Nursing Care Interventions in Clients with PituataryAdrenal Gland

Nursing Care & Interventions in Clients with Pituatary/Adrenal Gland Disorders Keith Rischer RN, MA, CEN 1

Today’s Objectives… Ø Ø Ø Compare and contrast pathophysiology & manifestations of pituitary/adrenal gland dysfunction. Identify, nursing priorities, and client education associated with pituitary/adrenal gland dysfunction. Interpret abnormal laboratory test indicators of pituitary/adrenal gland dysfunction. Analyze assessment to determine nursing diagnoses and formulate a plan of care for clients with pituitary and adrenal gland dysfunction. Describe the mechanism of action, side effects and nursing interventions of pharmological management with pituitary and adrenal gland dysfunction. 2

Patho: Endocrine System Ø Endocrine glands • • • Ø Pituitary glands Adrenal glands Thyroid glands Islet cells of pancreas Parathyroid glands Gonads Hormones • Negative feedback mechanism 3

Patho: Pituitary Gland Ø Anterior • • • Ø Growth hormone Thyroid Stimulating Hormone (TSH) Adrenocorticotropic Hormone (ACTH) Follicle Stimulating Hormone (FSH) Luteinizing Hormone (LH) Posterior • Vasopressin ü Antidiuretic hormone (ADH) 4

Anterior Hypo-pituitarism Ø Causes • Tumor ü • • Ø Ø • Ø Anorexia Shock Growth hormone Gonadatropins • Ø Brain or pituitary Women Men TSH ACTH 5

Anterior Hypo-pituitarism Ø Labs • • Ø T 3, T 4 Testerone, estradiol levels Nursing interventions • Replacement of deficient hormones ü Androgen therapy – gynecomastia can occur ü Estrogens and progesterone ü Growth hormone • Assess function of target organ ü thyroid 6

Anterior Hyper-pituitarism Ø Causes • Pituitary tumors or hyperplasia ü Gigantism ü Acromegaly 7

Hypophysectomy Ø Post op Care • Closely monitor neuros • Assess for postnasal drip “halo sign” • Avoid coughing early after the surgery. • Keep HOB elevated • Assess for meningitis • Replace hormones and glucocorticoids as needed • Diabetes insipidus ü Assess I&O closely first 24 hours 8

Posterior Pituitary Gland: Diabetes Insipidus Ø Patho • Antidiuretic hormone ü • deficiency Water unable to be reabsorbed 9

Diabetes Insipidus: Clinical Manifestations Ø CV • • • Ø Renal • Ø Dramatic increased u/o Skin • Ø Tachycardia Hypotension Heme concentration Dry mucous membranes Neuro • • • Thirst Irritable Lethargy to unresponsive 10

Diabetes insipidus: Interventions Ø Nursing Diagnostic Statements • • Ø Priorities • • Ø Deficient fluid volume r/t… Decreased cardiac output r/t… Early detection dehydration Maintain adequate hydration Desmopressin acetate (DDAVP) intranasally • • Synthetic vasopressin I&O-daily weights 11

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Ø Patho • Vasopressin (ADH) ü • Water retained ü Ø Increased Dilutional hyponatremia Causes • • Cancer Infection Chemo agents COPD 12

SAIDH: Clinical Manifestations Ø Fluid retention • Ø Neuro • • • Ø Lethargy HA Altered LOC CV • Ø Hyponatremia Tachycardia Renal • u/o decrease 13

SAIDH: Nursing Interventions Ø Nursing diagnostic priorities • • Ø Ø Fluid restriction Drug therapy • • Ø Decreased cardiac output r/t… Fatigue Diuretics Hypertonic saline (3%) Neurologic assessment • • Orientation Safe environment 14

Adrenal Glands Ø Patho • • • Aldosterone Cortisol Catecholamines ü Epinephrine – Beta receptors ü Norepinephrine – Alpha receptors • Deduced aldosterone levels ü Hyperkalemia – acidosis ü Hyponatremia – hypovolemia 15

Adrenal Glands: Hypofunction Ø Acute adrenal insufficiency • • Addisonian crisis Causes ü Steroids Ø stopped abruptly Clinical manifestations • • Muscle weakness, fatigue, constipation Hypoglycemia ü • • Diaphoresis, tachy, tremors Blood volume depletion Hyperkalemia ü cardiac arrest-rhythm changes 16

Addison’s Disease: Interventions Ø Ø Ø Promote fluid balance and monitor fluid deficit. • Careful I&O • Record weight daily Assess vital signs every 1 to 4 hours, assess for dysrhythmias or postural hypotension. Monitor laboratory values • Na • K • Glucose Cortisol and aldosterone replacement therapy Diet - ↑ sodium, ↓ potassium, ↑ Carbs 17

Adrenal Gland: Hyperfunction Patho Ø Pheochromocytoma Ø Cushing’s syndrome Ø • Causes ü Primary/secondary malignancies ü Steroids • • Lymphocytes Inflammatory/immune response 18

Cushing’s Disease: Clinical Manifestations Ø Obesity • Changes in fat distribution ü Ø Ø Ø Facial hair for women Thin skin Blood vessels fragile Acne Immunosupression HTN • Ø Moon face Water/sodium retention Lab changes • • Glucose WBC Sodium Potassium 19

Nursing Priorities Excess fluid volume r/t… Ø Risk for infection r/t… Ø Deficient knowledge Ø 20

Medical Management Ø Drug therapy • • Mitotane If caused by side effect of medication ü Ø try to decrease or change meds Radiation therapy • Pituitary tumors 21

Cushings: Surgical Management Total hypophysectomy Ø Adrenalectomy Ø Preoperative care Ø • Ø Correct lyte imbalances Postoperative care • • • Prevent skin breakdown Pathologic fractures Education regarding lifelong steroid use ü Take with meals ü Never skip doses ü Weigh daily 22