Chapter 45: Assessment & Management of Patients with Endocrine Disorders Anterior and Posterior Pituitary and their functions ? Management of Pituitary conditions/disorders Goal is to return hormone levels to normal, reduce headaches and visual disturbances, prevent complications and reverse body changes where possible Drug therapy Surgical removal or pituitary gland and tumor called hypophysectomy (most common treatment for hyperpituitarism) Ā· Post-op management Q1H Neuro checks Assess for Post nasal drip/increased swallowing Assess drainage fro glucose Elevate head of bed Avoid coughing and blowing nose Assess for meningitis Hormone replacement Avoid bending and straining Strict I & O at risk for DI Risk for CSF leask Avoid toothburshing approx 2 weeks Numbness around incision Education: Decreased sense of smell Ā· Gigantism vs Acromegaly
o Manifestations HA & visual changes Arthritis, widened brow bone, thickened arch of nose, acromegaly (groth and thickening of hands/face/feet) HTN, HF, CAD, organomegaly Treatments/medications (including nursing interventions) Tx - Somatostatin analogs (somastostatin) I to inhibit release of Growth Hormone Ā· Post-op management Ā· Tumor removal - see above for protocol Ā· Hypothyroidism vs. Hyperthyroidism o Manifestations Hyperthyroid (Graves Disease - most common) - high metabolic rate, increased temp, cardiac dysrhythmia, nervousness/tremours, exopthalmos (bulging of eyes), visual changes, goiter, hypoglycemia, skin - warm/flushed/soft/moist, increased appetite/gastric activity/motility, weight loss, insomnia, intolerance, hair loss, light or absent menses Hypothyridism (Hashimoto's most common) = decreased energy, increased sleep, weight gain, decreased appetite, cold indolterance, myxedema, cardiac enlargement, decreased pulses, decreased cardiac output, constipation, abdominal distention o Labs (TSH, calcitonin, T3, T4) Hyperthyroid - t3, t4, free t4 and uptake of t3 all increased Hypothyroid - t3 & t4 levels all decreased, TSH increased o Treatments/medications (including nursing interventions) Hyperthyroid - Meds -Radioactive Iodine 131, methimazole, propylthiouracil, sodium or potassium iodide solutions, beta blockers, eye lubricants Surgery - Total or subtotal thyroidectomy - thyroid cancer risk Nursing Mgmt - Assess & monitor - VS, daily wight, I&O, eyes and vision, goiter, thyroid hormone levels, seizures Hypothyroid -
Nursing Mgmt - Assess VS, Sp02, daily wight skin texture/color/turgor/integrity, serum calcium levels, bowel elimination. Administer - lifelong thyroid replacement, use narcotics and sedatives with caution, provide warming blanket, turn and reposition often o Post-op management and complications of thyroidectomy Maintain airway/Breathing - watch for horseness, stridor, laryngospasm, Keep HOB elevated, keep emergency trach/suction/ambu bag Diet as tolerated - clear liquids then advance Activity as tolerated - DVT prophylaxis Complications - hemorrhage, Labs - monitor calcium for signs of tetany, have calcium gluconate at bedside, monitor pain, watch for infection, avoid tensin to neck insision Ā· Hypoparathyroidism vs. Hyperparathyroidism o Manifestations Hyperparathyroidism - apathy, fatigue, muscle weakness, atrophy, N/V, anorexia, constipation, hypertension, cardiac dysrhythmias, increased ionized and serum calcium levels, decreased phosphorous levels, low back pain and increased risk of pathological fractures, increased risk of kidney stones Hypoparathyroidsim - low calcium & high phosphate levels, tetany, paresthesia in extremities, stiffness of hands/feet, bronchospasm, laryngeal spasm, caropedal spasm, anxiety, irritability, depression, delirium, ECG changes, bone pain seizures, hypotension o Labs (electrolytes, etc.) Hyperparathyroidism - Calcium, Phosphate,