrenal glands Thyroid glands Islet cells of pancreas Parathyroid glands Gonads Hormones Negative feedback mechanism Endocrine glands…secrete hormones….hormones are natural chemicals that exert effects on target organs through transport in the blood Includes pituitary, adrenal,thyroid, islet cells of pancreas, parathyyroid glands and gonads Works with nervous system to regulate overall body function and maintain homeostasis…keeping body temp-lytes, glucose in normal range Hormones recognize target tissues and bind to receptor sites on target tissue through a lock and key receptivity Nrgative feedback mech….hormone secretion dependant on need of body for final action of hormone…the secretion of that hormone causes the OPPOSITE action Example-insulin and blood glucose

4 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) Alterations of one or more hormone results in metabolic problems and sexual dysfunction. Growth hormone stimulates the liver to produce substances known as somatomedins that enhance growth activity. Growth hormone Bones and soft tissues…promote growth Thyroid Stimulating Hormone (TSH) Thyroid…stimulate synthesis and release of thyroid hormone Adrenocorticotropic Hormone (ACTH) Adrenal cortex…stimulate synthesis and release of corticosteroids Follicle Stimulating Hormone (FSH) Luteinizing Hormone (LH) Both ovary or testes…men testosterone and sperm production Women ovulation and estrogen secretion Posterior Vasopressin Antidiuretic hormone (ADH)…kidney…promotes water reabsorption

5 Anterior Hypo-pituitarism
Causes Tumor Brain or pituitary Anorexia Shock Growth hormone Gonadatropins Women Men TSH ACTH Usually it is one hormone not global Deficiencies in ACTH, TSH most life threatening due to corresponding decr in adrenal and thyroid glands Growth hormone Decr. Bone density, muscle strength Gonadatropins Women Amenorrhea, anovulation, low estrogen, breast atrophy Men Decr facial hair, decr libido, impotence, reduced muscle mass TSH Decr thyroid levels…weight gain, alopecia, lethargy ACTH Decre cortisol levels…lethargy, anorexia, hypoglycemia, hyponatremia

6 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 Labs Easier to measure the effects of the hormones rather than their actual levels

7 Anterior Hyper-pituitarism
Causes Pituitary tumors or hyperplasia Gigantism Acromegaly Hormone most commonly involved is growth hormone Gigantism is the onset of growth hormone hypersecretion before puberty. Acromegaly is the onset of growth hormone hypersecretion after puberty.

8 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 Hypophysectomy…surgical removal of the pituitary gland…most common treatment for hyperpituitary Incision made in upper lip and access pit. Gland through the sphenoid sinus…nasal packed

9 Posterior Pituitary Gland: Diabetes Insipidus
Patho Antidiuretic hormone deficiency Water unable to be reabsorbed Water metabolism problem caused by an antidiuretic hormone deficiency Water is excreted as urine instead of being reabsorbed. Polyuria and dehydration Diabetes insipidus is classified as: Nephrogenic - inherited Primary – deficit in hypothalmus or pituitary Secondary – trauma, tumors Drug-related – lithium, declomycin

10 Diabetes Insipidus: Clinical Manifestations
CV Tachycardia Hypotension Heme concentration Renal Dramatic increased u/o Skin Dry mucous membranes Neuro Thirst Irritable Lethargy to unresponsive

11 Diabetes insipidus: Interventions
Nursing Diagnostic Statements Deficient fluid volume r/t… Decreased cardiac output r/t… Priorities Early detection dehydration Maintain adequate hydration Desmopressin acetate (DDAVP) intranasally Synthetic vasopressin I&O-daily weights

12 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
Patho Vasopressin (ADH) Increased Water retained Dilutional hyponatremia Causes Cancer Infection Chemo agents COPD Patho ADH secreted evn though serum osmolality normal…common complication w/some cancers Water is retained which results in dilutional hyponatremia Cancer Small cell lung CA, pancreatic CA, hodgkins-non-hodgkins lymphomas

13 SAIDH:Clinical Manifestations
Fluid retention Hyponatremia Neuro Lethargy HA Altered LOC CV Tachycardia Renal u/o decrease Neuro sx when Na decreased below 115

14 SAIDH: Nursing Interventions
Nursing diagnostic priorities Decreased cardiac output r/t… Fatigue Fluid restriction Drug therapy Diuretics Hypertonic saline (3%) Neurologic assessment Orientation Safe environment Input of 500cc water

15 Adrenal Glands Patho Aldosterone Cortisol Catecholamines
Epinephrine Beta receptors Norepinephrine Alpha receptors Deduced aldosterone levels Hyperkalemia acidosis Hyponatremia hypovolemia Patho On top of each kidney Aldosterone Maintains extracellular fluid volume Promotes sodium and water reabsorption and K excretion Regulated by renin-angiotensin system Cortisol Influences CHO, fat and protein metabolism Body response to stress Immune function Must be present for other important processes to occur

16 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 Causes –MOST COMMON STEROID THERAPY STOPPED SUDDENLY…STEROIDS DEPRESS NATURAL PRODUCTION AND MUST BE TAPERED TO ALLOW PITUITARY PRODUCTION OF ACTH AND ACTIVATIOOF ADRENAL CELLS TO PRODUCE CORTISOL Life threatening event in which need for cortisol and aldosterone is greater than available supply Occurs as result of stressful event…surgery-trauma-infection MOST COMMON CAUSES

17 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 S&P

18 Adrenal Gland: Hyperfunction
Patho Pheochromocytoma Cushing’s syndrome Causes Primary/secondary malignancies Steroids Lymphocytes Inflammatory/immune response Pheochromocytoma Catecholamine-producing tumors that arise in chromaffin cells Intermittent episodes of hypertension or attacks varying in length from a few minutes to several hours Main treatment: surgery Cushings Excess stimulation of ACTH…adrenal hyperplasia resulting in adrenals being less responsive to gonadatropin

19 Cushing’s Disease: Clinical Manifestations
Obesity Changes in fat distribution Moon face Facial hair for women Thin skin Blood vessels fragile Acne Immunosupression HTN Water/sodium retention Lab changes Glucose WBC Sodium Potassium Lab changes Glucose-incr WBC-decr Sodium-incr Potassium -decr

20 Nursing Priorities Excess fluid volume r/t… Risk for infection r/t…
Deficient knowledge

21 Medical Management Drug therapy Radiation therapy Mitotane
If caused by side effect of medication try to decrease or change meds Radiation therapy Pituitary tumors Drug therapy Mitotane Adrenal cytotoxic agent used for inoperable adrenal tumors to decrease cortisol secretion

22 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

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