Please enable JavaScript.

Coggle requires JavaScript to display documents.

Pituitary Disorders (Anterior Pituitary Disorders (Acromegaly (Treatments-…

- - - - Diagnostics- Skull X-ray, MRI, CT scan, Labs- GHRH level, glucose tolerance test,
  - - - Usual cause is a pituitary tumor. Other causes include: autoimmune disorders, infections, pituitary infarction or trauma, surgery, radiation. The ethnic group with the highest incidence of pituitary adenomas are African Americans.
        
        Clinical manifestations include headaches, visual changes, loss of smell, nausea/vomiting and seizures.
        Hormone deficiency:
        GH-sublte, nonspecific findings. Truncal obesity, decreased muscle mass and strength, weakness, fatigue, depression, or flat affect.
        FSH & LH-Women: menstrual irregularities, loss of libido, changes in secondary sex characteristics such as decreased breast size. Men: testicular atrophy, diminished spermatogenesis, loss of libido, impotence, decreased facial hair and muscle mass.
        TSH-mild form of primary hypothyroidism: fatigue, cold intolerance, constipation, lethargy, wt. gain.
        ACTH-involves deficiency of cortisol: weakness, fatigue, headache, dry and pale skin, diminished axillary and pubic hair, lowered resistance to infection, fasting hypoglycemia.
        
        Collaborative Management Treatment includes surgery or radiation therapy followed by lifelong hormone therapy.
        Somatropin (omnitrope, genotropin, humatrope) is used fro long-term hormone therapy in adults with GH deficiency.
        Hormone therapy is offered for gonadal deficiency, although not life threatening, will improve sexual function and general well being. This therapy is contraindicated in individuals with breast cancer, phlebitis, and pulmonary embolism in women and prostate cancer in men.
        Estrogen and progesterone replacement therapy may be indicated for hypogonadal women to treat hot flashes, vaginal dryness, and decreased libido.
        Testosterone is used to treat men with gonadotropin deficiency.The benefits achieved with testosterone therapy include return of male secondary sex characteristics; improvement libido; and increased muscle mass, bone mass, and bone density.
        
        Diagnostic testing: MRI and CT to identify a pituitary tumor.
        Laboratory tests: Evaluation of Growth Hormone (GH) somatotropin-, Growth Hormone Stimulation such as insulin tolerance test and Arginine-GHRH test, Gonadotropins.
- - - - Clinical Manifestations and Diagnostic Studies ADH increases the permeability of the renal distal tubule and collecting duct, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, glomerular filtration rate increases, and sodium levels decline ( dilutional hyponatremia).
        Signs and Symptoms experience low urine output and increased body weight. As the serum sodium levels falls below 120mEq/L, manifestations become more severe including vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, which leads to lethargy, confusion, headache, seizures, and coma.
        
        The diagnosis of SIADH is made by measurement of urine and serum osmolality. Dilutional hyponatremia is indicated by serum sodium level less than 134mEq/L, serum osmolality less than 280 mOsm/kg and urine specif gravity greater than 1.025. As serum osmolality indicates the in appropriate excretion of concentrated urine in the presence of dilute serum.
      - .
        
        Nursing and Collaborative Management be alert for low urine output with a high specific gravity, a sudden weight gain with out edema, or a decreased sodium level. Monitor intake and output, vital signs, and heart and lung sounds. Observe for signs of hyponatremia, including seizures, nausea and vomiting, muscle cramping, and decreased neurologic function.
        If symptoms are mild and serum sodium is greater than 125 mEq/L the only treatment may be a fluid restriction of 800 to 1000ml/day.
        
        Frequent repositionining and range of motions if patient bedridden.
        
        Implement seizure precautions
        *Because furosemide increases potassium,calcium, and magnesium losses, supplements may be needed. A fluid restriction of 500ml/ day may be indicated for those with severe hyponatremia.
        
        The use of icechips or sugarless chewing gum helps to decrease thirst. Have the patient weight daily to monitor changes in fluid balance. Teach the patient to supplement the diet with sodium and potassium, especially if loop diuretics are also prescribed.
  - - - Signs and symptoms: Excessive thirst, water electrolyte imbalance, dehydration, fatigue or malaise. Urinary- excessive urination, frequent urination or bedwetting. Also, headache or weight loss.
        
        diagnostics: fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. Pt is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI. Other diagnostic procedures include concurrent measurements of plasma levels of ADH and plasma and urine osmolality as well as a trial of desmopressin (synthetic vasopressin) therapy and intravenous (IV) infusion of hypertonic saline solution
        
        Management: IV fluids/Fluid replacement, Low sodium diet (1500-2400mg per day), Medication-Antidiuretic-DDAVP(decrease urine output), diuretic( rid excess salt)
        Microzide, Amiloride. Must see endocrinologist and nephrologist
        
        Nursing Interventions: Monitor intake and output, polydipsia, weigh daily, monitor urine specific gravity, serum and urine osmolarity, sodium urine and serum levels, potassium serum levels, and monitor for signs and symptoms of hypovolemic shock. The nurse is responsible to educate the patient, family, and other caregivers about follow-up care, prevention of complications, and emergency measures. Specific verbal and written instructions should include the dose, actions, side effects, and administration of all medications and the signs and symptoms of hyponatremia. The nurse should demonstrate and observe a return demonstration of medication administration to ensure that the patient received the prescribed dosage. The patient should be advised to wear a medical identification bracelet and carry required medication and information about DI at all times..