Exam 3 Study Guide

Chapter 65

Hypophysectomy Post-op Care
Monitor neurologic response
Assess for postnasal drip
HOB elevated
Assess nasal drainage
Avoid coughing early after surgery
Assess for meningitis
Hormone replacement
Avoid bending
Avoid strain at stool
Monitor fluid status and lab data
Avoid toothbrushing- Use toothette sponges until directed to resume toothbrushing
Numbness in the area of the incision
Decreased sense of smell
Vasopressin

Diabetes Insipidus
Water metabolism problem caused by an ADH deficiency (either decrease in ADH synthesis or inability of kidneys to respond to ADH), symptoms of dehydration, increase in frequency of urination and excessive thirst
Interventions
Oral chlorpropamide
Desmopressin acetate
Early detection of dehydration and maintenance of adequate hydration
Lifelong vasopressin therapy with permanent condition
Teach patients to weigh themselves daily to identify weight gain

SIADH
Vasopressin secreted even when plasma osmolarity is low or normal, feedback mechanisms do not function properly, water is retained, results in hyponatremia
Interventions
Fluid restriction
Drug therapy: diuretics, hypertonic saline, tolvaptan, conivaptan
Monitor for fluid overload
Safe environment
Neurologic assessment

Addison’s Disease
Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids) from the adrenal gland, resulting in deficiency of the corticosteroid hormones.
Primary Causes
Idiopathic (autoimmune) disease
Tuberculosis
Metastatic cancer
Fungal lesions
AIDS
Hemorrhage
Gram-negative sepsis
Adrenalectomy
Abdominal radiation therapy
Drugs (mitotane) and toxins Secondary Causes
Sudden cessation of long term glucocorticoid therapy
Pituitary tumors
Pastpartum pituitary necrosis
Hypophysectomy
High-dose pituitary radiation
High-dose whole-brain radiation Interventions
Monitor for signs and symptoms of fluid volume deficit, encourage fluids and foods, select foods high in sodium, administer hormone replacement as prescribed
Avoid stress and activity until stable, perform all activities for patient when in crisis, maintain a quiet nonstressful environment, measures to reduce anxiety
Teaching

Adrenal Crisis Clinical Manifestations
Profound fatigue
Dehydration
Vascular collapse (decrease in bp)
Renal shut down (decreased serum NA, Increased serum K)

Cushing’s Disease Diet
Encourage diet high in protein, potassium, calcium and vitamin D
Fluid and sodium intake decrease to control fluid volume

Expected outcomes with fluid overload
Hypertension, rapid increase in body weight, shift in serum electrolytes

Psychosocial Assessment
Can result in emotional instability, pt’s state they do not feel like themselves
Ask about mood swings, irritability, confusion or depression.
Often reports sleep difficulties and fatigue

Chapter 66

Hyperthyroidism Clinical Manifestations
Nervousness, palpitations, rapid pulse, tolerate heat poorly, termors, skin is flushed, warm, soft, and moist, exophthalmos, increased appetite and dietary intake, weight loss, elevated systolic BP, may progress to cardiac dysrhythmias and failure
Drug Therapy
PTU and methimazole
Sodium or potassium iodine solutions
Dexamethasone
Beta-blockers
Complications
Thyroid storm- excessive thyroid hormone release. Manifestations include fever, tachycardia, and systolic hypertension.
Maintain airway, give antithyroid drugs, sodium iodide solution, propranolol, glucocorticoids, and cool the patient down.
Diet
High calorie diet

Hypothyroidism
Clinical Manifestations
Fatigue, hair, skin and nail changes, numbness and tingling of fingers, menstrual disturbances, subnormal temp and pulse, weight gain, subdued emotional and mental responses, slow speech, tongue, hands and feet may enlarge, personality and cognitive changes, cardiac and respiratory complications
Drug Therapy
Levothyroxine Sodium
Complications