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136 Cards in this Set

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Which anterior pituitary cells are most likely to have tumors?
Those that produce growth hormone, prolactin, and ACTH
Most common cause of hyperpituitarism:
Pituitary adenoma
Define pituitary adenoma:
A benign tumor of one or more tissues within the anterior pituitary
Symptoms of a pituitary adenoma pressing on brain tissue:
Visual changes, headache, and increased intracranial pressure
Most common type of pituitary adenoma:
Prolactin (PRL)-secreting tumors
Overproduction of GH results in:
Gigantism or acromegaly
GH blocks the action of which hormone?
Insulin
Excess ACTH leads to the development of:
Cushing's disease
Assessment for pituitary disorders:
Changes in hat/glove/ring/shoe size, backache/arthralgias (GH), headaches/changes in vision
Manifestations of hypersecretion of prolactin:
Sexual dysfunction, menstrual changes, impotence, decreased libido
Initial manifestations of GH hypersecretion:
Changes in facial features
Manifestations of prolactin hyperproduction:
Hypogonadism
Galactorrhea
Increased body fat
Decreased libido
Sexual dysfunction
Impotence
Manifestations of ACTH hyperproduction (Cushing's disease):
Elevated plasma cortisol levels
Weight gain
Truncal obesity
“Moon face”
Extremity muscle wasting
Loss of bone density
Hypertension
Hyperglycemia
Purple striae
Acne
Thin, easily damaged skin
Hyperpigmentation
Manifestations of TSH hyperproduction:
Elevated plasma TSH levels
Elevated plasma thyroid hormone levels
Weight loss
Tachycardia and dysrhythmias
Heat intolerance
Increased GI motility
Fine tremors
Major nursing diagnoses for anterior pituitary disorders:
Disturbed Body Image
Sexual Dysfunction related to disease
Acute Pain and Chronic Pain related to compression of tissues by tumor
Anxiety
Disturbed Sensory Perception (Visual)
Most common drugs used to treat anterior pituitary hyperfunction:
Dopamine agonists, including bromocriptine mesylate, cabergoline, and pergolide
Common side effects of bromocriptine:
Orthostatic hypotension
Headaches
Gastric irritation
Nausea
Abdominal cramps
Constipation
Serious/rare side effects of bromocriptine:
Cardiac dysrhythmias
Coronary artery spasm
CSF fluid leakage
Pre-surgery teaching for transsphenoidal hypophysectomy:
Nasal packing 2-3 days postop
"Mustache" dressing under nose
Body changes, organ enlargement, visual changes not reversible
Avoid increasing ICP post-op
Post-op care for the s/p transsphenoidal hypophysectomy patient:
Neurologic checks!!!
Diabetes insipidus
CSF leakage signs (postnasal drip)
Infection
Increased ICP signs
Ways to tell if nasal drainage is CSF:
Glucose present
Light yellow color at edge of clear drainage ("halo sign")
Persistant, severe headaches
What should we teach patients to avoid early after hypophysectomy surgery to keep the incision intact?
COUGHING/sneezing/bending
What signs of infection are important to monitor for after a transsphenoidal hypophysectomy?
Meningitis signs: headache, fever, nuchal rigidity
What hormones need to be replaced lifelong if the entire pituitary gland is removed?
Thyroid
Glucocorticoid
(Possibly) Gonadal
How long after a transsphenoidal hypophysectomy does the pt need to avoid increasing ICP?
2 months
Oral care after transsphenoidal hypophysectomy:
No brushing for 2 weeks
Mouthwash q4-6hr
Floss daily
Hormone produced by the posterior pituitary:
ADH/vasopressin
ADH deficiency leads to:
Diabetes insipidus
ADH excess leads to:
SIADH
Manifestations of diabetes insipidus:
Polyuria
Polydipsia
Dehydration
Types of diabetes insipidus:
Nephrogenic (tubules do not react to ADH)
Primary (defect in hypothalamus/pituitary)
Secondary (tumor/trauma/infection/surgery)
Drug-related (lithum, Declomycin)
Characteristics of urine in a pt with diabetes insipidus:
Low specific gravity
Low osmolarity
Urine output per 24hr with diabetes insipidus:
4-30L
Pharmaceutical treatment of diabetes insipidus:
Chlorpropamide (increases ADH action)
Vasopressin replacement therapy
Nursing management of diabetes insipidus:
Accurate I&Os
Checking urine SG
Urge pts to drink fluids in amount equal to urine output OR make sure IV is replacing fluids appropriately
Important patient teaching for diabetes insipidus:
Daily weight monitoring
Recognizing other signs of water toxicity (headache, confusion)
Changes in electrolyte levels as a result of SIADH:
Hyponatremia
Early manifestations of SIADH:
Water retention
GI disturbances (N/V, anorexia)
Is edema a manifestation of SIADH?
No
VS changes seen in SIADH:
Tachycardia
Hypothermia
CNS manifestations of SIADH:
Lethargy
Headaches
Hostility
Disorientation
Change in LOC (all the way to coma)
Changes in plasma and urine osmolarity in SIADH:
Urine: volume down, osmolarity up
Plasma: volume up, osmolarity down
Medical interventions for SIADH:
Restrict fluid intake
Promote excretion of water
Replace sodium
Interfere with ADH action
With a patient with SIADH, what should be used for mixing tube feeds, GI tube irrigation, etc?
Saline, not normal water
Problematic side effect of demeclocycline:
Oral candidiasis
Nursing assessment for SIADH:
Fluid status
Neurological status
Three general causes for adrenal hypofunction:
Inadequate ACTH
Dysfunctional of the hypothalamic-pituitary control mechanism
Direct dysfunction of the adrenal gland
Impaired secretion of cortisol causes:
Decreased gluconeogenesis
Hypoglycemia
Reduced aldosterone secretion causes:
Imbalances in potassium, sodium, and water:
Hyperkalemia
Hyponatremia
Hypovalemia
Define Addisonian crisis:
A life-threatening event in which the need for cortisol and aldosterone is greater than the available supply
Most common cause of secondary adrenal insufficiency:
Long-term glucocorticoid therapy
Lab results seen in primary adrenal insufficiency:
Elevated plasma ACTH and MSH
Definitive test for adrenal insufficiency:
ACTH stimulation test
Nursing interventions for adrenal insufficiency:
Promote fluid balance
Monitor for fluid deficit
Prevent hypoglycemia
Hypersecretion by the adrenal cortex results in:
Cushing's disease/syndrome and/or
Hyperaldosteronism and/or
Excessive androgen production
Tumor of the adrenal cortex resulting in excessive production of catecholamines:
Pheochromocytoma
Define Cushing's disease:
Exaggerated actions of glucocorticoids, arising from excessive secretion
Define Cushing's syndrome:
Excess glucocorticoids as a result of drug therapy for another health problem
Laboratory findings that accompany hypercortisolism/Cushing's:
Increased blood glucose
Decreased lymphocyte count
Increased sodium
Decreased calcium
Decreased potassium
Priority nursing diagnoses for Cushing's:
Excess fluid volume
Risk for injury
Risk for infection
What pt is most at risk for acute adrenal insufficiency?
The one who has Cushing's as a result of glucocorticoid drug therapy
Differentiate hyperthyroidism and thyrotoxicosis:
Hyperthyroidism: excessive thyroid hormone secretion from the thyroid gland
Thyrotoxicosis: the manifestations of hyperthyroidism, regardless of the origin of hormones
Two very generalized manifestations of hyperthyroidism:
Hypermetabolism
Increased SNS activity
How does hyperthyroidism affect the cardiovascular system?
Palpitations
Chest pain
Increased SBP
Widened pulse pressure
Tachycardia
Dysrhythmias
How does hyperthyroidism affect the integumentary system?
Diaphoresis
Warm, moist skin
Thinning of scalp hair
How does hyperthyroidism affect the pulmonary system?
Shortness of breath
Rapid, shallow respiration
How does hyperthyroidism affect the gastrointestinal system?
Weight loss
Increased appetite
Increased stools
Hypoproteinemia
How does hyperthyroidism affect the musculoskeletal system?
Muscle weakness
Muscle wasting
How does hyperthyroidism affect the neurological system?
Blurred/double vision
Eye fatigue
Increased tears
Photophobia
Hyperactive tendon reflexes
Tremors
Insomnia
How does hyperthyroidism affect metabolic systems?
Increased metabolic rate
Heat intolerance
Low-grade fever
Fatigue
How does hyperthyroidism affect the psychological/emotional systems?
Decreased attention span
Restlessness
Irritability
Emotional lability
Manic behavior
Define goiter:
Swelling in the neck from hypertrophy/hyperplasia of the thyroid gland
Define exophthalmos:
Protrusion of the eyes (seen in Graves' disease)
Most common cause of hyperthyroidism:
Graves' disease
Is a goiter a defining sign of hyperthyroidism?
No
Define Graves' disease:
Autoimmune disorder in which antibodies attack to the TSH receptor sites
Another name for T3 hormone:
Triiodothyronine
Another name for T4 hormone:
Thyroxine
Which VS is most critical to monitor in a hyperthyroid patient?
Temperature
What does an increase in temperature in a hyperthyroid potentially indicate?
Thyroid storm
Manifestations of thyroid storm:
Fever
Tachycardia
Systolic hypertension
Potential complications of thyroidectomy:
Hemorrhage
Respiratory distress (can be hemorrhage-related)
Hypocalcemia (parathyroid-related)
Tetany (parathyroid-related)
Laryngeal nerve damage
Production of alpha & beta cells of the pancreas:
Alpha: glucagon
Beta: insulin, amylin
What is the relationship between glucagon and insulin?
They counterregulate each other
Function of glucacon:
Causes release of glucose from cell storage sites when blood glucose levels are low
Function of insulin:
Allows body cells to store/use energy
Cause of Type 1 diabetes:
Beta cell destruction
Autoimmune process, possibly virus-triggered
Cause of Type 2 diabetes:
Insulin resistance
Classic symptoms of diabetes:
Polyuria
Polydipsia
Polyphagia
The dehydration that occurs with diabetes leads to (5 H's):
Hemoconcentration
Hypovolemia
Hyperviscosity
Hypoperfusion
Hypoxia
How does blood pH change with an absence of insulin?
Acidotic
What breathing pattern is associated with diabetic acidosis?
Kussmaul respiration
Define Kussmaul respiration:
Increased rate and depth
What characteristic can be noted in the breath of someone with diabetic acidosis?
Fruity/acetone breath
What electrolyte gets out of whack with a lack of insulin?
Potassium
Three glucose-related emergencies that can occur in diabetics:
Diabetic ketoacidosis (DKA)
Hyperglycemic-hyperosmolar state (HHS)
Hypoglycemia
Macrovascular complications of diabetes:
Coronary heart disease
Cerebrovascular disease
Peripheral vascular disease
Microvascular complications of diabetes:
Nephropathy
Neuropathy
Retinopathy
What's the earliest clinical sign of diabetic nephropathy?
Microalbuminuria
How can Type 2 diabetes be prevented or delayed?
Weight loss, increased physical activity
Questions to ask a pt to assess for diabetes:
Ask about fatigue, polyuria, polydipsia
Ask about major/minor infections (esp. yeast infections in women)
Ask if wounds take longer to heal
Ask about vision and sense of touch
What's the ideal range for hemoglobin A1c?
4-6%
What level of hemoglobin A1c indicates poor diabetic control?
> 8%
What's another name for hemoglobin A1c testing?
Glycosylated hemoglobin assay
What are ketone bodies a byproduct of?
Fat metabolism
Which diabetic patients can benefit from sulfonylurea agents?
Those with some remaining beta-cell function
How do sulfonylurea agents work?
Stimulate insulin secretion from beta cells & increase sensitivity at cell receptor sites
Side effects of sulfonylurea agents:
Weight gain
Hypoglycemia
How do meglitinide analogues work?
Same as sulfonylurea agents - stimulate insulin secretion
How does Metformin work?
Decreases liver glucose production and improves insulin receptor sensitivity
Why is Metformin the drug of choice for Type 2 diabetes?
No weight gain/hypoglycemia
Low cost
Few adverse effects
Side effects of metformin:
Abdominal discomfort/diarrhea
Lactic acidosis in renal patients
How do alpha-glucosidase inhibitors work?
Delay absorption of carbohydrates
Side effects of alpha-glucosidase inhibitors:
Flatulence, diarrhea, abdominal discomfort
How do TZDs work?
Improve insulin sensitivity, reduce liver glucose production
Side effects of TZDs:
Increase in adipose tissue
Fluid retention
What type of insulin is used for basal coverage?
NPH or long-acting insulin
Types of rapid-acting insulin:
Insulin aspart (NovoLog)
Insulin glulisine (Apidra)
Human lispro (Humalog)**
Types of short-acting insulin:
Regular insulin (anything w/ an "R" at the end, i.e. Humulin R)
Types of intermediate-acting insulin:
NPH (anything w/ an "N" at the end)
Insulin detemir
Type of long-acting insulin:
Insulin glargine (Lantus)
Where is insulin absorption fastest subcutaneously?
The abdomen
When insulins are mixed, which should be drawn into the syringe first?
The SHORT-ACTING one
Which insulins should NOT be mixed?
Insulin glargine (Lantus)
Insulin detemir
What type of insulin is used with an insulin pump?
Rapid-acting
How should insulin be stored?
Insulin not in use should be refrigerated, away from sunlight
Insulin in use can be kept at room temp for 28 days
When mixing insulins, which bottle should you inject air into first?
The intermediate-acting insulin (NPH) bottle
Sx of hypoglycemia:
Weakness/fatigue
Confusion
Behavior changes
Seizures
LOS
Shaking/tremors
Pounding heart
Nervousness/anxiety
Sweating
Hunger
Tingling
Management of hypoglycemia:
Carbohydrate replacement
Glucagon drug therapy
What is the most common initial trigger for DKA?
Infection
DKA vs. HHS: onset
DKA is sudden
HHS is gradual
DKA vs. HHS: precipitating factors
Both precipitated by infection and other stressors
DKA: inadequate insulin
HHS: poor fluid intake
DKA vs. HHS: manifestations
DKA: Kussmaul respiration, "fruity" breath, nausea and abdominal pain
HHS: Altered CNS function

Both: dehydration, electrolyte loss, lethargy, coma
Management of hyperglycemia:
Assess fluid status
Keep patient hydrated
Insulin to lower blood glucose
Potassium replacement
Acidosis management
Management of HHS:
Fluid therapy!
IV insulin/potassium
When is IV insulin administered in a patient with HHS?
AFTER rehydration