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Module 4 (MedSurg 2) > Pituitary Gland > Flashcards

Pituitary Gland Flashcards

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1
Q

Functions of the Endocrine System

A

Maintain & regulate vital functions
Response to Stress and Injury
Growth & development of children and genes
Energy metabolism
Balance of fluids, electrolytes, and acid-base

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2
Q

During stress blood glucose

A

rises

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3
Q

Risk Factors for Overall Endocrine Disorders

A

Age - usually elderly
Trauma –to an organ or close to endo organs
Heredity
Environmental factors (chemicals, radiation from thyroid)
Consequences of other disorders - COPD, long steroid use

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4
Q

General Assessment for Endocrine Health Information

A

Past history
Meds
surgery and tx (radiation)
exposure to toxins - FARMS,-CIDES, dust

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5
Q

Physical Assessment

A

VS
Skincare (wt distribution changes)
Ht and Wt
Mental and emotional status
Head-to-toe assessment
Photographs show overtime changes

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6
Q

If the confusion is not caused by a UTI, then try

A

thyroid levels

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7
Q

Endocrine r/t aging
Assessments for Metabolism

A

low cold tolerance
low appetite
low HR and BP

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8
Q

Endocrine r/t aging
Assessments for LOW ADH

A

dilute urine with low fluid intake

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9
Q

Endocrine r/t aging
Assessments for LOW ESTROGEN

A

LOW bone density
skin dry, thin, fragile

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10
Q

Nursing Actions r/t Aging Endocrine

A

Monitor thyroid labs and meds
Layer clothing
nutrition
constipation/diarrhea
altered LOC
Offer fluids every 2 hours (if not contraindicated) due to increased risk for dehydration
handle with care due to injury risk
reposition every 2 hours
moisturize skin

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11
Q

Where is the pituitary gland located?

A

directly below the hypothalamus

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12
Q

The hypothalamus produces what to the pituitary?

A

releasing hormones

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13
Q

The pituitary gland is known as the

A

“master gland”

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14
Q

The posterior pituitary gland secretes

A

ADH (Vasopressin)
Oxytocin

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15
Q

The anterior pituitary gland secretes

A

GH
ACTH (adrenocorticosteroids)
TSH leading to T3 and T4
FSH and LH (testosterone, estrogen, and progesterone)
Prolactin

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16
Q

The hypothalamus, pituitary gland, and organs are a part of a

A

feedback loop

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17
Q

Anterior Pituitary Disorders

A

Acromegaly
Dwarfism
Cushing Syndrome and Disease

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18
Q

Acromegaly

A

Abe Lincoln and James Bond villians old movies
Large hands and feet size due to pituitary tumor making too much GH

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19
Q

Dwarfism

A

pedi mainly
lack of GH

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20
Q

Cushing’s Syndrome

A

occurs when your body makes too much cortisol, a hormone related to the body’s stress response.
- fatty hump, moon face, straie

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21
Q

Posterior Pituitary Disorders

A

Diabetes Insipidus (DI)
SIADH

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22
Q

Excessive Anterior Pituitary Disorders

A

Acromegaly
Cushing’s Disease (type of syndrome)
-excess ACTH impacts the adrenal glands

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23
Q

Deficiency Anterior Pituitary Disorders

A

Dwarfism
Hypopituitarism

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24
Q

Excessive Posterior Pituitary Disorders

A

SIADH

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25
**Deficiency** Posterior Pituitary Disorders
DI
26
SIADH
increase the release of ADH - leads to H2O excess - Low Na
27
SIADH level of ADH
Increases
28
SIADH level of water
excess (water intoxication)
29
SIADH level of Na
low: **Hyponatremia Dilutional** (diluted from excess water)
30
Causes of SIADH
Pituitary surgery **Head injury CVA** recent infection Malignant tumors secrete ADH independently
31
What malignant tumors secrete ADH independently?
Lung Pancreas Hodgkin's lymphoma
32
What secretes ADH on its own without the pituitary gland?
Malignant tumors (lung, pancreas, Hodgkin's lymphoma)
33
SIADH S/S
fluid **vol. excess in the belly** Wt gain w/o peripheral edema H/A, **alter LOC, seizure risk** **Concentrated amber urine** fatigue, N/V water intoxication
34
SIADH is represented by
Spongebob in salt water - arms and legs are smaller compared to the middle
35
What is hyponatremia s/s
**Seizures** and Stupor **Abdominal cramping**, attitude confusion **Lethargic** Tendon reflex low **Low urine output** **Orthostatic hypotension and overactive BS** **Shallow resp.** (late due to muscle weakness) **Spasms of muscles**
36
SIADH Labs Urine osmolality Serum Osmolality Hct, BUN, Na
high urine Osm. and specific gravity low serum osm., Hct, BUN, **Na**
37
SIADH Mgmt
fluid restriction 800-1000 mL (severe 500) give IV or PONa slowly Diuretics Vasopressin antagonist Labs
38
What assessments/monitoring needs to be done when managing SIADH?
VS, **Cardiac &Neuro** Daily wt, I&Os
39
What safety precautions need to be taken when managing SIADH?
confusion (Fall bundle) seizure (side laying, suction, and pads)
40
What medications are going to be given to a SIADH pt?
Vasopressin antagonist (**Declomycin - demeclocycline**) Diuretic (Lasix - furosemide) Sodium - PO/IV Fluid restrictions including frozens to 800-1000
41
If on fluid restriction severe?
500 mL
42
Declomycin is a
vasopressin antagonist
43
If the SIADH is caused by a tumor, what is the treatment options for them?
radiation surgery
44
When should you call a doctor about weight gain?
2 lbs in a day 5 lbs in a week 2 lbs = 1 kg = 1000mL = 1L of fluid added
45
Nursing problems with SIADH mgmt
altered thought process fatigue nutrition = less than required knowledge deficit **teach and reteach**
46
Education for SIADH
Medications - **Na slowly rise** Report **wt gains** **Fluid restrictions** (include IV meds, ice cream, ice, and popsicles) **Daily wt**
47
Nurses need to evaluate for SIADH
compliance cognition teaching Labs normal wt and fluids monitored No seizures
48
What does the urine of a SIADH look like?
thick concentrated sticky on the floor LOW OUTPUT
49
DI is a disorder of what pituitary gland
posterior
50
DI relationship with ADH
LOW
51
DI has __________ water loss through ________
excessive; polyuria
52
The primary cause of DI
malfunction of the posterior pituitary
53
The secondary cause of DI **MOST COMMON**
trauma CNS infection recent CVA surgery CA - lung, breast
54
Nephrogenic causes of DI
Kidneys are resistent to ADH (electrolytes, medications, and genetics)
55
What medication causes DI?
Lithium
56
DI Assessment
low fluid vol polyuria 4-30 L looks clear w/ water polydipsia
57
Does reducing the intake of DI pt affect the reduction in urine output?
no
58
Labs for DI
LOW urine SG and osmolality HIGH serum Na and osmolality **SLUDGE BLOOD**
59
What restrict needs to be in place for DI
SALT
60
What is the major difference between DI and DM?
DI loses fluids not fat extra peeing clothes too big
61
DI Testing
**fluid deprivation test** plasma ADH levels and osmolality urine osmolality (urine vs serum) synthetic vasopressin trial
62
Fluid deprivation Test
WITHHOLD fluid for 8-12 hours - measure body weight in the beginning and every 2 hours weight again - if you notice **3-5% body weight loss**, then stop test and Dx as DI Can lose up to 30L in a day
63
DI Mgmt
Identify & correct the underlying cause Fluid & electrolyte balance **Replace ADH – DDAVP (neurogenic DI)** Surgery – if pituitary problem
64
Monitor what in DI mgmt
VS CV (hypovolemia sue to heart problems) NEURO WT
65
Labs needed for DI mgmt
electrolytes serum vs urine osmolality
66
What drugs do you give a DI pt?
ADH (Vasopressin) **DDAVP (Desmopressin acetate)**
67
Vasopressin main goal
renal conservation of water
68
Vasopressin is used in
DI Vasodilatory shock Nocturnal enuresis
69
Vasopressin adverse effects
**vasoconstriction and increase BP** H/A chest pain water intoxication - overdose
70
Vasopressin contraindicated
chronic renal failure
71
Vasopressin monitoring
**BP, HR** EKG I&O - urine osmolality **dehydration vs. fluid overload**
72
Vasopressin Teachings
no alcohol med alert ID **Limit fluid intake**
73
DDAVP is
desmopressin acetate
74
DDAVP main goal
decrease output and increase urine osmolality
75
DDAVP used for
**neurogenic DI** nocturnal enuresis
76
If a pedi has nocturnal enuresis, what drug would you give them?
DDAVP
77
DDAVP adverse effects
erythema of injection site, nasal irritation, **hyponatremia (seizure), does not raise BP**
78
DDAVP contraindications
no concurrent use of loop diuretics or glucocorticoids **Hold if creatinine clearance < 50 mL/min**
79
DDAVP monitor
I&O, urine and serum osmolality daily wt
80
DDAVP assessments
hypovolemia hypervolemia
81
DDAVP Teachings
no alcohol med alert bracelet administer (IV, SQ, nasal spray)
82
DI nursing problems
fluid volume deficit low cardiac output knowledge deficit **teach and reteach** risk of skin tear, constipation, injury
83
What is the mascot of DI?
Cali raisins shriveled up leads to skin breakdown and constipation high concentrated blood
84
DI education
Medications Symptoms to report fluid balance daily wt
85
DI Evaluation
med admin labs wt baseline monitor output skin turgor
86
DI mnemonic "How dry I am"
Dry I&O, daily wt Low specific gravity Urinates lots Treat = ADH, DDAVP rEhydrate DILUTE URINE (water)
87
What surgery is used for pituitary tumors?
Transsphenoidal pituitary surgery - Hypophysectomy
88
Hypophysectomy is the
removal of pituitary glands no scarring through the nose
89
Hypophysectomy Major Risks
stroke - vision loss - meningitis - CSF leak - DI - can be permanent in 2-5% and treated by medication
90
Hypophysectomy Post-Op
HOB greater than 45 Monitor for I&Os, electrolytes, osmolality Incision PACKING monitor for spinal fluid D/C Teaching
91
D/C teaching of Hypophysectomy
**brushing teeth/oral care** - don't stretch upper lips **caution activity increases ICP** **corticosteroid and thyroid hormone replacement** foley for 48 hours **stool softeners** to not strain with constipation **Try if needed to cough/sneeze with your mouth open (avoid an increase of ICP)** no lifting no bending head bc gravity
92
What is the halo effect?
cerebrospinal fluid drainage around the blood in circles -dipstick for BG + ICP activity monitoring for 1 month
93
A patient with a urinary creatinine clearance of 55 mL/min is prescribed desmopressin [DDAVP]. It is most important for the nurse to assess the patient for what? a)Irritability, muscle weakness, and back pain b)Drowsiness, listlessness, and headache c)Fever, tachycardia, and hypotension d)Decreased skin turgor, weight loss, and dry skin
b)Drowsiness, listlessness, and headache risk for water intoxication

Module 4 (MedSurg 2) (36 decks)

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