Chapter 62, 63, 64 Ignatavicius Flashcards Preview

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Flashcards in Chapter 62, 63, 64 Ignatavicius Deck (49):

Problems in the hypothalamus that change the function go the anterior pituitary gland result in which condition?

Secondary Pituitary Dysfunction


A malfunctioning posterior pituitary gland can result in which disorders? Select all that apply.
a. Hypothyroidism
b. Altered sexual function
c. Diabetes insipidus
d. Growth retardation
e. Syndrome of inappropriate antidiuretic hormone (SIADH)

Diabetes Insipidus and SIADH


A malfunctioning anterior pituitary gland can result in which disorders? Select all that apply.
a. pituitary hypofunction
b. pituitary hyperfunction
c. DI
d. hypothyroidism
e. osteoporosis

Pituitary hypofunction, Pituitary hyperfunction, hypothyroidism, and osteoporosis


The assessment findings of a male patient with anterior pituitary tumor include reports of changes in secondary sex characteristics, such as episodes of impotence and decreased libido. The nurse explains to the patient that these findings are a result of overproduction of which hormone?
a. Gonadotropins inhibiting prolactin (PRL)
b. Thyroid hormone inhibiting PRL
c. PRL inhibiting secretion of gonadotropins
d. steroids inhibiting production of sex hormones

c. PRL inhibiting secretion of gonadotropins


A patient with a PRL- secreting tumor is likely to be treated with which medication?
a. Dopamine agonists
b. Vasopressin
c. Steroids
d. Growth Hormone (GH)

a. Dopamine agonists


A patient is prescribed bromocriptine mesylate (Parlodel). Which information does the nurse teach the patient? Select all that apply.
a. get up slowly from a lying position
b. take medication on an empty stomach
c. take daily for purposes of raising GH levels to reduce symptom of acromegaly
d. begin therapy with a maintenance level dose
e. report watery nasal discharge to the health care provider immediately.

a. get up slowly from a lying position
e. report watery nasal discharge to the health care provider immediately.


Patients diagnosed with an anterior pituitary tumor can have symptoms of acromegaly or gigantism. These symptoms are a result of overproduction of which hormone?
b. PRL
c. Gonadotropin
d. GH

d. Growth Hormone


The nurse is performing an assessment of an adult patient with new-onset acromegaly. What does the nurse expect to find?
a, extremely long arms and legs
b. thickened lips
c, changes in menses with infertility
d. rough, extremely dry skin

b. thickened lips


Posterior Pituitary Hormones are what?

Oxytocin and ADH(Vasopressin)


Which two diseases uses ADH

Diabetes Insipidus and SIADH


Which hormones are in the anterior pituitary?

TSH, ACTH, LH, FSH, PRL, MSH(melanocyte-stimulating hormone)


What does the TSH target in the body?

thyroid- stimulates synthesis and release of thyroid hormone


What does the ACTH (adrenocorticotropic hormone) target?

Adrenal Cortex- Stimulates synthesis and release of corticosteriods and adrenocortical growth


What does LH target?

ovary- stimulates ovulation and progesterone secretion
testis- stimulates testosterone secretion


What does FSH target?

ovary- stimulates estrogen secretion and follicle maturation
testis- stimulates spermatogenesis


What does PRL- prolactin target?

mammary glands- promotes growth through lipolysis, protein anabolism, and insulin antagonism


T3 and T4 has an inverse relationship with what?



What does MSH (melanocyte stimulating hormone) target?

melanocytes- promotes pigmentation


What does Vasopressin target?

kidneys- promotes water reabsorption


What does oxytocin target?

Uterus and mammary glands- stimulates uterine contractions and ejection of breast milk


If there is a Primary problem it comes from what?



If there is a secondary problem it comes from what?



What are some causes of Hypopituitarism?

benign or malignant tumors, malnutrition, rapid loss of body fat, shock (or severe hypotension), head trauma, AIDS, postpartumhemmorage (Sheehans syndrome)


Sheehans syndrome is what?

is postpartum hemorrhage that causes hypopituitarism- under secretion of the gland


What are signs and symptoms of low GH? Example?

Dwarfism- decreased bone density, pathologic fractures, decreased muscle strength, increased cholesterol levels


What are signs and symptoms of low LH for women? example?

amenorrhea, loss of bone density, low estrogen levels, breast atrophy, - early menopause


What are signs and symptoms of low LH in men? example?

decreased facial hair, reduced muscle mass, loss of bone density, decreased libido, impotence- ex. Poor unfortunate man


What are signs and symptoms of low TSH? Example?

weight gain, intolerance to cold, scalp alopecia, hirsutism, lethargy-ex. Hashimoto’s


What are signs and symptoms of low ACTH? Example?

Decreased serum cortisol, pale sallow complexion, anorexia, postural hypotension, headache, hypoglycemia, hyponatremia- ex. Addison’s


What is the assessment for hypopituitarism?

-First signs are the change in vision (diplopia)
-Measure T3 and T4, testosterone and estradiol from the gonads
-Skull x-ray- looking for enlargement, erosion, and calcification as a result of pituitary tumors


What are the interventions for hypopituitarism in men?

-replacement of deficient hormones
-Men receive testosterone- fertility may require additional therapy (GnRH)
Side effects: gynecomastia(breast development), acne, boldness, prostate enlargement (CANNOT be given to a man with PROSTATE CANCER)


What are interventions for hypopiuitarism in women?

replacement of deficient hormones.
Usually estrogen and progesterone
Side effects: increased risk for hypertension and thrombosis


What are the signs and symptoms of an increased PRL?

hypogonadism, increased body fat


What are the signs and symptoms of an increased GH? Example?

Thickened lips, coarse facial features, increased head size, enlarged hands and feet, joint pain, enlarged heart, lungs and liver


What are the signs and symptoms of increased ACTH? Example

-Cushing's-elevated cortisol levels, weight gain, truncal obesity, moon face, muscle wasting, hypertension, hyperglycemia, acne


What are the signs and symptoms of an elevated TSH level?

-Grave's Disease-
elevated plasma levels, weight loss, tachycardia, dysrhythmia, heat intolerance, increased GI motility


What is an example of increased LH and FSH?

Men: hypogonadism or hypergonadism
Women: normal LH and FSH


What are some diagnostic tests to assess for acromegaly?

Serum hormone levels and MRI


What are the interventions for acromegaly?

Goal is to return the hormone levels to normal
-Drug therapy-
--Dopamine Agonist
--Radiation Therapy- may take several years for effects to take place


Explain Dopamine Agonist.

(bromocriptine mesylate and cabergoline)- stimulate dopamine receptors and inhibit release of HC and PRL.
Side Effects: orthostatic hypotension, GI irritation, nausea, headache, abdominal pain, and constipation


Exaplain somastatin analog

inhibit GH and GH receptor blocker


What are the surgical interventions for acromegaly and what do you assess for pre and post op?

-Transhphenoidal -minimally invasive or craniotomy

Pre-op- nasal packing, nose/drip pad, bending from the knees, don't blow nose, effects on sense of smell

Post- op- monitor neurologic status, vision changes, LOC, strength of extremeties- CSF LEAK!!!- HALO SIGN
-Infection control


What does the replacement therapy include after a surgical intervention for acromegaly?

Replacement therapy of thyroid hormone and glucocorticoids (thyroid and glucocorticoids are given if the anterior pituitary was removed) and vasopressin(help with fluid balance).


Explain Diabetes Insipidus.

Loss of water due to ADH deficiency or the inability of kidneys to respond to ADH

Kidney tubules and collecting ducts are not able to reabsorb water.

Large volumes of urine are excreted
Dehydration and fluid and electrolyte imbalance
will present with excessive thirst


What does the hypothalamus do?

Regulates hunger, thirst, sleep, and wakefulness plus most of your involuntary mechanisms including body temperature


Symptoms of SIADH

low urinary output, high levels of ADH, Hyponatremia, over hydrated, retain too much fluid, may present with excessive thirst.


Symptoms of Hypoparathyroidism

HYPOCALCEMIA, numbness or tingling in extremities, bone pain, muscle cramps, tetany, twitching, muscle weakness, itching, hypomineralized bone, tooth problems, speech problems, cataracts, hair loss, brain fog, heart arrhythmia


What are the tests for hypocalcemia?

chvostek;s sign and troussea's sign


What do you monitor post op for thyroidectomy or parathyroidectomy?

BOWTIE! Bleeding, open airway, whisper, trache set, incision, emergency

monitor calcium level if parathyroid gland is removed
monitor voice for laryngeal damage
monitor thyroid and parathyroid levels