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Care of Patients With Pituitary and Adrenal Gland Problems

Terms in this set (27)

What lab findings are consistent with a patient diagnosed with hyper aldosteronism?

Arterial pH 7.48

Serum sodium 148 mEq/L

Serum calcium 8.0 mg/dL

Serum glucose 358 mg/dL

Serum potassium 5.3 mEq/L
Arterial pH 7.48

Serum sodium 148 mEq/L

Rationale
Patients diagnosed with hyperaldosteronism usually are alkalotic and have hypernatremia. Calcium and glucose are not usually affected with this diagnosis. Potassium is usually low, not high.
What findings are consistent with a diagnosis of hyperaldosteronism?


Headache

Dehydration

Muscle weakness

Profuse diaphoresis

Intermittent hypertension
Headache

Dehydration

Muscle weakness

Rationale
Headache, dehydration, and muscle weakness are common findings in patients diagnosed with hyperaldosteronism. Profuse diaphoresis and intermittent hypertension are not consistent with this diagnosis.
Which laboratory results indicate that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)?


Decreased hematocrit

Decreased serum osmolality

Increased serum sodium

Increased urine specific gravity
Increased serum sodium

Rationale
Increased serum sodium due to fluid restriction indicates effective therapy. Hemoconcentration is a result of hypovolemic hyponatremia caused by SIADH and diabetes insipidus. Plasma osmolality is decreased as a result of SIADH. Urine specific gravity is decreased with diabetes insipidus and is increased with SIADH.
The patient is being seen by the primary care provider for thyroid-stimulating hormone (TSH) deficiency. What assessment findings are consistent with this diagnosis?

Headache

Weight gain

Scalp alopecia

Slowed cognition

Postural hypotension
Weight gain

Scalp alopecia

Slowed cognition

Weight gain, scalp alopecia, and slowed cognition are common findings in patients with a deficiency in TSH. Headache and postural hypotension are commonly found in patients with deficiency of ACTH, not TSH.
A patient has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the patient?

<p>A patient has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the patient?</p>

Encourages the patient to cough and deep-breathe.

Instructs the patient not to strain during a bowel movement.

Instructs the patient to blow the nose for postnasal drip.

Places the patient in the Trendelenburg position.
Instructs the patient not to strain during a bowel movement.

Straining during a bowel movement increases ICP and must be avoided. Laxatives may be given and fluid intake encouraged to help with this. Although deep-breathing is encouraged, the patient must avoid coughing early after surgery because this increases pressure in the incision area and may lead to a cerebrospinal fluid (CSF) leak. If the patient has postnasal drip, he or she must inform the nurse and not blow the nose; postnasal drip may indicate leakage of CSF. The head of the bed must be elevated after surgery.

p. 1284
What are the most common features of acromegaly?

Moon face

Thickened lips

Fine tremors

Acne
Thickened lips

Rationale
Overproduction of GH in adults results in acromegaly. The onset may be gradual with slow progression and may be noticed as thickened lips, coarse facial features, increasing head size and lower jaw protrusion. Moon face is related to Cushing's disease. Fine tremors are associated with excessive thyroid stimulating hormone and acne is associated with hyperproduction of adrenocorticotropic hormone (ACTH).
After receiving a change-of-shift report about these four patients, which patient does the nurse attend to first?
Patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL

Patient with diabetes insipidus who has a dose of desmopressin (DDAVP) due

Patient with hyperaldosteronism who has a serum potassium of 3.4 mEq/L

Patient with pituitary adenoma who is reporting a severe headache
Patient with acute adrenal insufficiency who has a blood glucose of 36 mg/dL

Rationale
A glucose level of 36 mg/dL is considered an emergency; this patient must be assessed and treated immediately. Although it is important to maintain medications on schedule, the patient requiring a dose of desmopressin is not the first patient who needs to be seen. A serum potassium of 3.4 mEq/L in the patient with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The patient reporting a severe headache needs to be evaluated as soon as possible after the patient with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel (UAP).

p.1274
A patient has undergone a hypophysectomy. What postoperative interventions does the nurse perform for this patient?
Monitor neurologic status every 4 hours.

Discard and replace the nasal drip pad at regular intervals.

Have the patient lie flat after surgery.

Have the patient avoid brushing the teeth for 2 weeks after surgery
Have the patient avoid brushing the teeth for 2 weeks after surgery

Rationale
Following a hypophysectomy, the patient should be instructed to avoid brushing the teeth for 2 weeks after surgery until the incision sufficiently heals. Frequent mouth care with mouthwash and daily flossing provide adequate oral hygiene. The patient must use a mirror to check the gums for bleeding; reduced sensation in the mouth increases the risk for injury. The nurse monitors the patient's neurologic status every hour for the first 24 hours and then every 4 hours. The nasal drip pad is assessed for quantity and quality of drainage before it is discarded; a light yellow color at the edge of clear drainage on the dressing is indicative of cerebrospinal fluid leak. The head of the bed is elevated after surgery to prevent edema.

p. 1271
What nursing interventions are appropriate for a patient diagnosed with adrenal hypofunction? .

Monitor BUN levels

Monitor hematocrit levels

Administer steroid therapy

Place patient on salt restrictions

Administer a potassium replacement
Monitor BUN levels

Monitor hematocrit levels

Administer steroid therapy
A patient diagnosed with diabetes insipidus (DI) has received education about his diagnoses. What statement by the patient indicates an understanding of the teaching?
"I will need to decrease the amount of fluid I drink."

"I should increase my sodium intake to avoid seizures."

"It is important to take my conivaptan at the same time every day."

"I will need to change positions slowly to avoid getting lightheaded."
"I will need to change positions slowly to avoid getting lightheaded."

Rationale
DI can lead to orthostatic hypotension. Patients should be taught to change positions slowly. Patients with DI need increased, not decreased, fluid intake. The patient will have hypernatremia and should not increase sodium intake; instead, it should be restricted. Conivaptan is indicated in patients with SIADH, not DI, to promote water excretion.
A patient with hypercortisolism is at risk for bone fractures. What does the nurse instruct the unlicensed assistive personnel (UAP) to do when caring for this patient?

Use a gait belt to assist the patient when walking.

Grasp the patient when assisting movement in bed.

Allow the patient to use the walker without assistance.

Place mats next to the bed to protect the patient from cold floors.
Use a gait belt to assist the patient when walking.

Rationale
The patient with hypercortisolism has low bone density and is at risk of bone fractures so a gait belt should be used to assist the patient when walking. The UAP must use lift sheets to help the patient to move in bed, and not grasp and lift the patient. This helps reduce the shear on the skin and prevents any risk of injury to the patient. The UAP must remind the patient to call for help when ambulating; the patient must not be allowed to use the walker or cane and move without assistance. The UAP must ensure that the room is free of objects that can cause the patient to trip and fall.

p. 1280
Which condition results from excessive secretion of vasopressin even when plasma osmolarity is low or normal?

Cushing syndrome

Sheehan's syndrome

Schwartz-Bartter syndrome

Waterhouse-Friderichsen syndrome
Schwartz-Bartter syndrome

Rationale
Schwartz-Bartter syndrome is also known as the syndrome of inappropriate antidiuretic hormone secretion. In this condition, excess vasopressin or antidiuretic hormone is secreted even when plasma osmolarity is low or normal. Cushing's syndrome is characterized by the increased secretion of cortisol from the adrenal cortex, which results in widespread problems. Sheehan's syndrome is described as pituitary ischemia or infarction caused by postpartum hemorrhage resulting in decreased secretion of hormones. Waterhouse-Friderichsen syndrome is caused by adrenal gland failure resulting from severe gram-negative sepsis.

p. 1272
The nurse is caring for a patient who is diagnosed with adrenal insufficiency. The patient has the following lab results: potassium 5.9 mEq/dL, sodium 128 mEq/dL, and calcium 8.0 mg/dL. The patient reports palpitations. What action by the nurse is priority?
Rationale
Patients with hyperkalemia may experience dysrhythmias. The patient's cardiac rhythm must be assessed and monitored because the patient is reporting they have palpitations, which is indicative of a dysrhythmia. An increase in IV fluids may be needed, yet it is not the first priority in this situation. Weighing the patient daily is important in assessing fluid balance in a patient with adrenal insufficiency, yet it is not a priority intervention when the patient reports palpitations. Assessing the potassium intake is also not a priority.

p. 1275
A patient presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this patient?

Administering furosemide

Providing isotonic fluids

Replacing potassium losses

Restricting sodium
Rationale
Providing isotonic fluid is the priority intervention because this patient's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone. Furosemide is a loop diuretic, which this patient does not need. Potassium is normally increased in acute adrenal insufficiency, but potassium may have been lost if the patient has had diarrhea; laboratory work will have to be obtained. Any restrictions, including sodium, should not be started without obtaining laboratory values to establish the patient's baseline.
What is the rationale for administration of ranitidine to a patient who is experiencing acute adrenal insufficiency?
Treatment of nausea

Reduction of potassium

Prevention of gastric ulcers

Replacement of adrenocorticotropic hormone (ACTH)
Prevention of gastric ulcers

Rationale
Histamine blockers (including ranitidine) are administered to prevent ulcers in patients with acute adrenal insufficiency. The medication is not indicated for treatment of nausea. The medication will not reduce potassium. The medication will not replace adrenocorticotropic hormone.
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