Nursing Care

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Nursing Care Interventions in Clients with
Pituatary/Adrenal Gland Disorders

• Keith Rischer RN, MA, CEN

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Todays Objectives

• 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.

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Patho Endocrine System

• Endocrine glands
• Pituitary glands
• Adrenal glands
• Thyroid glands
• Islet cells of pancreas
• Parathyroid glands
• Gonads
• Hormones
• Negative feedback mechanism

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Patho Pituitary Gland

• Anterior
• Growth hormone
• Thyroid Stimulating Hormone (TSH)
• Adrenocorticotropic Hormone (ACTH)
• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormone (LH)
• Posterior
• Vasopressin
• Antidiuretic hormone (ADH)

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Anterior Hypo-pituitarism

• Causes
• Tumor
• Brain or pituitary
• Anorexia
• Shock
• Growth hormone
• Gonadatropins
• Women
• Men
• TSH
• ACTH

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Anterior Hypo-pituitarism

• Labs
• T3, T4
• Testerone, estradiol levels
• Nursing interventions
• Replacement of deficient hormones
• Androgen therapy
• gynecomastia can occur
• Estrogens and progesterone
• Growth hormone
• Assess function of target organ
• thyroid

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Anterior Hyper-pituitarism

• Causes
• Pituitary tumors or hyperplasia
• Gigantism
• Acromegaly

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Hypophysectomy

• 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
• Assess IO closely first 24 hours

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Posterior Pituitary Gland Diabetes Insipidus

• Patho
• Antidiuretic hormone
• deficiency
• Water unable to be reabsorbed

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Diabetes Insipidus Clinical Manifestations

• CV
• Tachycardia
• Hypotension
• Heme concentration
• Renal
• Dramatic increased u/o
• Skin
• Dry mucous membranes
• Neuro
• Thirst
• Irritable
• Lethargy to unresponsive

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Diabetes insipidus Interventions

• Nursing Diagnostic Statements
• Deficient fluid volume r/t
• Decreased cardiac output r/t
• Priorities
• Early detection dehydration
• Maintain adequate hydration
• Desmopressin acetate (DDAVP) intranasally
• Synthetic vasopressin
• IO-daily weights

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Syndrome of Inappropriate Antidiuretic Hormone
Secretion (SIADH)

• Patho
• Vasopressin (ADH)
• Increased
• Water retained
• Dilutional hyponatremia
• Causes
• Cancer
• Infection
• Chemo agents
• COPD

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SAIDHClinical Manifestations

• Fluid retention
• Hyponatremia
• Neuro
• Lethargy
• HA
• Altered LOC
• CV
• Tachycardia
• Renal
• u/o decrease

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SAIDH Nursing Interventions

• Nursing diagnostic priorities
• Decreased cardiac output r/t
• Fatigue
• Fluid restriction
• Drug therapy
• Diuretics
• Hypertonic saline (3)
• Neurologic assessment
• Orientation
• Safe environment

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Adrenal Glands

• Patho
• Aldosterone
• Cortisol
• Catecholamines
• Epinephrine
• Beta receptors
• Norepinephrine
• Alpha receptors
• Deduced aldosterone levels
• Hyperkalemia
• acidosis
• Hyponatremia
• hypovolemia

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Adrenal Glands Hypofunction

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

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Addisons Disease Interventions

• Promote fluid balance and monitor for fluid
  deficit.
• Careful IO
• 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

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Adrenal Gland Hyperfunction

• Patho
• Pheochromocytoma
• Cushings syndrome
• Causes
• Primary/secondary malignancies
• Steroids
• Lymphocytes
• Inflammatory/immune response

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Cushings Disease Clinical Manifestations

• Obesity
• Changes in fat distribution
• Moon face
• Facial hair for women
• Thin skin
• Blood vessels fragile
• Acne
• Immunosupression
• HTN
• Water/sodium retention
• Lab changes
• Glucose
• WBC
• Sodium
• Potassium

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Nursing Priorities

• Excess fluid volume r/t
• Risk for infection r/t
• Deficient knowledge

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Medical Management

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

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Cushings Surgical Management

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