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The pituitary glad regulates?
- sexual development
The posterior pituitary secretes _____.
- AKA antidiuretic hormone ADH
Surgical removal of the pituitary gland is called _____.
- nursing care - watch for postoperative postnasal drip and keep HOB elevated. Watch for the presence of glucose (indicates CSF), it is a light yellow color at the edge of the clear drainage on the dressing called "halo sign"
- teach pt to report postnasal drip
- avoid coughing
- avoid bending from waist-increases ICP
- avoid toothbrushing for 2 weeks
- avoid straining during bowel movement
Diabetes insipidus is caused by _________.
- ADH deficiency-results in the excretion of lg volumes of dilute urine, leading to polyuria and dehydration.
- pts will have decreased mentation (weak & confused)
Meds for DI
Desmopressin-synthetic vasopressin is the drug of choice.
Syndrome of inappropriate antidiuretic hormone SIADH
In SIADH, vasopressin is secreted even when plasma osmolarity is low or normal
ADH continues to be released evven when plasma is hypo-osmolar. Water is retained, which results in dilutional hyponatremia and fluid overload.
***vasopressin AKA ADH
The anterior pituitary released an excess of TSH.
Manifestations of Grave's Disease
- Hyperthyroidism causes Grave's Disease
- pretibial myxedema-dry front of lower legs
Physical manifestations of hypothyroid
- cool pale skin
- dry skin
- dry, brittle hair
- decreased basal metabolic rate
- cold intolerance
- slowness or slurring of speech
- lethargy, confusion
- weight gain
- Severe hypothyroidism
- Gradually give thyroid hormone IV to replace it.
Physical manifestations of hyperthyroid
- heat intollerant
- increased RR
- increased appetite
What are you concerned about for a postop thyroidectomy?
- swelling=respiratory distress
- keep a trach at the bedside
- also monitor for bleeding
- thyroid storm
Hallmark of hyperthyroidism
- visual changes may be first prob pt notices...esp exopthalmos with Grave's
Drug for hypothyroid
What electrolytes will pay close attention to in postop thyroidectomy?
calcium & photphorus balance because these are regulated by the parathyroid glands which could be damaged during a thyroidectomy.
What test will be ran for a pt with exopthalmos?
T3 & T4
Suspect _____ when a pt presents with a round or puffy face, with a dull expression.
Vitiligo, or patch skin pigment is related to hypofunction of ______
Striae are caused by _______
Cushing's disease is causes by ______
hyperpituitarism-ACTH (adrenocorticotropic hormone) release causes excessive production of glucocorticoids, mineralcorticoids, and androgens, leading to cushing's disease.
What endocrine condition would you suspect with a pt who has a high fever, tachycardia, and severe hypertension.
- thyroid storm
- Immediately report a temp increase of even 1 degree
- If temp increases assess the pts cardiac status
Promoting comfort for thyroid storm
- Reduce stimulation, encourage rest, quiet, limiting visitors, & postponing nonessential care
- Reduce room temp-heat intolerance
- fresh ice water at all times
- change bed linens, diaphoresis
- cool showers
Drug therapy for thyroid storm
- Antithyroid drugs
- Preferred drugs are the thionamides (propylthiouracil PTU, methimazole (tapazole))
- These drugs block thyroid hormone production by preventing iodide from binding in the thyroid gland
What drug is used to treat hyperthyroid in patients who won't tolerate any other antithyroid drugs?
Lithium-its use is limited because of side effects such as depression, diabetes insipidus, tremors, N&V
Numbness and a decreased sense of smell are common after _____
The key manifestations of diabetes insipidus are _____&______.
Increase in the frequency of urination and excessive thirst.
___ is considered if urine output is more than 4L during a 24 hour period
DI-from a deficiency of ADH
When DI is severe, ADH is replaced by a synthetic form of vasopresin called _____
Suspect ______ with a bounding pulse, increasing JVD, crackles, peripheral edema, reduced urine output.
In _____ water is retained resulting in dilutional hyponatremia, this leads to fluid overload.
Adrenal insufficiency is AKA?
Lethargy, fatigue, muscle weakness, salt cravings, vigilito, N&V, and weight loss are all S&S of _____
Adrenal insufficiency (Addison't disease)
Two diseases caused by oversecretion of adrenal hormones are:
Cushing's disease (Syndrome), and hyperaldosteronism
Cushing's Disease is caused by the exaggerated secretion of _____ from the adrenal cortex.
In _______ you will see a buffalo hump, truncal obesity, and moon face.
Pts with ____ have an increased risk of infection due to a decreased immune function.
What medications would you ask about with pts who present with Cushing's disease?
glucocorticoid therapy because it is a common cause of hypercortisolism