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

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Presentation on theme: "1 Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders Keith Rischer RN, MA, CEN."— Presentation transcript:

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

2 2 Todays 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 3 Endocrine glands Pituitary glands Adrenal glands Thyroid glands Islet cells of pancreas Parathyroid glands Gonads Hormones Negative feedback mechanism

4 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)

5 Anterior Hypo-pituitarism 5 Causes Tumor Brain or pituitary Anorexia Shock Growth hormone Gonadatropins Women Men TSH ACTH

6 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

7 Anterior Hyper-pituitarism 7 Causes Pituitary tumors or hyperplasia Gigantism Acromegaly

8 8 Hypophysectomy Post op Care Closely monitor neuros Assess for postnasal driphalo 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

9 Posterior Pituitary Gland: Diabetes Insipidus 9 Patho Antidiuretic hormone deficiency Water unable to be reabsorbed

10 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 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 12 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Patho Vasopressin (ADH) Increased Water retained Dilutional hyponatremia Causes Cancer Infection Chemo agents COPD

13 13 SAIDH:Clinical Manifestations Fluid retention Hyponatremia Neuro Lethargy HA Altered LOC CV Tachycardia Renal u/o decrease

14 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

15 Adrenal Glands 15 Patho Aldosterone Cortisol Catecholamines Epinephrine –Beta receptors Norepinephrine –Alpha receptors Deduced aldosterone levels Hyperkalemia –acidosis Hyponatremia –hypovolemia

16 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

17 17 Addisons 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

18 18 Adrenal Gland: Hyperfunction Patho Pheochromocytoma Cushings syndrome Causes Primary/secondary malignancies Steroids Lymphocytes Inflammatory/immune response

19 19 Cushings 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

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

21 21 Medical Management Drug therapy Mitotane If caused by side effect of medication try to decrease or change meds Radiation therapy Pituitary tumors

22 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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