Chapter 49: Endocrine Problems: disorders of the pituitary gland

Which rationale would the nurse give a patient who had a hypophysectomy to avoid vigorous coughing and sneezing?

to prevent cerebrospinal fluid leakage

Which findings in a patient diagnosed with acromegaly would require the nurse to prepare the patient for surgery?

1. appearnace of pituitary tumors 2. increase in growth hormone (GH) concentration after oral glucose tolerance test

which endocrine problem is more common in men than in women?

Ectopic adrenocorticotropic hormone production

A patient has a dysfunction of the pituitary gland. Which hormone secretion may be altered in a patient with a dysfunction of the pituitary gland?

prolactin

Which assessment finding would be increased in a patient with diabetes insipidus?

urine output Diabetes insipidus is a disorder of the posterior pituitary gland that results in a deficiency of antidiuretic hormone, which in turn causes the kidneys to be unable to reabsorb water. This deficiency leads to increased urine output as a primary clinical manifestation of the disorder. Without treatment, an affeced individual can become severely dehydrated and experience hypovolemic shock.

The nurse receives health care provider prescriptions for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication prescription would the nurse question?

vinblastine chemotherapeutic agents such as vinblastine are contraindicated for SIADH because these drugs induce the release of antidiuretic hormone (ADH).

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium level of 130mEq/L and complains of a severe backache. What are the most appropriate nursing interventions? Select all that apply.

1. assessing the patient's weight 2. positioning the head of the bed flat 3. restricting fluid intake to 900 mL/day

Which clinical manifestations of severe serum sodium level decline would the nurse assess in a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH)? select all that apply

1. coma 2. lethargy 3. confusion 4. headache

Which pathophysiologic events occur with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

1. decreased serum osmolality 2. increased water reabsorption 3. occurrence of dilutional hyponatremia 1 & 3 occur in cases of SIADH due to increased water reabsorption in the renal tubules and impairment in water excretion caused by the inability to suppress the secretions of antidiuretic hormone (ADH).

Which interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy?

1. elevate the head of the bed 30 degrees (Decreases pressure on the sell turcica in the brain/decreasing risk of headache) 2. monitor for and report clear nasal drainage (clear drainage may represent a clerebral spinal fluid leak) 3. monitor for and report increased urinary output

Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly?

1. increased shoe size 2. elevated blood glucose 3. complaint of headaches acromegaly is a disorder in which there is increased secretion of growth hormones. Enlargement of the feet and hands occurs as a result of overgrowth of bones and tissue. GH antagonizes the action of insulin, and therefore blood glucose is elevated. Headaches also are common if the increased secretion of GH is caused by a pituitary adenoma, which increases pressues on the optic nerve. The skin becomes thick and leathery.

Which clinical manifestations would the nurse document that correlate with the development of diabetes mellitus in a patient with a history of acromegaly?

1. increased thrist 2. increased urination since growth hormone (GH) antagonizes the action of insulin leading to hyperglycemia, glucose intolerance and manifestations of diabetes mellitus might occur including polydipsia (increased thirst) and polyuria (increased urine output)

Which interventions would the nurse include in the plan of care for a patient who has been diagnosed with syndrome of inapporpriate antidiuretic hormone secretion (SIADH)?

1. limit fluids to 1000 mL per day 2. keep the head of the bed at 10 degrees or less elevation the care for the patient with SIADH will include limiting fluids to 1000 mL per day or less to decrease weight, increase osmolality, and imporve symptoms. The head of the bed should be kept elevalted at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of antidiuretic hormone (ADH)

which actions would the nurse take when caring for a patient status post a transsphenoidal hypophysectomy?

1. monitoring the pupillary response (helps rule out any visual changes) 2. elevating the head of the patients bed (alleviates pressure on the sella turcica and decreases headaches) 3. observing the patient for any signs of bleeding (utmost importance, hemorrhage) 4. monitoring extremity strength to detect neurologic complications (rule out postoperative neurologic complications (ataxia))

Which side effects would the nurse assess in a patient who is on desmopressin acetate (DDAVP)?

1. weight gain 2. altered mental status 3. fluctuating sodium levels DDAVP is a synthetic analog of the natural pituitary hormone, arginine vasopressin, an antidiuretic hormone (ADH) that affects renal water conservation.

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure?

Acromegaly excess GH after closure of the epiphyseal plates results in acromegaly.

Which condition is associated with the symptoms of numbess and a "pins and needles" sensation in the thumb, middle, and index finger, especially at night?

acromegaly in acromegaly, carpal tunnel syndrome may exist, which is characterized by feelings of numbness and discomfort in the thumb and fingers.

Which intervention is required for a patient having a water deprivation test for central diabetes insipidus in the hospital?

administer desmopressin acetate (DDAVP) subcutaneously the patient is given DDAVP subcutaneously or nasally. The patient is deprived of water for 8-12 hours before administration of DDAVP.

The nurse is caring for a patient diagnosed with nephrogenic diabetes insipidus not responding to primary treatment. Which intervention would be useful in increasing the renal response to antidiuretic hormone?

administering indomethacin a nonsteroidal antinnflammatory drug that helps to increase the renal response to antidiuretic hormone.

A patient who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum sodium level of 114 mEq/L and presents with seizures. Which intervention would be the most appropriate for this patient?

administration of IV hypertonic saline solution in case of severe hyponatremia (sodium levels below 120 mEd/L), especially in the presence of neurologic manifestations such as seizures, SLOW administration of IV hypertonic (3% or 5%) solution is recommended to help to improve sodium levels.

Which hormone plays a key role in the regulation of water balance and osmolarity?

arginine vasopressin antidiuretic hormone (ADH) is also referred to as arginine vasopressin, which plays a major role in the regulation of water balance and osmolarity.

Which focus of care is priority when caring for a patient with central diabetes insipidus (DI)?

avoiding dehydration and fluid volume deficit

Which disorder is characterized by fat pads on the back of the neck, an increased abdominal girth, a "buffalo hump." and a "moon" face?

cushing syndrome caused by excessive secretion of adrenocorticotropic hormone. Weight gain is the most common feature. It results from the accumlation of adipose tissue in the trunk (centripetal obesity), face (moon face), and cervical areas (buffalo hump).

Which effect does an increased level of plasma insulin-like growth factor-1 have on growth hormone levels?

growth hormone levels are elevated in acromegaly, the level of insulin-like growth factor-1 is tested to evaluate growth hormone levels. Increases in insulin-like growth hormone indicate increased levels of growth hormone. Insulin-like growth factor-1 is proportional to the growth hormone

A patient status post a hypophysectomy had drainage on the moustache dressing. which complication is this patient at risk for if the glucose level of the drainage is 50 mg/dL?

meningitis A hypophysectomy is usually performed through the sphenoid sinuses, and the health care provider packs the sphenoid sinus with gauze. When a specimen is tested for a cerebrospinal fluid (CSF) leak, a glucose level greater than 30 mg/dL indicates a CSF leak from an open connection with the brain. If this happens, then the patient has an increased risk for meningitis.

the RN is teaching a nursing student about the drug profile of octreotide. Which statement made by the student indicates the need for further teaching?

octreotide levels are measured every four weeks Octreotide is administered three times a week. It is the primary drug used in the treatment of acromegaly; it is a somatostatin analog that reduces the growth hormone levels to normal levels in many patients.

Which medication blocks the hepatic production of insulin-like growth factor-1 in a patient with acromegaly?

pegvisomant

Which nursing intervention would promote a reduction in the release of antidiuretic hormone (ADH) in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

positioning the head of the bed flat Once SIADH is diagnosed, the treatment is directed at the underlying causes. Positioning the head of the patient's bed flat enhances venous return to the heart and increases the left arterial filling pressure, thereby reducing the release of antidiuretic hormone (ADH).

A nurse has just received a report from the emergency department on a patient admitted with a closed head injury after falling down a flight of stairs. The nurse is reviewing the patient's lab results: sodium level of 128 mEq/L, serum osmolality of 271 mOsm/kg, and urine specific gravity of 1.030. This data is indicative of which condition?

syndromve of inappropriate antidiuretic hormone secretion (SIADH) the characteristics of SIADH include a decreased serum sodiuem level, serum osmolality less than 280 mOsm/kg, and an increased urine specific gravity above 1.025

which medication would the nurse plan on teaching a patient about who is admitted to the hospital for treatment of euvolemia-hyponatremia?

tolvaptan a vasopressin receptor antagonist used to treat euvolemia-hyponatremia.

A patient has a serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and the urine specific gravity is greater than 1.025. which medication is most beneficial for this patient?

tolvaptan levels indicate dilutional hyponatremia. Tolvaptan is an antihyponatremic drug used to treat dilutional hyponatremia by increasing the sodium concentration in the body.

A patient who underwent surgery for acromegaly complains of postoperative headache and running nose. What action should the nurse take to resolve the problems within 72 hours? Select all that apply.

1. maintain bed rest 2. elevate head of the bed to 30 degrees

The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? A - Urine Volume decreases to 50 ml/HR B - Urine Osmolality of 260 mOsm/kg C - Urine Osmolality of 600 mOsm/kg D - Responds to ADH analog by concentration volume

Patient B patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg as shown with Patient B

which nursing intervention is a priority for a patient recovering from hypophysectomy?

assessing for signs of increased intracranial pressure (ICP) because removal of a pituitary tumor (a hypophysectomy) involves entering the cranium, increased ICP is always a risk, especially in the immediate postoperative period. With this knowledge, assessment for increased ICP is a priority for the nurse.

A patient with diabetes insipidus has an IV of dextrose 5% in water (D5W) infusing. Which parameter would the nurse monitor for the management of osmotic diuresis?

serum glucose levels if IV glucose solutions are administered, then the serum glucoses levels of the patient should be monitorored because hyperglycemia and glcosuria can occur, which can lead to osmotic diuresis and increase in fluid volume deficit.

About which treatment would the nurse plan to teach a patient who is newly diagnosed with central diabetes insipidus (DI)?

desmopressin acetate (DDAVP) an analog of antidiuretic hormone, is the hormone replacement choice for central diabetes insipidus

Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

fluid retention the posterior pituitary gland secretes an excess of antidiuretic hormone (ADH), which ultimately increases fluid retention and causes decreased serum osmolality.

Which complication would the nurse include in the teaching plan when educating a patient about possible postsurgical complications related to a hypophysectomy?

infertility hypophysectomy may result in permanent loss or deficiencies of follicle-stimulating hormone, luteinizing hormone, and thyroid hormones resulting in decreased fertility or infertility.

A young adult female patient with normal body weight has excessive hair growth on her face, infrequent menstraution, and infertility. Which type of endocrine disorder is suspected in the patient?

prolactinomas a common type of pituitary adenomas that are associated with hirsutism, infrequent menstruation, and inability to conceive in females.

The patient with small cell lung cancer experiences a sudden 5-pound weight gain without edema and a decreased urinary output. Serum sodium is 128 mEq/L. Which treatment would the nurse plan to teach the patient about?

1000 mL per day fluid restriction the patient is exhibiting signs of syndrome of inapprorpiate antidiuretic hormone secretion (SIADH). Small cell lung cancer is one of the most common causes of SIADH. In patients with SIADH, there is an excess of antidiuretic hormone (ADH); this causes excess water reabsorption by the kidneys, resulting in increased vascular volume. the decreased excretion of water by the kidneys/resulting increased intravascular volume leads to wt gain without edema, decreased urinary output with an increase in urine specific gravity, decreased plasma osmolarity and dilutional hyponatremia. if the patients serum sodium is above 125 mEq/L, a fluid restriction may be all that is needed

A patient who had surgery for the treatment of acromegaly asked about the possibility of becoming pregant. the nurse's response would be based on which physiologic factor?

There will be a permanent loss of hormones surgery for acromegaly may result in permanent loss or deficiencies in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which leads to decreased fertility.

A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate?

"you have developed the condition due to overgrowth of the tongue." acromegaly most often occurs because of a benign growth hormone (GH)- secreting pituitary adenoma. The excess GH results in an overgrowth of soft tissues and bones in the hands, feet, and face.

A patient is suspected of having acromegaly. When gathering a health history, what questions would be important for the nurse to ask? Select all that apply.

1. do you snore? 2. have you noticed an increase in shoe size? 3. have you experienced unusual thirst and excessive urination? 4. have you experienced numbness or tingling in your fingers or hands?

A patient is instructed to ingest 75 g of glucose orally as a part of an oral glucose tolerance test. In addition, growth hormone measurements are taken consecutively at 30, 60, 90, and 120 minutes. Glucose levels and growth hormone levels are found to be constant during the test. What does the nurse infer from these findings?

Acromegaly in addition to the patient history and physical examination, the oral glucose tolerance test is a specific test for acromegaly. Because growth hormone secretion is normally inhibiited by glucose, measurement of glucose nonsuppresibility is required. Growth hormone concentration normally falls during the oral glucose tolerance test, but in patients with acromegaly, the growth hormone levels do not fall.

Which hormone is secreting excessively if a patient with a pituitary tumor has developed excessive height and increased hat size and shoe size?

Growth hormone (GH) excessive secretion of GH results in overgrowth of soft tissues and bones resulting in acromegaly.

Which symptom would the nurse assess in a patient with acromegaly?

Increase in shoe size acromegaly is a rare condition characterized by overproduction of growth hormone. Excess secretion of growth hormone results in overgrowth of soft tissues and bones in the hands, fett, and face. Evaluation of physical changes such as increase in shoe size is important because they are gradual and slow; hence, the patient may not identify them. Identification of these symptoms helps in treatment with which bone growth can be stopped and tissue hypertrophy can be reversed.

which statement by the patient who is status post a transsphenoidal hypophysectomy indicates a need for further education?

It is important that I brush my teeth every day tooth burshing should be avoided for 10 days to protect the suture line.

What patient is at greatest risk for developing colon polyps and colorectal cancer and should have a screening colonscopy every three to four years?

a patient with acromegaly patients with acromegaly are at higher risk for colon polyps and colorectal cancer and should have a screening colonoscopy performed every three to four years.

Which disorder is characterized by excessive secretion of the hormone vasopressin?

Syndrome of inappropriate antidiuretic hormone secretion another name for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extracellular fluid volume and hyponatremia. This disorder can cause cardiopulmonary overload and neurologic problems as a result of water intoxication..

The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) who has muscle twitching, vomiting, severe abdominal cramps, and begins to have seizures. The nurse assesses a serum sodium level of 116 mEq/L. What is the priority nursing action for this patient?

administer hypertonic saline solution slowly a patient with a serum sodium level of 116 mEq/L is severely hyponatremic and needs replacement with a hypertonic saline solution (at least 3% to 5%) slowly to correct the neurologic effects of the severe hyponatremia.

Which discharge instructions regarding desmopressin acetate would be given to a patient with diabetes insipidus?

report a sudden increase in thirst to your health care provider. desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Patients should be taught to report any sudden increase in thrist because this may indicate that they need to increase the dosage of the drug

which cause is associated with central diabetes insipidus?

the presence of a brain tumor which occurs due to the interference with antidiuretic hormone synthesis, transport, or release.

Which clinical manifestation would be most prominent in the assessment of a patient with suspected Cushing syndrome?

weight gain, including truncal obesity. the most prominent clinical manifestation in Cushing syndrome is weight gain leading to truncal obesity with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump". Cushing syndrome's results from an overproduction of adrenocorticosterioids or large doses of steroid medication.

For which complication would a 35-year-woman who had a hypophysectomy and who developed a deficiency of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) be at risk?

decreased fertility rate when a hypophysectomy is performed on the pituitary gland, it may result in damage to the pituitary gland, which affects the release of FSH and LH associated with reproduction and development of eggs in women. Therefore decreased fertility rate is a side effect of the surgery.

A patient has recently undergone transsphenoidal hypophysectomy and reports severe supraorbital headache. the nurse maintains the patient's head in an elevated position and requests the patient stay on bed rest for three days. Which finding in the laboratory report is the reason for this nursing action?

glucose level 40 mg/dL in the nasal drainage a glucose level greater than 30 mg/dL in the nasal drainage indicates cerebrospinal leakage from an open connection to the brain. Supraorbital headache in a patient who has undergone transsphenoidal hypophysectomy is caused by CSF leakage into the sinuses

Which factor would be seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

increased intravascular volume SIADH is characterized by an increased in ADH levels in the body. As a result, the patient will have an increased intravascular volume.

The nurse would implement which nursing action when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

initiate seizure preacautions SIADH is a disorder in which there is abnormally high production of antidiuretic hormone (ADH). Dilutional hyponatremia is characteristic of SIADH and can cause seizures, nausea and vomiting, muscle cramps, and decreased neurologic function.

Which nursing action would prevent the leakage of cerebrospinal fluid (CSF) after a transsphenoidal hypophysectomy?

instructing the patient to avoid vigorous coughing, sneezing, and straining at stool the patient should lie in an elevated position, with the head of the bed at a 30-degree angle, as opposed to lying in the supine position.

which nursing intervention would be included in the plan of care for a patient who underwent a transsphenoidal hypophysectomy?

monitor pupillary response and speech patterns the nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of bed is elevated at all times to a 30-degree angle to avoid pressure on the sella turcica and to decrease headaches, a frequent postoperative problem. The nurse must perform mouth care for the patient every four hours to keep the surgical area clean and free of debris

Which nursing intervention is most important for a patient with diabetes insipidus?

monitoring fluid intake and output polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore strict monitoring of fluid intake and output is a priority nursing intervention.

A transsphenoidal hypophysectomy involves surgical resection of which gland?

pituitary The surgical approach to the pituitary gland is made through an incision through the upper gum and nare into the base of the skull.

which discharge instructions regarding desmospressin acetate would be given to a patient with diabetes insipidus?

report a sudden increase in thirst to your health care provider desmopressin acetate is used to treat diabetes insipidus be replacing the antidiuretic hormone that the patient is lacking. Patients should be taught to report any sudden increase in thirst because this may indicaite that they need to increase the dosage of the drug.