Chapter 41 and 42
hyposecretion of hormones from anterior pituitary gland; deficiency of one of the anterior pituitary hormones results in changes in metabolic or sexual function
hypopituitarism
in children before the closure of the epiphyses, ______ (small stature) develops
dwarfism
a lack of GH in adults does not affect bone length, but does affect bone
density and osteoporosis may develop
clinical manifestations of decreased glucocorticoids associated with hypopituitarism?
clinical manifestations of decreased mineralocorticoids associated with hypopituitarism?
clinical manifestations of growth hormone associated with hypopituitarism?
clinical manifestations of thyroid-stimulating hormone (TSH) associated with hypopituitarism?
think decreased levels of T3 and T4
aldosterone controls?
Na+ and water
lack of ACTH with a resultant decrease in glucocorticoids and mineralocorticoids is a life-threatening emergency because the pt is unable to maintain adequate fluid volume status, which may lead to circulatory collapse
panhypopituitarism
what do pt's VS look like with hypopituitarism?
what must we teach our patients about taking hormone at home?
taking hormone supplements in the morning mimics the normal release of these hormones
hypersecretion of hormones from anterior pituitary gland; usually related to a hypersecreting tumor
hyperpituitarism
in children before the closure of the epiphyses, _____ (large stature) develops
gigantism
an excess of GH in adults does not affect bone length because of closure of the epiphyses but does affect bone density, and ______ (thickening of bones, particularly of the hands, feet, and facial bones) may develop
acromegaly
clinical manifestations of increased glucocorticoids associated with hyperpituitarism?
clinical manifestations of increased mineralocorticoids associated with hyperpituitarism?
clinical manifestations of GH associated with hyperpituitarism?
clinical manifestations of thyroid-stimulating hormone (TSH) associated with hyperpituitarism?
think increased T3 and T4
vital signs with hyperpituitarism?
review nursing interventions for a pt after transphenoidal hypophysectomy
pt 925
A nurse is caring for a client who is being evaluated for acromegaly. Which of the following manifestations should the nurse expect to find during assessment? Select all that apply.
A. Loss of color discrimination
B. Coarse facial features
C. Enlarged distal extremities
D. Hepatomegaly
E. Moon face
A, B, C, D
where are your adrenal glands located?
on top of each kidney
the adrenal cortex secretes?
primary glucocorticoid and its actions include carbohydrate, fat, and protein metabolism; suppression of the immune response; and control of the body's stress response
cortisol
primary mineralocorticoid, and its primary actions are to promote sodium and water reabsorption and potassium excretion in the kidneys?
aldosterone
what happens if exogenous corticosteroids are discontinued abruptly?
Addisonian crisis (acute adrenal crisis)
adrenal insufficiency that may result from destruction of the adrenal glands or insufficiency or Addison's disease
adrenal cortical insufficiency
adrenal cortical insufficiency (Addison's crisis) is a decrease/increase in glucocorticoids and mineralocorticoids
decrease
patients presenting with acute adrenal insufficiency require emergency stabilization with IV fluids and glucose, along with IV administration of glucocorticoids
***
clinical manifestations of adrenal cortical insufficiency/Addison's crisis?
what is our volume like in adrenal cortical insufficiency/Addison's crisis?
FVD
what replacement is necessary for adrenal insufficiency?
replacement of cortisol
The nurse correlates which clinical manifestation with the pathophysiology of adrenal insufficiency?
A. Heat intolerance
B. Weight gain
C. Peripheral edema
D. Hypoglycemia
D. Hypoglycemia
A patient has been receiving doses of prednisone for treatment of RA for the past 3 months. If this medication is suddenly discontinued, for which complication is the patient at risk?
A. Hypovolemia
B. Hypernatremia
C. Hypothermia
D. Hyperglycemia
A. Hypovolemia
adrenal cortex disorder in which there is an excessive secretion of glucocorticoids and mineralocorticoids
adrenal cortex hyperfunction; Cushing's
clinical manifestations of adrenal cortex hyperfunction/Cushing's?
clinical manifestations of adrenal cortex hyperfunction/Cushing's related to overproduction of cortisol?
decreased inflammatory and immune responses
what is our fluid like in adrenal cortex hyperfunction/Cushing's?
FVE
safety alert
pg 938
what are the electrolytes and BS doing in adrenal cortex hyperfunction/Cushing's?
patients who have an adrenalectomy are at risk for?
Addison's; will need steroids
possible complications from adrenal cortex hyperfunction/Cushing's?
rare catecholamine secreting tumors of the adrenal medulla; secrete epi and norepi
pheochromocytoma
clinical manifestations of pheochromocytoma?
treatment for pheochromocytoma?
adrenalectomy is the definitive treatment
vital signs in pheochromocytoma?
pheochromocytoma is/is not life threatening
is life threatening
what is important to remember about the morning of adrenalectomy?
administer glucocorticoid to avoid adrenal insufficiency
A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make?
A. It is caused by the lack of production of insulin by the pancreas.
B. It is caused by the lack of production of aldosterone by the adrenal gland.
C. It is caused by the overproduction of growth hormone by the pituitary gland.
D. It is caused by the overproduction of parathormone by the parathyroid gland.
B. It is caused by the lack of production of aldosterone by the adrenal gland.
A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching?
A. Limit intake of potassium-rich foods
B. Restrict sodium intake
C. Increase carbohydrate intake
D. Decrease protein intake
B. Restrict sodium intake
A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize that which of the following are manifestations of Cushing's syndrome? (Select all that apply.)
A. Alopecia
B. Tremors
C. Moon face
D. Purple striations
E. Buffalo hump
A, C, D, E
A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect?
A. Hyperpigmentation
B. Intention tremors
C. Hirsutism
D. Purple striations
A. Hyperpigmentation
A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortiolism?
A. A client who has a butterfly rash on his face
B. Moon face
C. A client who has a positive Chvostek's sign
D. A client who has muscle hypertrophy
B. Moon face