ATI: Chapter 77 - Pituitary Disorders Flashcards
(199 cards)
1
Q
The _____ gland (hypophysis) is known as the master gland due to its regulation of many bodily functions.
A
pituitary
2
Q
Located underneath the hypothalamus, at the base of the skull, the pituitary gland is regulated by the _______.
A
hypothalmus
3
Q
The hypothalamus is divided into two lobes; anterior (_______) and posterior (_______), which secrete regulatory hormones.
A
adenohypophysis
neurohypophysis
4
Q
The hormones associated with the posterior pituitary are produced in the ________ and stored in the posterior pituitary, where they are released into the circulation as needed.
A
hypothalamus
5
Q
Anterior Pituitary hormones (6)
A
Thyroid stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH) Luteinizing hormone Follicle stimulating hormone Prolactin Growth Hormone (GH)
FLATPG
6
Q
Thyroid stimulating hormone stimulates the ______.
A
thyroid gland
7
Q
The thyroid stimulating hormone is released from the ______ pituitary gland.
A
anterior
8
Q
Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to secrete _________.
A
glucocorticoids
9
Q
Luteinizing hormone in women stimulate maturation of ______ and _____.
A
ova and ovulation
10
Q
Luteinizing hormone in men stimulate ______.
A
sperm production
11
Q
Prolactin stimulates ______ production during lactation.
A
breast milk
12
Q
Growth hormone (GH) stimulates protein synthesis and growth of ________
A
muscle and bone
13
Q
Posterior pituitary hormones (2)
A
antidiuretic hormone (ADH) vasopressin Oxytocin (OT)
14
Q
Antiduiuretic hormone (ADH) (vasopressin): increases re-absorption of water in the ______.
A
kidneys
15
Q
Oxytocin (OT) stimulates ______ of uterus following delivery.
A
contraction
16
Q
Oxytocin (OT) stimulates ejection of _____ during lactation.
A
breast milk
17
Q
Altered function of the pituitary gland can be caused by disease of the pituitary gland or the ________, trauma, tumor, or vascular lesion.
A
hypothalamus
18
Q
Hyperfunction or hypofunction of the anterior and posterior pituitary gland can occur ______ of one another.
A
independently
19
Q
Over secretion of ACTH from the anterior pituitary gland in results in ________.
A
Cushing’s disease
20
Q
Over secretion of GH results in ______ in children and _______ in the adult client.
A
gigantism
acromegaly
21
Q
In the adult client, acromegaly manifests as ______ of body parts without affectign the client’s height.
A
enlargement
22
Q
Under secretion of GH in children results in ______.
A
dwarfism
23
Q
Insufficient secretion of hormones in the anterior pituitary typically affects all the hormones, termed _________.
A
panhypopituitarism
24
Q
Panhypopituitarism affects the target organs of the hormones produced in the anterior pituitary, including the thyroid, _______, and gonads.
A
adrenal cortex
25
A deficiency of ____ causes diabetes insipidus (DI),
ADH
26
Diabetes insipidus is characterized by the excretion of a large quantity of _______.
diluted urine
27
Excessive secretion of ADH causes _______.
SIADH
28
In SIADH, the ____ retain water, urine output decreases, and extracellular fluid volume is increased.
kidneys
29
Posterior pituitary disorders result in fluid and ______.
electrolyte imbalances
30
_______is characterized by excess growth hormone in adults, which causes an increase in size of body parts but not height.
Acromegaly
31
Manifestations of acromegaly are widespread, including overgrowth of _____; bones of the forehead, jaw, feet and _____; and enlargement of organs including the liver and the heart.
skinhands
32
If acromegaly is untreated can cause hypertension, _______, and heart problems.
diabetes mellitus
33
Onset of _____ is gradual and can progress for years before becoming noticeable
acromegaly
34
Risk Factors for acromegaly
```
age (adulthood)
benign tumors (pituitary adenoma)
```
35
Acromegaly expected findings
```
severe headaches
visual disturbances (diplopia, decreased visual acuity)
thick lips with coarse facial structures
joint pain
decreased libido
enlarged hands and feet
hyperglycemia
barrel-shapped chest
lower jaw protrusion
increasing head size
change in voice characteristics
change in menstrual pattern
sleep apnea
increases in intracranial pressure (decreased LOC, pupillary changes, sever hypertension, widened pulse pressure, bradycardia, seizures)
```
36
Growth hormone level is measured as a baseline and following administration of _______, typically 0.5 g/kg or 1000 g with a growth hormone suppression test. Elevated glucose levels are expected to suppress GH; however, clients who have ______ will show only a slight decrease or no decrease at all in GH levels.
glucose
| acromegaly
37
For a growth hormone suppression test you need to obtain baseline GH and glucose levels, administer prescribed glucose, obtain GH and blood levels at ____, _____, and _____ minutes after glucose administration.
10, 60, 120 minute
38
Clients should receive nothing but water for ___ to _____ hours preceding the growth hormone suppression test.
6 to 8 hours
39
Diagnostic Procedures for Acromegaly (3)
xrays of the skull
CT or MRI of the head
Cerebral angiography
40
________ identify abnormalities of the sella tircica, the location of the pituitary gland within the skull associated with acromegaly.
x-rays of the skull
41
______ or _______ of the head identify soft tissue lesions associated with acromegaly.
CT or MRI
42
__________ is used to evaluate for the presence of vascular malformation or aneurysms with acromegaly.
cerebral angiography
43
Hypophysectomy is the removal of the _________ through an endoscopic transnasal (most common) or oronasal (transsphenoidal) approach. If these approaches do not provide access to the tumor, a craniotomy is indicated.
pituitary gland
44
Preop to a hypophysectomy instruct the client not to brush his teeth, blow his nose, or _______ postoperatively. These actions can increase intracranial pressure.
bend at the waist
45
Prior to hypophysectomy assess ______ related to physical manifestations of disorder.
self-concept
46
Postoperative to hypophysectomy monitor _______ status.
neurological
47
Postoperative to hypophysectomy monitor drainage to __________.
mustache dressing (drip pad)
48
Postoperative to hypophysectomy notify the provider of the presence of glucose in the ________, which is an indication of leakage of cerebrospinal fluid).
drainage
49
Postoperative to hypophysectomy maintain the client in a _________ position.
high-fowlers
50
Postoperative to hypophysectomy monitor _______, especially greater output than intake (DI)
fluid balance
51
Postoperative to hypophysectomy encourage deep breathing exercises, but limit ______ as this increases intracranial pressure and can cause a leak of ________.
```
coughing
cerebrospinal fluid (CSF)
```
52
Postoperative to hypophysectomy assess for manifestations of _____.
meningitis.
53
Postoperative to hypophysectomy administer _______.
replacement hormones
54
________ (bromocriptine mesylate, cabergoline) inhibit the release of GH.
Dopamine agonists
55
Instruct the client to notify the provider immediately if _____, dizziness, or watery nasal discharge occurs while taking bromocriptine. This can indicate cardiac dysrhythmia, coronary artery spasms, or _______>
chest pain
| leakage of CSF
56
_______ (octreotide, lanreotide) inhibit GH release.
somatostatin analogs
57
________ (pegvisomant) prevents GH receptor activity and blocks production of insulin-like growth factor.
growth hormone receptor blocker
58
_______ therapy shrinks pituitary tumor over a period of time.
radiation
59
Hormone replacement therapy will be _____ after a hypophysectomy.
lifelong
60
Avoid activities that increase _______ after a hypophysectomy.
intracranial pressure
61
Report ______ or increased swallowing after a hypophysectomy.
postnasal drip
62
Rinse mouth frequently to minimize effects of ________ after a hypophysectomy.
mouth breathing
63
Use ______ and flossing to clean teeth. Avoid brushing teeth due to risk of trauma to the operative site after a hypophysectomy.
oral rinses
64
Consume a diet high in fiber to minimize ______ to defecate after a hypophysectomy.
straining
65
________ results from a deficiency of ADH, which is secreted by the posterior lobe of the pituitary gland (neurohypophysis).
Diabetes insipidus (DI)
66
Decreased ADH reduces the ability of the distal renal tubules in the kidneys to collect and concentrate urine, resulting in excessive diluted urination, ______, electrolyte imbalance, and excessive fluid intake.
excessive thirst
67
Types of Diabetes Insipidus
Primary
Secondary
Nephrogenic
Drug-Induced
68
______ diabetes insipidus is a lack of ADH production or release; caused by defects in the hypothalamus or pituitary gland.
primary
69
_____ diabetes insipidus is a lack of ADH production or release; caused by infection, tumors, in or near the hypothalamus or pituitary gland, _______, or brain surgery.
Secondary
| head trauma
70
________ diabetes insipidus is inherited; renal tubules do not react to ADH.
nephrogenic
71
_________ diabetes insipidus is when lithium carbonate or demeclocyline can alter the way the kidneys respond to ADH.
drug-induced
72
Clients who have a head injury, tumor or lesion, surgery or irradiation near or around the pituitary gland or infection (meningitis, encephalitis) are risk factors for _______.
diabetes insipidus
73
Clients who are taking _______ or demeclcycline are at risk for diabetes insipidus.
lithium carbonate
74
Older adult clients are at higher risk for dehydration due to lower water content of the body, decreased thirst response, decreased ability of the __________, increased use of diuretics, swallowing difficulties, or inadequate food intake. (Risk factor for DI)
kidneys to concentrate urine
75
An expected finding of DI includes ______ (abrupt onset of excessive urination, urinary output of 4 to 30 L/day of dilute urine): failure of the renal tubules to collect and reabsorb water.
polyuria
76
An expected finding of DI is _______, excessive thirst, consumption of 2 to 20 L/day.
polydipsia
77
Other expected findings of DI includes fatigue, nocturia, and ______.
dehydration
78
An expected finding of DI is dehydration, as evidenced by extreme thirst, weight loss, _____, headache, constipation, and dizziness.
muscle weakness
79
Physical assessment findings of Diabetes Insipidus
```
Sunken eyes
tachycardia
hypotension
loss or absence of skin turgor
dry mucous membranes
dry mucous membranes
weak, poor peripheral pulses
decreased cognition
```
80
With DI there will be an electrolyte imbalance such as increased ______.
sodium
81
With DI the urine chemistry is very _______>
diluted
82
With DI there will be a decreased urine specific gravity, less than _____.
1.005
83
With DI there will be decreased urine osmolality, less than ______ mOsm/L.
200
84
With DI there will be decreased urine pH, sodium, and _____.
potassium
85
As urine volume increases with DI, urine osmolality _______.
decreases
86
The serum chemistry of a patient with DI will be ________.
concentrated
87
Pts with DI have increased serum osmolality, greater than _____ mOsm/L.
300
88
Pts with DI have increased serum potassium and _______.
sodium
89
Serum volume decreases, the serum osmolaltiy increases with pts with ______.
DI
90
The _______ is positive for DI if the kidneys are unable to concentrate urine despite increased plasma osmolarity.
water deprivation test (ADH simulation test)
91
For DI patients obtain a baseline weight, vital signs, serum electrolytes and osmolarity, and _______ and osmolarity.
urine specific gravity
92
With DI pts monitor _____ vital signs, urine specific gravity, osmolarity, and body weight.
hourly
93
Discontinue a water deprivation test (ADH stimulation test) if the client has more than a 2kg body weight loss and ____.
rehydrate
94
Monitor for the early indications of _______ with the water deprivation test that include postural hypotension, tachycardia, and ______.
dizziness
95
When a pt is have a water deprivation test (ADH stimulation test) explain the test to the client and advise the client to report any ______, headache, or nausea.
dizziness
96
A subq injection of _____ produces urine output with an increased specific gravity if the client has central diabetes inspdidus.
vasopressin
97
Administer vasopressin subq and obtain a urine sample for osmolality ____to ____ after administration.
30 to 60 minutes
98
Explain the test procedure to the client with a vasopressin test. Advise the client to notify the nurse of any dizziness, ____, or nausea.
headache
99
With Di monitor vital signs, _____, central venous pressure, I&O, specific gravity, and lab studies (potassium, sodium, BUN, creatinine, specific gravity, osmolarity).
urinary output
100
A DI pt should be weighed _____.
daily
101
Promote the prescribed diet (regular diet with restriction of foods that exert a ______, such as caffeine) with DI patients.
diuretic effects
102
IV therapy: Hydration (I&O must be matched to prevent dehydration) and ________ replacement for DI.
electrolyte replacement
103
With DI patients promote safety: keep bedside rails up while client is in bed, and provide assistance with _______ due to dizziness or muscle weakness. Ensure easy access to a bathroom or bedpan.
ambulation
104
With Di patients add bulk foods and fruit juices to the diet if constipation develops. A _______ might be needed.
laxative
105
With DI patients assess skin turgor and ______.
mucous membranes
106
With DI patients provide skin and mouth care, and apply a lubricant to cracked or sore lips. Use a soft toothbrush and _________ to avoid trauma to the oral mucosa. Use alcohol free skin care products, ane apply emollient lotion baths.
mild mouthwash
107
Encourage a DI client to ______ in response to thirst.
drink fluids
108
Desmopressin, which is a _________, or aqueous vasopressin administered intranasally, orally, or parentally for the treatment of DI.
synthetic ADH
109
The use of ________, a synthetic ADH for DI patients, results in increased water absorption from kidneys and decreased urine output.
desmopressin
110
With ADH replacement medications, desmopressin or aqu, patients, monitor vital signs, urinary output, central venous pressure, I&O, specific gravity, and lab studies (potassium, sodium, ______, ______, specific gravity, osmolarity).
BUN
| creatinine
111
Doses of desmopressin or aquaeous vasopressin can be adjusted depending on ______.
urine output
112
Give vasopressin cautiously to clients who have coronary artery disease because the medication can cause _________.
vasoconstriciton
113
Monitor for headache, confusion, or other indications of _________ with ADH replacement agents.
water intoxication
114
ADH replacement agents
desmopressin
| aqueous vasopressin
115
Educate the DI client regarding ______ self administration of vasopressin therapy.
lifelong
116
For an intranasal dose of ADH replacement agents, teach the client to ________ and sit upright prior to inhalation.
clear nasal passage
117
Instruct the client to monitor weight daily and notify the provider of a gain greater than _______ in 24 hours with ADH replacement agents.
0.9 kg (2 lbs)
118
Instruct the client to ______ if directed and notify the provider of headache or confusion with ADH replacement agents.
restrict fluids
119
DI patients may require, home assistance for fluid, medication, and ______ might be required.
dietary managment
120
With DI patients instruct the client on medications for _____.
home use
121
Instruct the client to weight daily, eat a ______ diet, wear medical alert wristband and monitor fluid (I&O) with DI patients.
high fiber
122
Teach the client to monitor for indications of _______ (weight loss, dry cracked lips, confusion, weakness) with DI patients.
dehydration
123
Advise the client to restrict fluids as prescribed to prevent water intoxication, and avoid consumption of ______ with DI patients.
alcohol
124
Untreated DI can cause ______, hyperosmolarity, hypernatremia, circulatory collapse, unconsciousness, central nervous system damage, and seizures.
hypovolemia
125
Excessive urine output from DI can cause severe dehydration with can lead to _____.
complications
126
Monitor fluid blance and prevent dehydration by providing ______ with DI.
fluids
127
Advise the clients to seek early medical attention for any indications of ______ and follow care instructions.
DI
128
SIDAH or Schwartz-Bartter syndrome, is an excessive release of ADH, also known as vasopressin, secreted by the ______ lobe of the pituitary gland (neurophypophysis).
posterior
129
Excess ADH leads to renal reabsorption of water and suppression of __________, causing renal excretion of sodium leading to water intoxication, cellular edema, and _______.
renin-angiotensin mechanism
| dilutional hyponatremia
130
Fluid shifts within _______ causes decreased serum osmolarity wtih SIADH.
compartments
131
Conditions that stimulate the hypothalamus to hypersecrete ADH include malignant tumors, increased intrathoracic pressure (such as with positive pressure ventilation), head injury, ______, stoke, tb, and medications (chemo agnaents, TCAs, SSRIs, opiods, fluoroquinolone antibiotics)
meningitis
132
Early manifestations of SIADH include headache, weakness, anorexia, _______, and weight gain (without edema because water, not sodium is retained).
muscle cramps
133
As the serum sodium level decreases with SIADH, the client experiences ________, hostility, sluggish deep tendon reflexes, nausea, vomiting, diarrhea, and ________ with dark yellow concentrated appearance.
personality changes
| oliguria
134
Confusion, lethargy, and _______ respirations herald impending crisis with SIADH. When the serum sodium levels drops further, seizures, _____, and death can occur.
Cheyne Stokes
| coma
135
With SIADH, manifestations of fluid volume excess include tachycardia, boundign pulses, possible hypertension, crackles in lungs, distended neck veins, ______, and weight gain without edema. Intake is greater than output.
taut skin
136
With SIADH the urine chemistry is _______ and the blood chemistry is _____..
concentrated
| diluted
137
With a urine lab for SIADH there is a _______ in the sodium and osmolarity.
icnrease
138
As urine volume decreases with SAIDH, urine osmolarity _____.
increases
139
Decreased serum sodium with SIADH results in ________.
dilutional hyponatremia
140
Decreased serum osmolarity with SIADH results in less ________.
270 mEq/L
141
As serum volume ______ with SIADH, serum osmolarity decreases.
increases
142
Restrict oral fluids to _____ to ______ mL/day to prevent further hemodilution (first priority). During fluid restriction, proivde comfort measures for thirst, such as mouth care, ice chips, ______, and staggered water intake.
500 to 1000 mL/day
| lozenges
143
Flush all enteral and gastric tubes with 0.9% sodium chloride, instead of water to replace the ______ and prevent further hemodilution with SIADH patients.
sodium
144
For SIADH, monitor I&O. Report _____ output.
decreased
145
Monitor vital signs for increased _______, tachycardia, and hypothermia with SIADH patients.
bp
146
Ausculate lung sound to monitor for _________ (can develop rapidly and is a medical emergency) with SIADH patients.
pulmonary edema
147
Monitor for decreased serum sodium/osmolarity and elevated ______ with SIADH patients.
urine sodium/osmolarity
148
With SIADH patients weigh the clients daily. A weight gain of ______ indicates a gain of 1 L of fluid. Report this to the provider.
1 kg or 2.2 lbs
149
Report altered _______ (headache, confusion, lethargy, seizures, coma) with SIADH patients.
mental status
150
Reduce _____ and position the client as needed with SIADH patients.
environmental stimuli
151
Provide safe environment for clients who have altered levels of consciousness with SIADH patients and maintain ______.
seizure precautions
152
Monitor for indications of _____, which can occur from fluid overload with SIADH. Use a loop diuretic can be indicated.
heart failure
153
Unlabled use of tetracycline derivatives (demeclocyline) is to correct _______ by stimulating urine flow with SIADH.
fluid and electrolyte imblances
154
Tetracycline derivative (demeclocycline) is contraindicated in clients who have impaired _____.
kidney function
155
Monitor for effective treatment with tetracycline derivatives (demeclocyline), such as increased ______ and decreased __________.
increased serum sodium/osmolarity
| decreased urine sodium osmolarity
156
Instruct the client to avoid taking demecloycline at the same time as _____, _____, magnesium supplements, antacids containing aluminum, or milk products.
calcium, iron
157
Advise the client to monitor for indication of a _____, such as a white, cheese like film inside of the mouth with the use of tetracylcine derivatives (demeclocyline)
yeast infection
158
Advise the client to avoid prolonged exposure to sunlight. Protective clothing should be worn with _______.
tetracycline derivatives (demeclocyline)
159
Instruct the client to notify the provider if _____ develops with tetracycline derivative (demeclocyline).
diarrhea
160
Vasopressin antagonists (tolvapatan, conivapatan) promote water excretion without causing _____.
sodium losses
161
With vasopressin antagonists administration should be initiated in the acute care setting. Monitor blood glucose, serum sodium, intake and output, and _______.
bowel patterns
162
Advise the client to perform frequent _____ when taking vasopressin antagonists.
oral care
163
Instruct the client to monitor for indications of _________, such as weakness with the use of vasopressin antagonists.
dehydration
164
Loop diuretics (furosemide) is used to increase water excretion from the ____.
kidneys
165
Use loop diuretics with caution because loop diuretics cause _______ excretion and can worsen hyponatremia.
sodium
166
Advise the client to ______ slowly in case of postural hypotension with the use of loop diuretics.
change positions
167
Advise the client to notify the provider of findings of hyponatremia, such as nausea, _______, and vomitting when taking loop diuretics.
decreased appetite
168
Medications to treat SIADH (3)
tetracylcine derivative (demeclocyline)
loop diuretics (furosemide)
vasopressin antagnoists (tolvaptan, conivaptan)
169
A therapeutic procedure for SIADH is giving _______ via IV to elevate the sodium level enough to alleviate neurologic compromise.
hypertonic sodium chloride
170
In severe hyponatremia/water intoxication, administration of ____ to _____ mL hypertonic IV fluid (3 to 5% sodium chloride.
200 to 300 mL/
171
Monitor for fluid overload and _______ when giving hypertonic sodium chloride IV fluid with SIADH patients.
heart failure
172
When giving a patient hypertonic sodium chloride IV fluid explain the procedure, advise the client to report difficulty _____ or ________, which can indicate heart failure.
breathing or SOB
173
Include information about meds and ______ instructions with hypertonic sodium chloride IV fluid.
discharge
174
Instruct the client to obtain daily weights, wear a _____, and restrict fluid intake when giving hypertonic sodium chlorid IV fluids.
medical alert bracelet
175
Advise the client to monitor for indications of hypervolemia (weight gain, difficulty breathing) and any __________ (tremors, disorientation) which can lead to seizures.
neurological changes
176
Advise the client to notify the provider of indications of hyponatremia, such as nausea, decreased appetite and ________ with hypertonic sodium chloride IV fluid.
vomitting
177
Advise the client to avoid consumption of ____ when have hypertonic sodium chloride IV fluids.
alcohol
178
Home care can be required for fluid, medication, and _______ with SIADH patients.
dietary mangement
179
Without prompt treatment, SIADH can lead to these complication, which can result in coma or death; water intoxication, __________, and severe hyponatremia
cerebral/pulmonary edema
180
With SIADH complications monitor for early manifestations of water intoxication such a lung crackles, _______ frequently, seizure precautions, serum sodium level, and administer meds as prescribed.
neurologic status
181
Instruct the client and family about fluid restrictions and offer information about the condition and ______ .
treatment
182
Provide support to ease the client's _____ with complications of SIADH.
fears
183
Treatment for SIADH can result in central pontine myelinolysis characterized by _______ that is caused by the destruction of the myelin sheath in the brainstem (pons).
nerve damage
184
The most common cause of central pontine myelinolysis (SIADH complication) is a rapid changed in _____ levels in the body. This most commonly occurs when a client is being treated for hyponatremia and the sodium levels rise to fast.
sodium
185
During treatment with a vasopressin antagonist, hypertonic saline, or loop diuretics, ______ and serum sodium should be monitored every 2 to 4 hours. Report any deterioration in ________ status immediately with central pontine myelinolysis.
plasma osmolarity
186
A nurse is caring for a client who has syndrom of inapporpriate antidiurectic hormone (SIADH). Which of the following findings should the nurse expect?
```
A. Decreased serum sodium
B. urine specific gravity 1.001
C. serum osmolarity 230
D. Polyuria
E. Increased thirst
```
A Decreased serum sodium
C serum osmolarity 230
187
A nurse is assessing a client for diabetes insipidus. The nurse should expect which of the following findings?
Increased hematocrit
188
Urine specific gravity greater than 1.030 is caused by an _____ in the secretion of ADH.
increase
189
Increased thirst is an expected finding in a client who has _______.
diabetes insipidus
190
A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis lab findings should the nurse anticipate?
A. absence of glucose
B. decreased specific gravity
C. presence of ketones
D. Presence of red blood cells
B. decreased specific gravity
191
Ketones in the urine is indicative of ______.
diabetes mellitus
192
Red blood cells int eh urine is indicative of ______.
diabetes mellitus
193
Glucose in teh urine is indicative of ______.
diabetes mellitus
194
A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching?
A. I can drink up 2 quarts of fluid a day
B. I will need to use insulin to control my blood glucose levels.
C. i should expect to gain weight during this illness
D. Muscles weakness is a symptom of DI
D. Muscles weakness is a symptom of DI
195
Weight ___ is a manifestation of diabetes insipidus.
loss
196
A nurse is planning care for a client who has acromegaly and is postoperative following a transphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan?
A. maintain the client in low folwers position
B.Encourage deep breathing and coughing
C. Encourage the client to brush his teeth when awake and alert.
D. Observe dressing drainage for the presence of glucose.
D. Observe dressing drainage for the presence of glucose. (glucose indicates the presence of CSF)
197
A nurse is planning care for a client who has acromegaly and is postoperative following a transphenoidal hypophysectomy. What position should he be in?
high fowlers
198
______ should be limited in the client who is postoperative, as this increases ICP and can cause a CCSF leak.
coughing
199
______ teeth can cause a leak of CSF and is contraindicated.
brushing teeth
