Start with History & Physical:
•What is the chief, subjective complaint(s)?
-When started? What makes worse? What makes better?
-Changes from pt's normal state of health
-Recent trends with new or ongoing s/s
-Bladder/Bowel elimination pattern changes? (Hyperthyroid- everything revs up and diarrhea is a problem- bowel elimination.)
-Sexual function changes?
-Sleep and/or mood changes?
-New diet &/or supplements?
+ Past health problems
+ Family history
•Assess for the outcome/effect of previous or current medical treatment
*Include affect, mood, level of energy, overall appearance
*Endocine disorders can make a person look very depressed.
-Thorough Physical Exam, including:
*Physical exam including details like hair, skin texture, asymmetry, anything look unusual. If it feels odd, ask them- have you always had this? Or is this something new?
1. Neurological (think: space-occupying lesions)
-Headaches, visual changes, loss of smell, seizures (for some people, seizure is the first sign)
-Menstrual irregularities, diminished libido, impotence, changes in secondary sex characteristics; poor resistance to infections, hypotension, constipation, weight gain, decreased energy, reduced muscle mass, flat affect
•GH: truncal obesity, decreased muscle mass, decreased energy, reduced capacity to exercise, flat affect or appears depressed, impaired psych well-being
•FSH & LH: menstrual irregularities, diminished libido, changes in secondary sex characteristics, testicular atrophy, decreased sperm count, impotence
•ACTH: weakness, fatigue, head aches, dry/pale skin, diminished axillary & pubic hair; postural hypotension, fasting hypoglycemia, decreased tolerance to stress, poor resistance to *infectionn**
•TSH: similar to primary hypothyroidism but often milder: cold intolerance, constipation, fatigue, lethargy, weight gain
•Maintain nasal packing (floor of brain is exposed), reinforce prn
•NO nose-blowing, vigorous coughing, sucking on a straw- changes pressure, sneezing, bending over, straining w/BM (Valsalva maneuver)- pressure on surgical site.
-May increase pressure at site, cause CSF leak
•Clear nasal drainage? Send to lab for glucose level - results > 30 mg/dL indicate CSF leakage
-Increased risk for meningitis
-Complaints of persistent & severe Head Aches suggests CSF into sinuses from breach in suture
-Leak generally resolves w/in 72 hrs w/bed rest, HOB ↑
-If leak does not resolve, may need spinal taps &/or surgery to equalize pressure
•Give frequent oral care (warm NS rinses - avoid brushing teeth x 10 days to avoid disrupting suture line)
•HOB elevated 30 deg at all times: promotes venous drainage & drainage from surgical site, reduces risk of head aches
•Assess neuro status
•Assess visual acuity/visual fields (because so close to optic nerve)
- medications: ADH, cortisol, thyroid replacement for life
-Estrogen and testosterone- dependant on age.
- long term follow-up to make sure that their levels are functional to titrate levels accordingly
• S/S related to fluid/electrolytes:
(initially very thirsty)
-↓ Na+, K+, BUN, Hgb&Hct
- initial s/s thirst, DOE, fatigue
- u.o. ↓, body weights ↑, urine sp. gravity ↑
- as Na+ ↓ s/s worsen & include vomiting, abd cramps, seizures; muscle pain/weakness
-cerebral edema can occur -- leads to lethargy, anorexia, confusion, H/A, coma