Unit 5 & 6 Chapter 57 Hypophysectomy Flashcards
What is hyperpituitarism?
Hormone oversecretion occurs with anterior pituitary tumors or tissue hyperplasia (tissue overgrowth).
increased secretion of hormones and steroids
Most common hormones affected:
* Prolactin and growth hormone. * Acromegaly * Gigantism * Manifestations:
* Visual field disturbances.
* Headaches.
What are some characteristics of Hyperpituitarism?
Growth Hormone (GH), Acromegaly
* Thickened lips
* Coarse facial features
* Increasing head size
* Lower jaw protrusion
* Enlarged hands and feet
* Joint pain
* Barrel-shaped chest
Hyperglycemia
* Sleep apnea
Enlarged heart, lungs, and liver
-headaches and visual disturbances
What is hypophysectomy?
hypophysectomy: Surgical removal of the pituitary gland.
Pre-OP teaching for Hypophysectomy
AVOID ALL ACTIVITIES THAT CAN INCREASE INTRACRANIAL PRESSURE, IT CAN DELAY HEALING
You will lose your sense of smell for 3-4 months after the procedure
Explain that because nasal packing is present for 2 to 3 days after surgery
it will be necessary to breathe through the mouth, and a “mustache” dressing (“drip” pad) will be placed under the nose.
Instruct the patient not to brush teeth, cough, sneeze, blow the nose, or bend forward after surgery.
These activities can increase intracranial pressure (ICP) and delay healing.
Post-Op teaching Hypophysectomy
*Monitor for neurological, vision changes.
* Monitor for CSF leak
Avoid coughing
* Deep breathing hourly
* Avoid activities that would increase ICP
Do not brush teeth for 2 weeks
* Do not lift
* Assess nasal drainage for quantity, quality, and the presence of glucose (present in CSF)
DO NOT BLOW NOSE
* HOB elevated
* Do not sneeze
Take a stool softener avoid straining
Mouth breathe
* Instruct the patient to rinse the mouth frequently and to apply a lubricating jelly to dry lips to manage the dryness from mouth breathin
What is the importance of assessing for Cerebral spinal fluid leak post Hypophysectomy?
CSF leaks can cause fluid to leak through the ears, through the nose or into the spinal canal. CSF leakage through the ears or nose should be diagnosed and treated quickly and effectively to prevent meningitis, an infection of the meninges
Nursing Care Post Hypopophysectomy
- Monitor the patient’s neurologic status hourly for the first 24 hours and then every 4 hours.
- Monitor fluid balance, especially for output greater than intake.
- Encourage the patient to perform deep-breathing exercises.
- Instruct the patient not to cough, blow the nose, or sneeze.
Instruct the patient to use dental floss and oral mouth rinses rather than toothbrushing until the surgeon gives permission. - Instruct the patient to avoid bending at the waist to prevent increasing intracranial pressure.
- Monitor the nasal drip pad for the type and amount of drainage.
- Teach the patient self-administration of the prescribed hormones.
*may be an order of anti-emetic ondanstron to prevent vomiting on site
AVOID CONSTIPATIONS TEACHING
*Teach the patient methods to avoid constipation and subsequent “straining.”
* Eat high fiber foods
* Use Stool softener or laxative
* Drink plenty of fluids
What would the patient need life long after total removal of the pituitary gland
If the entire pituitary gland has been removed, replacement of thyroid hormones and glucocorticoids is lifelong.
Why should you assess for menigitis post Hypophysectomy
Assess for indications of infection, especially meningitis, such as headache, fever, and nuchal (neck) rigidity. The surgeon may prescribe antibiotics, analgesics, and antipyretics.
What hormone replacement may be needed after Hypophysectomy?
Hormone replacement with vasopressin may be needed to maintain fluid balance
